Delivered by Ingenta to: Economics Dept IP: 91.229.229.147 On: Wed, 29 Jun 2016 09:43:34 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm Objective improvement in nasal congestion and nasal hyperreactivity with use of nasal steroids in persistent allergic rhinitis Gustavo F. Wandalsen, Ph.D., Aline I. Mendes, M.D., and Dirceu Sole ´, Ph.D. ABSTRACT Objective: Our objective was to evaluate the action of topical nasal steroid in nasal congestion and nasal hyper-reactivity in children and adolescents with persistent allergic rhinitis. Methods: Twenty atopic children and adolescents (6 to 18 years) with moderate-to-severe persistent allergic rhinitis (PAR) were treated with mometasone furoate (100 g once a day) for 21 days. At the beginning and end of treatment, the following were recorded: a) nasal symptoms score; b) several parameters of nasal congestion measured by acoustic rhinometry (SRE 2000 Rhinometrics); c) degree of nasal hyper-reactivity to histamine (concentration of histamine necessary to induce at least 100% increase in total nasal resistance during nasal provocation test). Data were compared with those from 20 controls. Results: Compared to controls, PAR patients had significantly higher score of symptoms, as well as higher degree of nasal hyper-reactivity and lower nasal volumes. After treatment, there was a significant decrease in the mean nasal symptoms score (8.0 versus 3.8; p  0.001) and in the nasal hyper-reactivity (histamine concentration: 0.72 mg/ml versus 2.60 mg/ml; p  0.001). Congestion improvement was observed by the increase in all acoustic rhinometry parameters. Among all studied volumes, the volume in the segment between 2 and 5 cm showed the highest mean increase (19.8%). Conclusion: Treatment with topical nasal steroid objectively reduced nasal congestion and nasal histamine hyper-reactivity in children and adolescents with PAR. (Am J Rhinol Allergy 24, e32–e36, 2010; doi: 10.2500/ajra.2010.24.3427) Key words: Acoustic rhinometry, allergic rhinitis, nasal congestion, nasal hyperreactivity, nasal provocation test, nasal steroid, symptoms scores T opical nasal steroids are considered one of the main drugs for the treatment of allergic rhinitis. Because of their potent action in different steps of the inflammatory process, they are able to reduce or suppress clinical symptoms, the influx of inflammatory cells in the nasal mucosa, and the synthesis and release of several mediators. 1–3 Topical nasal steroids are, therefore, highly recommended as first-line therapy for the treatment of patients with persistent allergic rhinitis 4,5 with a large number of clinical trials that already have established its efficacy in the treatment of adults and children. 6–8 Differently from other chronic diseases, such as asthma, patients with allergic rhinitis are usually classified and monitored only by their self-complains without the addiction of any objective parameter. Individual perception of chronic subjective symptoms, such as nasal obstruction, can be largely variable and dependent on several factors. 9 In allergic rhinitis, the majority of clinical trials have used only subjective symptoms scores to evaluate drug actions and until now, few studies have evaluated the objective action of these drugs. Nasal congestion and nasal hyperreactivity are examples of two important characteristics of allergic rhinitis that can be objectively monitored. The purpose of this study was to objectively evaluate the action of mometasone furoate, a potent topical nasal steroid, on nasal conges- tion and nasal hyperreactivity in children and adolescents with per- sistent allergic rhinitis and to compare these evaluations with subjec- tive symptoms scores. METHODS Twenty-five children and adolescents, aged 6–18 years, with clini- cal diagnosis of moderate-to-severe allergic rhinitis 4 for 1 year and with positive skin-prick test (mean papule diameter 3 mm 10 ) for at least one inhaled allergen (Dermatophagoides pteronyssinus, D. farinae, Blomia tropicalis, dog and cat dander, Periplaneta americana, Blatella germanica, fungi, and pollens mixture; IPI-ASAC, Sa ˜o Paulo, Brazil) were studied. All patients were evaluated in absence of upper air- ways infection for at least one month. Nasal symptoms score, nasal congestion, and nasal hyperreactivity were measured at baseline and after treatment with mometasone furoate (100 g once a day) for 21 days (5 days). Baseline evaluation from these patients was compared with a control group composed of 24 children and adolescents from the same age range, without nasal symptoms and history of allergic rhinitis and other allergic diseases, with negative skin-prick test for the same allergens. Children with upper airways anatomic abnormalities were not included in either groups, as well as those who had used systemic or nasal steroids in the previous month. Antihistamines, when used, were suspended at least 1 week before the inclusion. The control group did not receive treatment with mometasone furoate. Patients and controls attributed a score (0–3) to their nasal symp- toms (obstruction, sneezing, itching, and rhinorrhea) occurring within the last 7 days. Total nasal score was calculated by adding the four scores. All patients with allergic rhinitis must have had total symp- toms score of at least 5 in a total of 12. Nasal congestion was measured by acoustic rhinometry (SRE 2000; Rhinometrics, Lynge, Denmark) according to standard recommenda- tions. 11 The following parameters were recorded: nasal volume from the first 4 cm (V4), from the first 5 cm (V5), from the segment between 2 and 5 cm (V2–5), and minimal cross-sectional area between 0 and 2.2 cm (MC1) and between 2.2 and 5.4 cm (MC2). Nasal volumes were calculated by adding each nostril value. 11 All measurements were performed three times and by the same operator. Nasal hyperreactivity was measured by histamine nasal provoca- tion test (NPT). Briefly, after 20 minutes of resting in a room with controlled temperature and humidity, 0.15 mL of saline and solutions with increasing concentrations of histamine (0.12, 0.25, 0.5, 1.0, 2.0, 4.0, and 8.0 mg/mL; IPI-ASAC) were sprayed in both nostrils. Nasal resistance was measured by active anterior rhinomanometry (SRE 2000) at the beginning of the test and 5 minutes after each adminis- From the Department of Allergy and Clinical Immunology, Federal University of Sa ˜o Paulo, Brazil Grant sponsor: Fundac ¸a ˜o de Amparo a ` Pesquisa de Sa ˜o Paulo (FAPESP) Address correspondence and reprint requests to Gustavo F. Wandalsen, Ph.D., Rua dos Otonis 725, Sa ˜o Paulo, Brazil 04025-002 E-mail address: gfwandalsen@uol.com.br Copyright © 2010, OceanSide Publications, Inc., U.S.A. e32 January–February 2010, Vol. 24, No. 1 DO NOT COPY