(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Rhinitis--Allergic--Perennial

Topics: Administration, Intranasal; Androstadienes; Anti-Inflammatory Agents; Beclomethasone; Budesonide; Chronic Disease; Diagnosis, Differential; Drug Administration Schedule; Fluocinolone Acetonide; Fluticasone; Glucocorticoids; Humans; Nurse Practitioners; Nurse's Role; Patient Satisfaction; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Severity of Illness Index; Triamcinolone

Primary principles relevant to the clinical management of allergic rhinitis include (1) avoidance of allergens and triggering factors, (2) use of appropriate pharmacotherapy, (3) evaluation regarding need for and appropriate use of immunotherapy, and (4) patient education and follow-up. Currently available pharmacotherapeutic options include oral and topical (intranasal) decongestants and corticosteroids, mast cell stabilizers, intranasal anticholinergics, and antihistamines. Future therapeutic options include leukotriene modifiers and anti-IgE antibodies.

Topics: Administration, Intranasal; Beclomethasone; Cromolyn Sodium; Histamine H1 Antagonists; Humans; Immunoglobulin E; Immunotherapy; Nasal Decongestants; Oxymetazoline; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Topical administration of corticosteroids can reduce the total dose of corticosteroid required to treat the patient and minimize side effects. This logic has led to the development of intranasal corticosteroids (INCS) for allergic and perennial rhinitis. The second generation of these compounds includes beclomethasone dipropionate, budesonide, flunisolide, fluticasone propionate, mometasone furoate, and triamcinolone acetonide. There is evidence that the INCS are effective in rhinitis; however, there is concern about the potential for these compounds to cause growth suppression. In one study, beclomethasone dipropionate significantly reduced growth in children; however, treatment of children with mometasone furoate nasal spray for 1 year showed no signs of growth suppression. It is evident that the differences among INCS lie in their pharmacokinetics. Structural differences among the various INCS influence their metabolism. The goal of INCS therapy is to have a high ratio of topical to systemic activity. The drug delivery device, absorption of the drug, and drug distribution all contribute to effective topical activity of an INCS. In addition, individual drug metabolism and elimination (half-life and drug clearance) also contribute to the therapeutic index of a drug. Overall, the second-generation INCS cause minimal systemic effects at recommended doses.

Topics: Absorption; Administration, Intranasal; Adrenal Cortex Hormones; Adult; Androstadienes; Anti-Allergic Agents; Anti-Inflammatory Agents; Beclomethasone; Budesonide; Child; Drug Delivery Systems; Fluocinolone Acetonide; Fluticasone; Humans; Mometasone Furoate; Pregnadienediols; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Structure-Activity Relationship; Tissue Distribution; Triamcinolone Acetonide

Topical intranasal corticosteroids (INS) are the most effective treatment for allergic rhinitis and are being increasingly prescribed to children. Due to the potent inhibition of childhood growth seen with oral corticosteroids, it is important to examine whether INS could have similar effects. The evidence available suggests that some INS, such as beclomethasone dipropionate (BDP), may slow growth when used regularly for prolonged periods. However, newer INS such as fluticasone propionate (FP) and mometasone furoate, which have substantially reduced bioavailability via gastrointestinal absorption, are unlikely to do so. Well-designed prospective studies are needed to distinguish those INS with reduced or absent effects on growth. In practice, choosing an INS which optimises the ratio of therapeutic effect to systemic bioavailability will probably reduce the risk of growth suppression to a negligible level.

Topics: Androstadienes; Anti-Inflammatory Agents; Beclomethasone; Child; Child, Preschool; Fluticasone; Growth; Humans; Rhinitis, Allergic, Perennial

Intranasal steroids (INSs) are established as first-line treatment for allergic rhinitis. Extensive use of INSs with few reported adverse events supports the safety of these medications. Nevertheless, the prescription of more potent INSs for consistent and more prolonged use to younger and older patients, often in combination with inhaled corticosteroids, justifies the careful examination of their potential adverse systemic effects. Systemic bioavailability of INSs, by way of nasal and intestinal absorption, can be substantial; but current INSs vary significantly in their degree of first-pass hepatic inactivation and clearance from the body of the swallowed drug. For safety studies of INSs, distinguishing detectable physiologic perturbations from important adverse events is aided by an understanding of normal endocrine physiology and the methods used to test these systems. A review of available information indicates that (1) sensitive tests can measure the effects of INSs on biologic feedback systems, but they do not accurately predict clinically relevant adverse effects; (2) the primary factors that influence the relationship between therapeutic and adverse systemic effects of INSs are dosing frequency and efficiency of hepatic inactivation of swallowed drug; (3) INS treatment in recommended doses does not cause clinically significant hypothalamic-pituitary-adrenal axis suppression; (4) growth suppression can occur with twice-daily administration of certain INSs but does not appear to occur with once-daily dosing or with agents with more complete first-pass hepatic inactivation; (5) harmful effects of INSs on bone metabolism have not yet been adequately studied but would not be expected with the use of an INS dose and dosing frequency that do not suppress basal hypothalamic-pituitary-adrenal axis function or growth; and (6) these conclusions apply to INS treatment alone and in recommended doses-the risk of adverse effects in individual patients who are treated with INSs is increased by excessive dosing or concomitant inhaled corticosteroid or other topical corticosteroid therapy.

Topics: Administration, Intranasal; Androstadienes; Beclomethasone; Budesonide; Endocrinology; Fluocinolone Acetonide; Fluticasone; Humans; Mometasone Furoate; Pregnadienediols; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Steroids; Triamcinolone Acetonide

Azelastine, a phthalazinone compound, is a second generation histamine H1 receptor antagonist which has shown clinical efficacy in relieving the symptoms of allergic rhinitis when administered as either an oral or intranasal formulation. It is thought to improve both the early and late phase symptoms of rhinitis through a combination of antihistaminic, antiallergic and anti-inflammatory mechanisms. Symptom improvements are evident as early as 30 minutes, after intranasal administration of azelastine [2 puffs per nostril (0.56mg)] and are apparent for up to 12 hours in patients with seasonal allergic rhinitis (SAR). The effect on nasal blockage is variable: in some studies objective and/or subjective assessment showed a reduction in blockage, whereas in other studies there was no improvement. Intranasal azelastine 1 puff per nostril twice daily is generally as effective as standard doses of other antihistamine agents including intranasal levocabastine and oral cetirizine, ebastine, loratadine and terfenadine at reducing the overall symptoms of rhinitis. The relative efficacies of azelastine and intranasal corticosteroids (beclomethasone and budesonide) remain unclear. However, overall, the corticosteroids tended to improve rhinitis symptoms to a greater extent than the antihistamine. Azelastine was well tolerated in clinical trials and postmarketing surveys. The most frequently reported adverse events were bitter taste, application site irritation and rhinitis. The incidence of sedation did not differ significantly between azelastine and placebo recipients and preliminary report showed cardiovascular parameters were not significantly altered in patients with perennial allergic rhinitis (PAR).. Twice-daily intranasal azelastine offers an effective and well tolerated alternative to other antihistamine agents currently recommended for the symptomatic relief of mild to severe SAR and PAR in adults and children (aged > or = 12 years in the US; aged > or = 6 years in some European countries including the UK). The rapid onset, confined topical activity and reduced sedation demonstrated by the intranasal formulation of azelastine may offer an advantage over other antihistamine agents, although this has yet to be confirmed.

Topics: Administration, Intranasal; Adult; Beclomethasone; Budesonide; Child; Drug Tolerance; Glucocorticoids; Histamine H1 Antagonists; Humans; Neutrophils; Phthalazines; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Nasal allergy is statistically related to inflammatory chronic sinusitis as a risk factor. But one question still remains unanswered: are the reactions and modifications observed in the sinuses after natural exposure to a nasal allergen or after nasal allergen challenge linked to an IgE mediated mechanism? Similarities in symptoms, eosinophils and mediators of inflammation in the mucosa have been found between allergic rhinitis and sinusitis. The same applies for the deposition of Major Basic Protein (MBP) and treatment results, especially when topical steroids are found. An original prospective study was held among 106 patients (24 patients allergic to perennial allergens, 82 non allergic patients) suffering from bilateral chronic inflammatory (no polyposis) ethmoidal sinusitis. The allergic group was submitted to a 3 months antiallergic treatment (Cetirizine 10 mg once a day, Beclomethasone dipropionate 50 micrograms three times a day) before being referred for bilateral endonasal ethmoidectomy under endoscopic control. Scores for rhinorrhea, nasal obstruction and global comfort (global assessment) were compared before and after ethmoidectomy. Both groups were significantly improved by surgery. Comparing both groups, no significant difference was found before and after surgery regarding the three above mentioned parameters. This suggests that 1) symptoms are common to both perennial nasal allergy and chronic ethmoidal sinusitis, 2) medical treatment failure in allergy must require a CT scan of the sinuses to assess a possible accompanying chronic sinusitis, 3) chronic ethmoidal sinusitis is probably the leading factor responsible for nasal symptoms such as rhinorrhea and nasal obstruction when associated with perennial allergy.

Topics: Allergens; Anti-Allergic Agents; Anti-Inflammatory Agents; Beclomethasone; Blood Proteins; Cetirizine; Chronic Disease; Endoscopy; Eosinophil Granule Proteins; Eosinophils; Ethmoid Sinus; Ethmoid Sinusitis; Humans; Immunoglobulin E; Inflammation Mediators; Mucous Membrane; Nasal Mucosa; Nasal Obstruction; Prospective Studies; Respiratory Hypersensitivity; Rhinitis, Allergic, Perennial; Ribonucleases; Risk Factors; Sinusitis; Tomography, X-Ray Computed

Topics: Administration, Topical; Anti-Inflammatory Agents; Beclomethasone; Cromolyn Sodium; Glucocorticoids; Histamine H1 Antagonists; Humans; Ipratropium; Nasal Decongestants; Rhinitis, Allergic, Perennial

Topics: Administration, Topical; Anti-Inflammatory Agents; Beclomethasone; Child; Fluocinolone Acetonide; Humans; Nasal Polyps; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Beclomethasone dipropionate has been demonstrated to be effective in the treatment of seasonal and perennial rhinitis. Comparative studies with other medications are lacking. Adverse reactions are frequent but minor. No alterations of the hypothalamic-pituitary-adrenal axis, nasal mucosal histology or bacterial and fungal flora have been recognized.

Topics: Administration, Topical; Anti-Inflammatory Agents; Beclomethasone; Glucocorticoids; Humans; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Placebos; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Sneezing; Time Factors

The article is a short review of some aspects of the surface structure of the human nose. It deals with the morphology of the surface epithelium in nasal allergy, viral and bacterial infection. Kartagener's triad and in rhinitis patients continuously treated with topically active steroids.

Topics: Bacterial Infections; Basement Membrane; Beclomethasone; Cilia; Common Cold; Humans; Kartagener Syndrome; Nasal Mucosa; Nasal Polyps; Nose Diseases; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

The effect of intranasal corticosteroids and oral antihistamines on acoustic rhinometry parameters has not been directly compared. The primary objective was to compare the effect of a 21-day course of treatment with nasal beclomethasone dipropionate (nBDP) with that of cetirizine (CTZ) on nasal patency measured using acoustic rhinometry in children with perennial allergic rhinitis (PAR). The secondary objective was to compare the effect of both drugs on nasal cytology, symptom severity, sleep quality, and quality of life.. In this 21-day, open-label, randomized controlled study, 34 children with PAR (age 6-14 years) with a Total 5-Symptom Score (T5SS) ≥5 received nBDP 100 μg per nostril twice daily or CTZ 10 mg tablets once daily. The measures of effect were the least square mean change (LSmc) in nasal volume, minimal cross-sectional area (MCA), and nasal cytology, as well as the scores on the T5SS, Pittsburgh Sleep Quality Index (PSQI), and Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ).. After 21 days, nBDP improved nasal volume and MCA more than CTZ (LSmc, 2.21 cm3 vs 0.20 cm3 [P=.013]; and LSmc 0.63 cm2 vs 0.13 cm2 [P=.002], respectively). Compared with the CTZ group, a more marked improvement was found in the nBDP group with respect to eosinophil classes (LSmc, -1.10 vs -0.40; P=.031) and neutrophil classes (LSmc, -0.97 vs -0.17; P=.010), T5SS (LSmc, -5.63 vs -3.54; P=.008), PSQI (LSmc, -1.30 vs -0.19; P=.025), and PRQLQ total scores (LSmc, -1.15 vs -0.69; P=.031).. In children with PAR, nBDP is more effective than CTZ in improving nasal patency measured by acoustic rhinometry, with associated beneficial effects on nasal cytology, symptoms, sleep quality, and quality of life.

Topics: Administration, Intranasal; Adolescent; Anti-Inflammatory Agents; Beclomethasone; Cetirizine; Child; Female; Humans; Male; Quality of Life; Rhinitis, Allergic, Perennial; Rhinometry, Acoustic; Surveys and Questionnaires

Beclomethasone dipropionate (BDP) nasal aerosol (non-aqueous) is approved for management of seasonal and perennial allergic rhinitis (PAR) in adolescents and adults.. To evaluate the efficacy and safety of BDP nasal aerosol at 80 μg/day in children with PAR.. This 12-week, phase 3, double-blinded, placebo-controlled, parallel-group study randomized 547 children (4-11 years old) with PAR to once-daily BDP nasal aerosol at 80 μg/day or placebo. The primary end point was change from baseline in average morning and evening reflective total nasal symptom score (rTNSS) during the first 6 weeks of treatment in patients 6 to 11 years old. Changes from baseline in average morning and evening instantaneous TNSS (iTNSS) in children 6 to 11 years old and average rTNSS and iTNSS in children 4 to 11 years old were assessed during the first 6 weeks of treatment.. Improvements were significantly greater with BDP nasal aerosol than with placebo during the first 6 weeks of treatment in children 6 to 11 years old in average morning and evening rTNSS and iTNSS (mean treatment difference -0.66 [P = .002] and -0.58 [P = .004], respectively). Improvements in average morning and evening rTNSS and iTNSS also were significantly greater in patients 4 to 11 years receiving BDP nasal aerosol than with placebo during the first 6 weeks of treatment (P = .002 and P = .004, respectively). Similar improvements were seen during 12 weeks of treatment. The safety profile of BDP nasal aerosol was comparable to that of placebo.. The BDP nasal aerosol at 80 μg/day in children 4 to 11 years old was well tolerated and effective in controlling nasal symptoms of PAR.. www.clinicaltrials.gov, identifier NCT01783548.

Topics: Administration, Inhalation; Anti-Allergic Agents; Beclomethasone; Child; Child, Preschool; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Nasal Sprays; Quality of Life; Rhinitis, Allergic, Perennial; Treatment Outcome

Intranasal corticosteroids are the mainstay of allergic rhinitis (AR) treatment. Their potential to suppress the hypothalamic-pituitary-adrenal axis should be evaluated, especially after long-term daily use in children.. To evaluate the effects of treatment with non-aqueous beclomethasone dipropionate (BDP) nasal aerosol on hypothalamic-pituitary-adrenal axis function in children with perennial AR.. In this double-blinded, placebo-controlled, parallel-group study, patients (6-11 years old) with perennial AR were randomized (2:1) to BDP nasal aerosol at 80 μg/day (n = 67) or placebo (n = 32). The primary end point was change from baseline in 24-hour serum cortisol (SC) weighted mean for BDP nasal aerosol and placebo after 6 weeks of treatment, which was analyzed in the per-protocol population.. The per-protocol population included 97 patients (BDP nasal aerosol, n = 66; placebo, n = 31). Baseline geometric mean SC weighted mean values were similar in the 80-μg/day BDP nasal aerosol and placebo groups (5.97 and 6.47 μg/dL, respectively). After 6 weeks' treatment, geometric mean values were 6.19 and 7.13 μg/dL, respectively, with no decrease from baseline in either group. Geometric mean SC ratio of BDP nasal aerosol at 80 μg/day to placebo was 0.91 (95% confidence interval 0.81-1.03), indicating predefined noninferiority. SC concentration-time profiles were similar for the placebo and 80-μg/day BDP nasal aerosol groups at baseline and week 6. BDP nasal aerosol at 80 μg/day was generally well tolerated.. In pediatric patients with perennial AR, 24-hour SC profiles were comparable for BDP nasal aerosol and placebo, indicating that once-daily BDP nasal aerosol treatment did not significantly affect hypothalamic-pituitary-adrenal axis function.. ClinicalTrials.gov; NCT01697956.

Topics: Administration, Inhalation; Anti-Allergic Agents; Beclomethasone; Child; Double-Blind Method; Drug Administration Schedule; Female; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Male; Nasal Sprays; Pituitary-Adrenal System; Rhinitis, Allergic, Perennial; Treatment Outcome

We aimed to evaluate the therapeutic effect of nebulized beclomethasone dipropionate (nBDP) on both allergic asthma and rhinitis. In a randomized, double-blind, placebo-controlled study, 40 children (mean age 10.7 ± 2.1 years) with allergic asthma and rhinitis received either nBDP (daily dose of 800 µg, administered twice daily) or placebo for 4 weeks (with a face mask), after a 2-week run-in period of clinical assessment. Nasal and oral fractional exhaled nitric oxide (FeNO) measurements together with pulmonary function tests, nasal and oral exhaled breath condensate (EBC) collection for pH and interleukin-5 (IL-5) measurements as well as nasal and bronchial symptom scores were obtained at baseline and after 4-week treatment. A significant improvement in oral FeNO, oral and nasal EBC IL-5 and nasal EBC pH was observed in the nBDP group when comparing the values with baseline, together with an improvement in symptom score of the visual analogue scale, nasal obstruction, sneezing, rhinorrhea, breathing difficulty, cough, wheezing and sleep disturbance (nBDP end treatment vs. baseline, Wilcoxon signed-rank test). nBDP was more effective than placebo (ANCOVA test) in improving [difference Δ = response after treatment at the last visit (active or placebo) - value at baseline] nasal pH, oral IL-5, oral FeNO, forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity, peek expiratory flow, visual analogue scale, breathing difficulty, cough, wheezing and sleep disturbance scores. No differences were observed between the nBDP and the placebo group for symptom score of rhinitis. nBDP is a useful treatment for airway inflammation and clinical status in children with concomitant allergic asthma and rhinitis.

Topics: Administration, Inhalation; Adolescent; Adrenergic beta-2 Receptor Agonists; Anti-Asthmatic Agents; Asthma; Beclomethasone; Breath Tests; Child; Double-Blind Method; Female; Humans; Immunoglobulin E; Interleukin-5; Male; Nebulizers and Vaporizers; Nitric Oxide; Pilot Projects; Respiratory Function Tests; Rhinitis, Allergic, Perennial

Perennial allergic rhinitis (PAR) affects children at a young age. Current guidelines recommend intranasal corticosteroids as the first-line treatment in patients with moderate-to-severe or persistent disease or in those who have congestion. In this study, the long-term safety and efficacy of mometasone furoate nasal spray (MFNS) were assessed in children with PAR.. In this multicenter, active-controlled, evaluator-blind, 12-month study, 255 children aged 6-11 years with a >or=1-year history of PAR were randomized to receive once-daily MFNS 100 microg (n=166) or the active comparator beclomethasone dipropionate (BDP) 168 microg (n=85). Changes from baseline in overall PAR symptoms and response to treatment were rated at each visit. Cosyntropin stimulation testing, as well as tonometry and slit lamp procedures, were performed. Safety variables were assessed.. A total of 137 subjects in the MFNS group and 68 in the BDP group completed treatment. The mean reductions in physician- and subject-rated overall condition of PAR at week 52 were -42.1% and -39.7%, respectively, for MFNS, compared with -44.0% and -39.0%, respectively, for BDP. A total of 94% and 100% of MFNS and BDP subjects, respectively, reported adverse events (AEs), which were mostly mild or moderate. The most frequently reported treatment-related AEs in both groups were epistaxis, headache, and pharyngitis. Response to cosyntropin was normal and no posterior subcapsular cataracts were observed in either group. Although no significant changes in intraocular pressure were observed with MFNS, one subject receiving BDP demonstrated this effect.. Treatment with MFNS 100 microg once daily for 1 year was well tolerated in children 6-11 years old, with negligible systemic exposure and no evidence of suppression of the hypothalamic-pituitary-adrenal axis or ocular changes.

Topics: Aerosols; Anti-Allergic Agents; Anti-Inflammatory Agents; Beclomethasone; Cerebrospinal Fluid Rhinorrhea; Child; Cosyntropin; Demography; Double-Blind Method; Female; Humans; Hydrocortisone; Male; Mometasone Furoate; Nasal Obstruction; Pregnadienediols; Rhinitis, Allergic, Perennial

In patients with allergic fungal sinusitis, the mainstay of treatment remains surgical removal of allergic mucin and fungal debris. But as a single modality, surgery is associated with high rates of recurrence, so a number of adjunctive medical modalities have been tried, including postoperative corticosteroid therapy. We conducted a study of 63 patients with allergic fungal sinusitis who underwent endoscopic sinus surgery with or without postoperative steroid therapy. A group of 30 patients who had been treated prior to January 2000 had undergone surgery only; their cases were reviewed retrospectively, and they served as historical controls. Another 33 patients who were treated after June 2000 underwent surgery plus oral and nasal steroid therapy. All patients were followed for a minimum of 2 years. Recurrences were seen in 50.0% (15/30) of the no-steroid group and 15.2% (5/33) of the steroid group-a statistically significant difference (p = 0.008). The results of our study strongly support the use of steroids to control allergic fungal sinusitis and prevent its recurrence, and we recommend further study to identify the optimal dosage and duration of therapy.

Topics: Administration, Intranasal; Adult; Anti-Inflammatory Agents; Antifungal Agents; Aspergillosis; Beclomethasone; Combined Modality Therapy; Endoscopy; Female; Humans; Hyperplasia; Male; Mucins; Nasal Mucosa; Postoperative Care; Prednisone; Prospective Studies; Retrospective Studies; Rhinitis, Allergic, Perennial; Risk Factors; Sinusitis

To study the effects of long term use of beclomethasone dipropionate (BDP) nasal spray on bone density with perennial allergic rhinitis (AR) in adults.. A 5-year randomized study was conducted on the effects of BDP nasal spray on serum calcium, phosphorus, alkaline phosphatase, and bone density determined before and after the treatment in 36 adult patients with perennial AR. 20-45 years of age, were randomly divided into 3 groups. That is group A (nasal spray 1 - <3 year), group B (nasal spray BDP 3 - <5 year) and group C (nasal spray BDP > or =5 year). The data were analyzed by paired t test.. The perennial AR were followed up for more than > or =1 year, > or =3 year and > or =5 year to observe the influences of nasal spray BDP. There were no significant difference between the data examined before and after the treatment (P > 0.05). Bone development is not influenced by nasal spray BDP < or =400 microg/d within 5 years.. Long term use of BDP nasal spray in adult patients does not lead to osteoporosis if the lowest effective steroid dose is given.

Topics: Adult; Alkaline Phosphatase; Beclomethasone; Bone Density; Calcium; Female; Humans; Male; Middle Aged; Phosphorus; Rhinitis, Allergic, Perennial; Young Adult

Asthma and allergic rhinitis are manifestations of a single unified allergic airway, for which the best treatment is uncertain.. To compare the anti-inflammatory efficacy in the unified allergic airway of combined oral mediator antagonism and combined topical steroid.. Subjects with asthma and perennial allergic rhinitis entered a randomized double blind crossover study comparing montelukast 10 mg and cetirizine 10 mg to extra-fine inhaled beclomethasone 400 mcg/day and intranasal beclomethasone 200 mcg/day, each taken once daily for 2 months, after 2-week placebo washouts. Measurements were made after each washout and randomized treatment, comprising: methacholine PC20, exhaled and nasal nitric oxide, blood eosinophils and eosinophilic cationic protein, symptoms, lung and nasal function tests.. Seventeen patients completed per protocol. For PC20 and exhaled nitric oxide, only combined topical steroid produced improvements (P < 0.005) from placebo baseline. Combined steroid was superior by a 0.93 (95% CI 0.14-0.93, P < 0.05) doubling dilution difference for PC20 and a 0.99 (95% CI 0.9-15.1, P < 0.01) doubling difference for exhaled nitric oxide. Both treatments attenuated eosinophils and eosinophilic cationic protein, and reduced nasal symptoms (P < 0.05). Only steroid improved nasal nitric oxide (P=0.05) and asthma symptoms (P < 0.05). Neither treatment affected lung or nasal function tests.. Combined topical steroid and combined mediator antagonism both attenuated systemic inflammation in the unified allergic airway, but only the former reduced bronchial and nasal inflammatory markers. The relevance of this to exacerbations and airway remodelling needs to be defined.

Topics: Acetates; Administration, Topical; Adolescent; Adult; Aged; Anti-Allergic Agents; Anti-Asthmatic Agents; Asthma; Beclomethasone; Cetirizine; Cross-Over Studies; Cyclopropanes; Double-Blind Method; Drug Administration Routes; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Quinolines; Rhinitis, Allergic, Perennial; Sulfides

This prospective randomized case controlled study was conducted to determine the efficacy of antihistamine (azelastine) nasal spray and compare it to steroid (beclomethasone) nasal spray on the symptoms of allergic rhinitis. Seventy five symptomatic patients of allergic rhinitis were included in this study. Diagnosis was made on the basis of history and physical examination. The patients were divided into three groups randomly. Group A was treated with Azelastine nasal spray, Group B was treated with Beclomethasone nasal spray and Group C was control group and only treated with steam inhalation. Efficacy of the treatment was assessed in the terms of Total Rhinitis Symptom Complex (TSC) scores and individual symptom score which was calculated on the basis of Okuda's grading system. Base line total symptom complex (TSC) scores were reduced in group A and group B by 84.0% after 4 week treatment whereas in group C it was reduced by only 38.0%. Decrease in mean score for sneezing was 95.0% in group A and group B whereas it was only 28.3% in group C. Similarly decrease in mean score for rhinorrhoea in azelastine group was 94.4% and in beclomethasone group was 95.3% in comparison to steam inhalation group where it was 25.0%. Only the beclomethasone reduced nasal stuffiness score significantly by 95.0%. No significant adverse effects of the drugs were observed. The present study establishes the relative efficacy and tolerability ofazelastine nasal spray as compared to beclomethasone nasal spray in symptomatic patients of allergic rhinitis.

Topics: Adolescent; Adult; Aerosols; Aged; Anti-Allergic Agents; Beclomethasone; Female; Glucocorticoids; Humans; Male; Middle Aged; Phthalazines; Prospective Studies; Rhinitis, Allergic, Perennial

Coexisting asthma and allergic rhinitis (AR) are often treated with both intranasal and inhaled corticosteroids. This study investigated whether intranasal ciclesonide 200 microg once daily has an additional effect on cortisol suppression when coadministered with inhaled hydrofluoroalkane-beclomethasone dipropionate (HFA-BDP). Adult patients (n = 150) with perennial AR received HFA-BDP 320 microg twice daily and placebo once daily during a run-in period. Patients were then randomized to ciclesonide or placebo and HFA-BDP (43 days). A single 2-mg dose of dexamethasone was administered on the last treatment day. Plasma cortisol decreased by 67.8 microg x h/dL (p < 0.001) during the run-in period. When ciclesonide was added, the change in mean plasma cortisol was similar for ciclesonide and placebo (8.5 microg x h/dL and 1.0 microg x h/dL, respectively). Dexamethasone decreased mean plasma cortisol (p < 0.001), demonstrating that further cortisol suppression was possible. This study suggests that intranasal ciclesonide can be used with an inhaled corticosteroid without increased cortisol suppression.

Topics: Administration, Inhalation; Administration, Intranasal; Adolescent; Adult; Anti-Allergic Agents; Anti-Asthmatic Agents; Asthma; Beclomethasone; Double-Blind Method; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Middle Aged; Patient Compliance; Pituitary-Adrenal System; Pregnenediones; Rhinitis, Allergic, Perennial

Rhinitis and asthma are considered to be synchronic or sequential forms of the same allergic syndrome. Treating the inflammation associated with allergic rhinitis influences the control of asthma. However, few studies have investigated the effect of treating perennial rhinitis on persistent asthma and vice versa. We determined the effects of inhaled or topical nasal beclomethasone dipropionate (BDP) administered separately or in combination on the control of asthma and bronchial hyperresponsiveness (BHR) in patients with the rhinitis/asthma association.. A double-blind, parallel, three-group study.. Outpatient clinic of Pulmonary Division/Heart Institute (InCor) and the Division of General Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil.. Seventy-four patients with mild-to-moderate asthma and allergic rhinitis (median age, 25 years).. Patients received nasal or inhaled BDP separately or in combination for 16 weeks after a 2-week placebo run-in period.. Nasal and pulmonary symptoms, as well as pulmonary function and BHR, were compared among the three groups after 4 weeks and 16 weeks of treatment. Patients in all three groups demonstrated a progressive and significant decrease in nasal and pulmonary symptoms, which started after 4 weeks (p < 0.05) and continued through the end of treatment (p < 0.001). Clinical improvement was similar and parallel in the three groups. Asthma-related morbidity, evaluated by quantifying absence from work, emergency department visits, and nighttime awakenings, also decreased in the three groups (p < 0.05).. Failure to consider treatment of rhinitis as essential to asthma management might impair clinical control of asthma. Furthermore, these data suggest that asthma and rhinitis in some patients can be controlled by the exclusive use of nasal medication.

Topics: Adolescent; Adult; Asthma; Beclomethasone; Bronchial Hyperreactivity; Double-Blind Method; Female; Glucocorticoids; Humans; Male; Multivariate Analysis; Rhinitis, Allergic, Perennial

Asthma and allergic rhinitis (AR) form a well-recognized comorbidity. This study aims at assessing the efficacy of nasally inhaled beclomethasone dipropionate (BDP) in their simultaneous treatment. A randomized controlled trial was conducted with 78 allergic rhinitis and asthma patients aged 5-17 years. Seventy-five individuals completed the study. During 8 weeks, 38 subjects received BDP-CFC aerosol (>or= 500 mcg/day) exclusively via nasal inhalation through a facemask attached to a plastic valved spacer. The control group (37 patients) received 200 mcg/day of aqueous intranasal beclomethasone plus oral inhalation of BDP-CFC (>or= 500 mcg/day) through a mouthpiece connected to the same spacer. Primary outcomes analyzed in order to assess the response to treatment were clinical scoring for allergic rhinitis and measurements of nasal inspiratory peak flow (NIPF). AR clinical scoring and NIPF did not differ in the two groups at admission or at nearly all follow-up visits. Nasal inhalation of beclomethasone dipropionate provides AR symptom relief while maintaining control of asthma by delivering it to the lungs. Therefore, this therapeutic strategy might be considered for patients suffering from this comorbidity, especially in low-resource countries, since it is less expensive than the conventional treatment.

Topics: Anti-Asthmatic Agents; Asthma; Beclomethasone; Comorbidity; Female; Humans; Male; Respiratory Function Tests; Rhinitis, Allergic, Perennial; Treatment Outcome

To evaluate the therapeutic effects of H(1) blocker in combination with low dose inhaled corticosteroid on allergic asthma.. A multi-center, double blind, randomized, placebo control study was conducted in 67 patients with mild to moderate allergic asthma. Patients were randomized to receive either Loratadine 10 mg or placebo twice a day on the basis of inhaled beclomethasone dipropionate (400 microg/d for 14 days, then reduced to 200 microg/d) for 5.3 +/- 1.3 months. Symptom scores of asthma, frequencies of episode of rhinitis and common cold and doses of inhaled Salbutamol as rescue drug were recorded. Bronchial hyperresponsiveness (PD(20) FEV(1) in response to Histamine) and serum ICAM-1 and VCAM-1 were measured before and after the treatment.. After treatment, there was much better improvement in symptom score (2.4 +/- 0.9 vs 3.1 +/- 0.9, P < 0.01), symptomatic days due to rhinitis (4.0 +/- 1.2 d/week vs 1.9 +/- 0.9 d/week, P < 0.001), episode of common cold symptom (0.8 +/- 0.5 time vs 1.1 +/- 0.4 time, P < 0.001), average doses of inhaled beta(2) agonist as rescue medication (2.6 +/- 0.9 puff/week vs 3.7 +/- 0.8 puff/week, P < 0.001) and bronchial responsiveness (P < 0.05) in Loratadine group as compared with the control group. However, there was no significant change in serum ICAM-1 and VCAM-1 levels after treatment in both groups (P > 0.05).. On the basis of low dose inhaled corticosteroid, orally administered Loratadine significantly improves the therapeutic efficacy of asthma in patients with allergic asthma and rhinitis.

Topics: Administration, Inhalation; Adolescent; Adult; Anti-Asthmatic Agents; Asthma; Beclomethasone; Child; Double-Blind Method; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Intercellular Adhesion Molecule-1; Loratadine; Male; Middle Aged; Rhinitis, Allergic, Perennial; Vascular Cell Adhesion Molecule-1

Allergic rhinitis causes an impairment of the mucociliary function in the nose. It is hoped that treatment of perennial allergic rhinitis would be able to revert mucociliary function to normal. This study aims to compare pre and post treatment mucociliary transport time in 3 different treatment modalities. Ninety-two newly diagnosed patients with allergic rhinitis were randomised into 3 groups and started on different treatment regimes. At the end of 8 weeks, the group treated with only intranasal beclomethasone showed some, though not significant, improvement in the mucociliary function. There were no changes in the mucociliary function in the other two groups treated with beclomethasone and loratidine or loratidine alone.

Topics: Administration, Intranasal; Administration, Oral; Anti-Inflammatory Agents; Beclomethasone; Drug Therapy, Combination; Histamine H1 Antagonists, Non-Sedating; Humans; Loratadine; Mucociliary Clearance; Rhinitis, Allergic, Perennial; Treatment Outcome

The main objective of this long-term prospective local safety study was to evaluate endoscopic and histologic changes in nasal epithelium after 6-month treatment with triamcinolone acetonide (TAA). We describe here a method to measure quantitatively epithelium thickness. Results were compared with those seen with the use of cetirizine (an antihistamine) and another oral intranasal corticosteroid, beclomethasone dipropionate (BDP).. Patients were examined by an ENT specialist who first performed an endoscopic evaluation of the nasal cavities, assessing any morphologic abnormalities and the aspect of the mucosa. Biopsies were taken from the inferior turbinate before and after 24 weeks of treatment. Biopsies were immediately fixed in cold acetone (-20 degrees C) and embedded in glycolmethacrylate; sections of 2 microm were cut on an ultramicrotome. Morphometric evaluations were done in a blinded fashion by computerized image analysis to measure an epithelial area over a minimum length of 50 microm. The thickness was ascertained by the ratio of area to length.. 1) For all three treatment groups, the nasal epithelium thickness decreased slightly from pretreatment to the end of treatment. 2) No statistically significant differences between the three treatment groups were found in epithelium thickness. 3) Macroscopically, nasal tissues in all treated groups were normal.. These results clearly indicate that long-term treatment with TAA has no atrophic effect on nasal mucosa.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Allergic Agents; Anti-Inflammatory Agents; Beclomethasone; Cetirizine; Demography; Endoscopy; Female; Glucocorticoids; Histamine H1 Antagonists; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Nasal Mucosa; Rhinitis, Allergic, Perennial; Triamcinolone Acetonide

Topics: Administration, Intranasal; Anti-Inflammatory Agents; Beclomethasone; Body Height; Child; Child, Preschool; Double-Blind Method; Female; Glucocorticoids; Humans; Long-Term Care; Male; Mometasone Furoate; Pregnadienediols; Rhinitis, Allergic, Perennial

A prospective multicentre study involving 219 patients with seasonal or aperiodic rhinitis was performed to assess the acceptability of a local treatment combining antihistamine (azelastine) and corticoid (beclomethasone) drugs. The drugs were administered either together (morning and evening, with a 5-minute interval) or separately (azelastine in the morning and evening, and beclomethasone later during the morning and in the afternoon) for 15 days. Treatment acceptability was measured by a nine-fold questionnaire (7-point scale, mean score per question). Patient participation, protocol and therapy compliance, and treatment efficacy and tolerance were also studied. The acceptability of the association was satisfactory (mean score for general facility of treatment: 4.7/6) and did not differ between administration schedules. Patients found treatment easy, and were not bothered by the bulk of the bottles or the risk of mixing them up. This acceptability was confirmed by the low percentage (4%) of patients refusing to be included in the study (refusing any treatment by nasal spray). The general acceptability was confirmed by the results for therapy compliance, general efficacy and tolerance: 94.9% of the patients took more than 75% of the administrations prescribed, 77.6% of the patients and 85.2% of the practitioners judged treatment efficacy as good or excellent, and 84.6% of the patients and 91.4% of the practitioners judged tolerance as good or excellent. Moreover, most of the adverse events consisted of minor signs of local intolerance, and were identical to those observed when the two treatments were administered alone.

Topics: Administration, Inhalation; Adult; Beclomethasone; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Phthalazines; Prospective Studies; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Treatment Outcome

Perennial rhinitis is a common condition that affects up to 10% to 20% of the population. Multiple agents are frequently administered since no single agent provides complete relief. Studies assessing the benefit/risk of combined therapy are important especially for newly approved agents such as ipratropium bromide nasal spray 0.03%, a topical anticholinergic agent, approved specifically for the treatment of rhinorrhea in allergic and non-allergic perennial rhinitis.. To compare the efficacy and safety of the combined use of ipratropium bromide nasal spray 0.03% (42 microg per nostril tid) and beclomethasone dipropionate nasal spray (84 microg per nostril bid) against that of either active agent alone for the treatment of rhinorrhea.. Multicenter, 6-week, double-blind, randomized active- and placebo-controlled, parallel trial.. Allergist and general practitioner clinical practices.. Five hundred thirty-three patients with perennial rhinitis (279 allergic and 274 non-allergic), 8 to 75 years of age, who had at least a mild degree of severity of rhinorrhea for a minimum of 2 hours per day during the 1 week screening period as well as congestion or sneezing also of at least mild severity.. Either (1) ipratropium bromide nasal spray 0.03% (42 microg per nostril tid) plus beclomethasone dipropionate nasal spray (84 microg per nostril bid), (2) ipratropium bromide nasal spray 0.03% (42 microg per nostril tid) alone, (3) beclomethasone dipropionate nasal spray (84 microg per nostril bid) alone, or (4) vehicle [matching placebo nasal spray for the ipratropium bromide (2 sprays per nostril tid)] or beclomethasone dipropionate (2 sprays per nostril bid).. Severity and duration of rhinorrhea, and patient and physician global assessment of control of rhinorrhea.. Ipratropium bromide nasal spray plus beclomethasone nasal spray was more effective than either active agent alone or vehicle in reducing the average severity and duration of rhinorrhea during 4 weeks of treatment. The advantage of ipratropium bromide plus beclomethasone nasal spray was evident by the first day of combined treatment and continued throughout the 2-week treatment period. Ipratropium bromide nasal spray had a faster onset of action during the first week of treatment and reduced the duration of rhinorrhea more than beclomethasone. Beclomethasone nasal spray was more effective in reducing the severity of congestion and sneezing than ipratropium. In patients who had not responded well to a nasal steroid prior to participation in the study based on a questionnaire administered at screening, ipratropium bromide was as effective in the steroid non-responders as steroid responders, whereas beclomethasone was more effective in steroid responders. Combined active therapy was well tolerated with no increase in adverse events over that seen previously with ipratropium bromide or beclomethasone nasal spray alone.. The combined use of ipratropium bromide nasal spray with beclomethasone dipropionate nasal spray is more effective than either active agent for the treatment of rhinorrhea, and does not result in a potentiation of adverse drug reactions. Ipratropium bromide nasal spray 0.03% alone should be considered in patients for whom rhinorrhea is the primary symptom, and its use in combination with a nasal steroid should be considered in patients where rhinorrhea is one of the predominant symptoms, or in patients with rhinorrhea not fully responsive to other therapy.

Topics: Administration, Inhalation; Adolescent; Adult; Aged; Anti-Asthmatic Agents; Beclomethasone; Bronchodilator Agents; Child; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Ipratropium; Male; Middle Aged; Quality of Life; Rhinitis; Rhinitis, Allergic, Perennial

To compare the safety and efficacy of ipratropium bromide 0.03% (IB) with beclomethasone dipropionate 0.042% (BDP) in the treatment of perennial rhinitis in children.. Thirty-three children with nonallergic perennial rhinitis (NAPR) and 113 with allergic perennial rhinitis (APR) were randomly assigned to either IB or BDP for 6 months in a single-blind, multicenter protocol in which the physician was blinded to treatment. At each visit, patients and physicians rated symptom control of rhinorrhea, nasal congestion, and sneezing. Patients also completed quality of life questionnaires at baseline and after 6 months of therapy.. Both treatments showed a significant improvement in control of rhinorrhea, congestion, and sneezing compared with baseline over the 6 months of treatment (P < .05). Only for the control of sneezing was BDP consistently better than IB (P < .05). Among the patients given IB, 61% to 73% assessed the control of rhinorrhea as good or excellent on different study visit days, 43% to 60% similarly rated the control of nasal congestion, and 39% to 43% the control of sneezing. The results for BDP were 68% to 78% for the control of rhinorrhea, 55% to 72% for the control of nasal congestion, and 54% to 68% for the control of sneezing. Quality of life assessment documented that both drugs significantly reduced interference with daily activities and disturbance of mood due to rhinorrhea compared with baseline (P < .05). Both treatments were well tolerated with IB causing less nasal bleeding and irritation than BDP.. Ipratropium bromide was safe and effective in controlling rhinorrhea and diminishing the interference by rhinorrhea in school attendance, concentration on school work, and sleep. Ipratropium bromide was as effective as BDP in the control of rhinorrhea and showed a relatively good effect on congestion. Patient and physician assessment favored BDP in the control of sneezing.

Topics: Adolescent; Beclomethasone; Child; Female; Humans; Ipratropium; Male; Placebos; Quality of Life; Rhinitis, Allergic, Perennial; Single-Blind Method; Surveys and Questionnaires

Topics: Administration, Intranasal; Adult; Aged; Anti-Inflammatory Agents; Beclomethasone; Equipment Design; Female; Forced Expiratory Volume; Glucocorticoids; Humans; Male; Masks; Middle Aged; Pulmonary Ventilation; Rhinitis, Allergic, Perennial; Spirometry; Treatment Outcome; Triamcinolone

It has been hypothesized that concentrations of exhaled nitric oxide (NO) may be related to the extent of cytokine-mediated airway inflammation. Recent findings indicate the nasal airways as an important site of NO production. Our objective was to evaluate whether children with allergic rhinitis show different nasal NO levels when compared with normal healthy subjects and the effect of topical steroids and anti-histamine therapy. We have measured the concentration of NO drawn from the nose of 21 children (5-17 years old) affected by perennial allergic rhinitis (house dust mite) out of therapy for at least 3 weeks. Thirteen children were then treated with nasal beclomethasone dipropionate (BDP) (400 micrograms daily) and eight subjects with nasal anti-histamine levocabastine (200 micrograms daily). Measurements were performed before and after 10 days of treatment. As a control group we evaluated 21 healthy children aged 5-15 years. To measure NO we used a chemiluminescence analyser. Before treatment the whole group of children with allergic rhinitis showed a mean (+/- SEM) nasal NO concentration of 267 +/- 18 ppb, significantly higher (P < 0.01) than the control group (186 +/- 15 ppb). The group of children treated with BDP showed, after 10 days of therapy, a significant (P < 0.05) decrease of nasal NO concentration (271 +/- 21 ppb vs. 212 +/- 20 ppb). Indeed, in the group treated with levocabastine, nasal NO concentrations did not present a significant difference (P not significant) compared with baseline (261 +/- 33 ppb and 252 +/- 31 ppb, respectively). These data suggest that (1) children with allergic rhinitis have higher levels of nasal NO than non-atopic controls and (2) intranasal steroid therapy significantly reduces nasal NO production in children with allergic rhinitis. We speculate that the allergic inflammatory response may influence the nasal NO levels and that NO measurements may be a useful marker of nasal inflammation.

Topics: Adolescent; Anti-Inflammatory Agents; Beclomethasone; Child; Child, Preschool; Female; Histamine H1 Antagonists; Humans; Male; Nitric Oxide; Pilot Projects; Piperidines; Rhinitis, Allergic, Perennial; Treatment Outcome

Perennial allergic rhinitis is chronic and persistent, may lead to a constellation of secondary complaints including sinusitis, mouth-breathing, and some symptoms resembling a permanent cold, and often requires constant medical intervention. Well-tolerated nasal corticosteroids, alone or in combination with antihistamines, have been found to be very effective in treating this condition.. To compare the effectiveness and tolerability of mometasone furoate aqueous suspension, a new once daily nasal spray, to placebo vehicle and to beclomethasone dipropionate, administered twice daily, in patients with perennial allergic rhinitis.. This was a randomized, double-blind, placebo-controlled, double-dummy, parallel group study, in 427 patients age 12 years and older at 24 centers in Canada and Europe. Patients allergic to at least one perennial allergen, confirmed by medical history, skin testing, and adequate symptomatology were eligible to receive one of the following regimens for 3 months: mometasone furoate, 200 micrograms only daily; beclomethasone dipropionate, 200 micrograms twice daily (400 micrograms total dose); or placebo vehicle control. The primary efficacy variable was the change from baseline in total AM plus PM diary nasal symptom score over the first 15 days of treatment.. Three hundred eighty-seven patients were valid for efficacy. For the primary efficacy variable, mometasone furoate was significantly (P < or = .01) more effective than placebo and was indistinguishable from beclomethasone dipropionate. Similar trends were seen among individual symptoms, physician symptom evaluations, and therapeutic response. There was no evidence of tachyphylaxis. All treatments were well tolerated.. Mometasone furoate nasal spray adequately controls symptoms of perennial allergic rhinitis, offers the advantage of once daily treatment, and is well tolerated.

Topics: Administration, Intranasal; Adolescent; Adult; Anti-Inflammatory Agents; Beclomethasone; Child; Circadian Rhythm; Double-Blind Method; Drug Administration Schedule; Female; Humans; Loratadine; Male; Mometasone Furoate; Pregnadienediols; Rhinitis, Allergic, Perennial

Topics: Anti-Asthmatic Agents; Asthma; Beclomethasone; Cetirizine; Cromolyn Sodium; Glucocorticoids; Histamine H1 Antagonists; Humans; Nasal Decongestants; Recurrence; Rhinitis, Allergic, Perennial; Terfenadine

Fluticasone propionate is a new potent, topically active corticosteroid with negligable oral bioavailability. Data on its comparative efficacy in perennial allergic and non-allergic rhinitis are limited.. To compare the efficacy and safety of fluticasone propionate aqueous nasal spray (FPANS) 200 micrograms once or twice daily with beclomethasone dipropionate aqueous nasal spray (BPD) 200 micrograms twice daily and placebo in patients with allergic and non-allergic perennial rhinitis.. The 12-week study had a multicentre, double-blind, randomized, parallel group design. Efficacy was assessed from symptom scores recorded on daily diary cards.. FPANS 200 micrograms once or twice daily was significantly better than placebo but not better than BDP in relieving the nasal symptoms of rhinitis. FPANS at either dose was equally effective in the treatment of allergic and non-allergic perennial rhinitis. There were few adverse events and no treatment-related abnormalities in laboratory measurements in either FPANS-treated group. Comparison between treatment groups indicated that FPANS was as well tolerated as placebo and BDP at the doses studied.. In the majority of patients FPANS 200 micrograms once daily in as effective as BDP 200 micrograms twice daily in the relief of perennial allergic rhinitis.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Androstadienes; Anti-Inflammatory Agents; Beclomethasone; Child; Double-Blind Method; Drug Administration Schedule; Female; Fluticasone; Glucocorticoids; Humans; Male; Middle Aged; Rhinitis; Rhinitis, Allergic, Perennial

This was an open, randomized, cross-over study comparing the efficacy and acceptability of aqueous nasal suspensions of budesonide, 200 micrograms b.i.d. and beclomethasone dipropionate (BDP), 100 micrograms q.i.d., each given for 6 weeks to patients with perennial rhinitis and a history of allergy. Forty men and women aged 18-65 years with perennial rhinitis diagnosed at least 1 year previously, were recruited for study provided they had at least two of the following symptoms of rhinitis--blocked nose, runny nose, itching nose or sneezing. They were requested to record the presence or absence of nasal and ocular symptoms on a severity scale of 0-3 (none, mild, moderate, severe) in daily diary cards. The sum of the nasal scores was calculated to give the total nasal symptom score. Mean individual symptom scores and total symptom score were calculated for each treatment. Thirty-seven patients completed the study. The mean total nasal symptom score was significantly lower during budesonide (2.13) than during BDP (2.75), P = 0.001. There were significantly fewer reports of blocked nose (P = 0.004), runny nose (P = 0.0005) and sore eyes (P = 0.047) during budesonide treatment compared with BDP. Four patients reported adverse events during budesonide treatment (two had nosebleeds and two nasal dryness) and three patients during BDP treatment (two had nasal dryness and one gastric discomfort). A significantly greater proportion of patients stated a preference for budesonide than for BDP on the basis of effect (P = 0.0001), side-effects (P = 0.01), and overall (P = 0.0001).

Topics: Administration, Intranasal; Adolescent; Adult; Anti-Inflammatory Agents; Beclomethasone; Budesonide; Cross-Over Studies; Drug Tolerance; Female; Glucocorticoids; Humans; Male; Middle Aged; Pregnenediones; Rhinitis, Allergic, Perennial; Severity of Illness Index

In order to compare the clinical efficacy and safety of beclomethasone dipropionate nasal spray (BDNS) manufactured in Chongqing Glaxo Limited (Group A) and Glaxo UK (Group B), a randomised double-blind parallel group study was performed. A total of 204 patients with seasonal or perennial allergic rhinitis were recruited into the study for a period of 2 weeks. Overall efficacy (excellent/good) was 88% for Group A (excellent 55%) and 90% for Group B (excellent 51%) respectively. Side effects were similar for both groups where dry nose was the most common complaint (4.9% for both groups). However, there was no statistical difference (P > 0.05) between the two groups either in efficacy or side effects. Pollen count was monitored throughout the study period. Pollen season was divided into three periods, i.e. the beginning, the peak and the end. There was no statistical difference (P > 0.05) between the two groups in any period.

Topics: Administration, Intranasal; Adolescent; Adult; Anti-Inflammatory Agents; Beclomethasone; Double-Blind Method; Female; Glucocorticoids; Humans; Male; Middle Aged; Nebulizers and Vaporizers; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Nasal cytograms of patients with allergic rhinitis contain increased numbers of eosinophils and basophilic cells. Neutrophils are also more numerous in cytograms of allergic persons. Topical intranasal corticosteroid therapy for allergic rhinitis has been shown to decrease the numbers of some inflammatory cell types. Fluticasone propionate aqueous nasal spray, a potent synthetic corticosteroid preparation, is effective therapy for seasonal and perennial allergic rhinitis.. Nasal mucosal scrapings were obtained with a Rhinoprobe (Apotex Scientific, Inc. Arlington, Texas) before and after therapy with fluticasone propionate aqueous nasal spray at several doses in patients with either seasonal allergic rhinitis (2 to 4 weeks' therapy) or perennial allergic rhinitis (24 weeks' therapy). More than 1000 paired nasal cytograms obtained from patients participating in five multicenter studies were evaluated.. The percentage of patients with nasal eosinophils (p < 0.01, most studies) and basophilic cells (p < 0.05, most studies) decreased significantly after treatment with fluticasone propionate compared with placebo-treated patients. Similar findings were observed with beclomethasone dipropionate in one study. The number of neutrophils remained relatively unchanged after treatment with the intranasal corticosteroids or placebo.. These findings suggest that the therapeutic benefits of topical intranasal fluticasone propionate and beclomethasone dipropionate for the therapy of seasonal and perennial allergic rhinitis are reflected by the decrease in inflammatory cells in the nasal mucosa.

Topics: Administration, Intranasal; Androstadienes; Anti-Inflammatory Agents; Beclomethasone; Double-Blind Method; Fluticasone; Glucocorticoids; Humans; Nasal Mucosa; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

A randomized, double-blind, crossover study of a new formulation of flunisolide nasal spray was performed comparing its acceptability and safety to that of aqueous beclomethasone dipropionate nasal spray. The single center study enrolled 100 adults with allergic rhinitis; of these, 99 provided valid data for analysis. Each study participant received a single dose of each study drug and assessed nasal burning/stinging and other adverse effects. Analysis of patient evaluations revealed no significant differences in nasal or pharyngeal irritation (P > .05); however, mild aftertaste was present with use of flunisolide (P = .059) compared with beclomethasone dipropionate. There was similar acceptance of both study drugs.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Beclomethasone; Double-Blind Method; Female; Fluocinolone Acetonide; Humans; Male; Nasal Mucosa; Rhinitis, Allergic, Perennial

A double-blind, randomized, parallel-group, placebo-controlled study involving 130 patients was conducted at 9 centres in the U.K. to assess the effect of 6 weeks of treatment with azelastine nasal spray (azelastine) and beclomethasone dipropionate nasal spray (BDP) on the symptoms of perennial rhinitis. Efficacy was assessed by patients recording daily the severity of the symptoms of rhinitis on 10-cm visual analogue scales. Analysis of this diary data showed significant reductions in sneezing, blocked nose, running nose, and itching nose during azelastine treatment. Patients on BDP recorded a consistent reduction in rhinitis symptoms, but these reductions were significant only for sneezing on treatment day 7. When rhinitis symptoms were assessed by clinical investigators on a 4-point scale, the scores obtained following treatment with the 2 study medications showed little change from baseline or "active" treatment scores. There was no evidence of a consistent change in nasal airway resistance, measured using anterior rhinomanometry, following treatment with either BDP or azelastine. Azelastine nasal spray and BDP nasal spray were well tolerated by the patients and the relative incidence of adverse events was similar in the azelastine and placebo/azelastine treatment groups, except that taste perversion occurred more frequently during azelastine treatment than during placebo/azelastine treatment. There was no evidence of an increased incidence of somnolence or fatigue in patients who received azelastine nasal spray. Overall, the results of this study indicate that azelastine administered twice daily as an intranasal spray is a safe and efficacious treatment for the symptoms of rhinitis in patients suffering from mild to moderate perennial rhinitis.

Topics: Administration, Intranasal; Adult; Beclomethasone; Double-Blind Method; Female; Histamine H1 Antagonists; Humans; Male; Phthalazines; Rhinitis, Allergic, Perennial

Two hundred and fifty-one patients, aged 16 years and over, with perennial rhinitis were recruited to this multicentre, randomized, double-blind, parallel group study. One hundred and fifty-nine patients received fluticasone propionate (200 micrograms) aqueous nasal spray (FPANS) twice daily, and 83 patients received beclomethasone dipropionate (200 micrograms) aqueous nasal spray (BDPANS) twice daily; treatment randomization being 2:1, respectively, in order to increase the number of patients in the FPANS group as FPANS was the drug under study. After 1 year of treatment, nasal blockage (p = 0.002), nasal discharge (p = 0.002) and eye watering/irritation (p = 0.048) were significantly improved in patients treated with FPANS twice daily, compared to patients treated with BDPANS twice daily. The symptom grades for nasal itching (p = 0.052) were improved in the FPANS group, but just failed to attain statistical significance at the 5% level. The symptom grades for sneezing tended to be better for the FPANS group, but the difference was not statistically significant. Assessment of changes in the findings during nasal examination (rhinoscopy) and in haematological, biochemical and urinary parameters, and measurements of plasma cortisol levels during the one year of treatment with the study drugs, showed that there were no clinically significant differences between the two treatment groups and that the study drugs were equally well tolerated. This study indicates that long-term use of FPANS provides better relief than BDPANS for most of the symptoms of perennial rhinitis.

Topics: Administration, Intranasal; Adult; Androstadienes; Anti-Inflammatory Agents; Beclomethasone; Double-Blind Method; Female; Fluticasone; Humans; Male; Rhinitis, Allergic, Perennial; Time Factors

Fluticasone propionate aqueous nasal spray, a new potent corticosteroid, is effective when given once or twice daily for seasonal allergic rhinitis.. Fluticasone propionate was compared with beclomethasone dipropionate in a multicenter double-blind, randomized, placebo-controlled, parallel-group study in 466 patients with perennial allergic rhinitis. Adults and adolescents (aged 12 to 71 years) with moderate to severe symptoms, nasal eosinophilia, and a positive skin test reaction (> or = 2+) to a perennial allergen received fluticasone propionate aqueous nasal spray 100 micrograms twice daily or 200 micrograms once daily, or beclomethasone dipropionate aqueous nasal spray 168 micrograms twice daily, or placebo for 6 months.. Clinician- and patient-rated scores for nasal obstruction (including obstruction on awakening), rhinorrhea, sneezing, and nasal itching were reduced by the first visit at 7 days after initiation of active treatment and remained lower than those of patients receiving placebo throughout the 6-month treatment period. Nasal eosinophilia was reduced in significantly more patients receiving active treatment. The incidence of adverse events was similar in all four treatment groups except for blood in nasal mucus, which was reported by significantly more patients in the two twice-daily active treatment groups compared with the placebo group. There was no evidence of systemic effects of fluticasone propionate. There were no significant differences between fluticasone propionate given once or twice daily or beclomethasone dipropionate given twice daily for any efficacy or safety evaluation.. Fluticasone propionate aqueous nasal spray given once daily in the morning is safe and effective therapy for perennial allergic rhinitis and is as effective as twice daily dosing with fluticasone propionate or beclomethasone dipropionate.

Topics: Administration, Topical; Adolescent; Adult; Aged; Androstadienes; Anti-Inflammatory Agents; Beclomethasone; Child; Double-Blind Method; Drug Administration Schedule; Female; Fluticasone; Glucocorticoids; Humans; Male; Middle Aged; Rhinitis, Allergic, Perennial

The effects of topical beclomethasone dipropionate on changes in nasal resistance and secretion induced by topical histamine were studied in eight patients with perennial rhinitis. Patients were studied at enrollment, after 3 weeks of beclomethasone (100 micrograms spray to each nasal cavity twice daily), and after 3 weeks of placebo (saline) treatment administered in a double-blind cross-over trial. Nasal airflow resistance (Rnaw) and total protein, albumin, lysozyme and glycoconjugate secretion in nasal lavage fluids were measured after topical application of histamine to the nasal mucosa. Resistance measurements and secretory parameters were similar for the initial study and after placebo treatment. In those studies, histamine (1 and 10 mg) increased both nasal resistance and secretion of total protein, albumin and glycoconjugates. After beclomethasone treatment the rise in respiratory resistance in response to histamine was significantly attenuated (delta Rnaw, +11.57 cm H2O/l/s with placebo, +5.80 with beclomethasone, P < 0.05). Beclomethasone had no effect on histamine-induced secretion. Because nasal resistance is determined mainly by vascular processes, beclomethasone treatment appears to have a prominent action on the vascular bed to reduce mediator-induced vasodilatation in perennial rhinitis.

Topics: Administration, Intranasal; Adult; Airway Resistance; Anti-Inflammatory Agents; Beclomethasone; Cross-Over Studies; Double-Blind Method; Female; Glucocorticoids; Histamine; Humans; Male; Middle Aged; Nasal Lavage Fluid; Nasal Mucosa; Nasal Provocation Tests; Rhinitis, Allergic, Perennial

Disorders of the upper respiratory tract, particularly allergic rhinitis, are commonly associated with bronchial hyperresponsiveness. The latter may be due to postnasal drip or to mediator or chemotactic factors into the lower airways that either directly alter airway reactivity or cause airway inflammation. The aim of this study was to compare the effect of an identical dose of nasal or bronchial corticosteroid administration on bronchial hyperresponsiveness in patients with allergic rhinitis. Eleven patients were studied. All of them were judged atopic on the basis of positive skin tests to common allergens. During control, spirometry, flow-volume curves, and specific airway conductance (SGaw) were measured. Bronchial challenges were then performed with increasing concentrations of carbachol, and dose-response curves were constructed. The concentration of carbachol that decreased SGaw by 35% from baseline (PD35) was determined by interpolating from the dose-response curve. Control measurements were repeated at 1-wk intervals to ensure that PD35 was stable in all the patients. Then the patients received for 2 wk, in a double-blind randomized crossover fashion, a topical administration of either an aerosol of 400 micrograms of beclamethasone dipropionate (B) into the nose (100 micrograms four times per day) or into the bronchi. During each trial period, identical sprays of placebo were used, the latter being administered into the nose when B was administered into the bronchi and vice versa. Measurements were then performed after 2 wk of intranasal administration and after 2 wk of intrabronchial administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Inhalation; Administration, Intranasal; Adult; Aerosols; Airway Resistance; Beclomethasone; Bronchial Hyperreactivity; Bronchial Provocation Tests; Carbachol; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Hydrocortisone; Male; Prospective Studies; Respiratory Mechanics; Rhinitis, Allergic, Perennial

Patients with ragweed-induced seasonal allergic rhinitis were assigned randomly to be challenged intranasally either with ragweed or histamine while asymptomatic before the ragweed season. After initial challenge, all were treated either by placebo (P), beclomethasone dipropionate (BE), 400 micrograms daily, or budesonide (BU), 1200 micrograms daily, intranasally for 14 days. Repeat challenge was then compared with the previous ones in order to assess the effects of both usual (400 micrograms) and high doses (1200 micrograms) of topical steroids on both allergen-induced and nonspecific (histamine) nasal reactivity. Incremental doses of either histamine or ragweed were insufflated intranasally until a positive response defined the threshold reactivity. Reactions were assessed by a combination of changes in flow rates (rhinomanometry), secretions (mL), and sneezes with ten minutes of challenge. There was no difference in initial threshold reactivities among the treatment groups. Neither BE nor BU changed reactivity to ragweed. There were no adverse reactions except epistaxis in two BU patients. Histamine challenges disclosed a change in threshold reactivity, BU (P much less than .01) greater than BE (P much less than .05), compared with placebo. In summary, even high doses (1200 micrograms) of topical steroids had minimal effects on the early response to intranasal ragweed challenge. In contrast, both usual and high doses affected nonspecific histamine reactivity; this may contribute to some of the clinical improvement noted in symptoms of allergic rhinitis.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Beclomethasone; Budesonide; Child; Dose-Response Relationship, Drug; Female; Glucocorticoids; Histamine; Humans; Male; Middle Aged; Nasal Provocation Tests; Pollen; Pregnenediones; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

A prospective, randomized study comparing the effectiveness of two nasal steroid sprays, flunisolide and beclomethasone dipropionate, in the treatment of nasal obstruction associated with allergic or vasomotor rhinitis has been conducted at New York University Medical Center-Bellevue Hospital. All patients underwent routine history and physical examinations and a modified radioallergosorbent test. Paranasal sinus films were used to exclude patients with sinusitis. The Rhinotest microprocessor rhinomanometer was used to quantify pretreatment and posttreatment total nasal air flow and resistance during a period of 2 months. These findings were assessed in conjunction with the patients' subjective complaints. Results demonstrated that anterior rhinomanometric assessment of the nasal airway during inhalant therapy correlated well with the patients' own subjective impressions of nasal air flow. Both steroid inhalants were effective; however, flunisolide provided for earlier and more substantial symptomatic relief. Beclomethasone dipropionate had milder side effects.

Topics: Adult; Anti-Inflammatory Agents; Beclomethasone; Ephedrine; Female; Fluocinolone Acetonide; Humans; Male; Manometry; Microcomputers; Middle Aged; Prospective Studies; Pulmonary Ventilation; Random Allocation; Rhinitis, Allergic, Perennial; Rhinitis, Vasomotor

Eighteen patients with perennial rhinitis were evaluated in this double-blind cross-over trial comparing beclomethasone dipropionate (BDP) aqueous nasal spray with terfenadine tablets. Both treatments were effective in reducing symptom scores but BDP was significantly better than terfenadine in relieving running nose and sneezing (P less than 0.05). BDP also had a greater effect on reducing nasal inflammation than terfenadine. Although the clinicians and patients assessed both therapies to be equi-effective, significantly more patients preferred the BDP treatment (P less than 0.003). Overall, BDP therapy proved more beneficial than terfenadine therapy in this small group of perennial rhinitis sufferers.

Topics: Adolescent; Adult; Aged; Beclomethasone; Benzhydryl Compounds; Child; Double-Blind Method; Female; Histamine H1 Antagonists; Humans; Male; Middle Aged; Nebulizers and Vaporizers; Rhinitis, Allergic, Perennial; Tablets; Terfenadine

After a 2-week run-in period 23 atopics and non-atopics with perennial rhinitis were treated with intranasally nebulized aqueous flunisolide or aqueous beclomethasone dipropionate in a randomized, double-blind cross-over study, each treatment period being 4 weeks. Before and after each treatment period daily rhinitis symptoms were recorded, and additional determination of nasal airway resistance was performed by posterior rhinomanometry. No statistically significant difference between drugs was observed for any effect parameter recorded, and furthermore no difference in patient preference for either drug was found. It is concluded that both steroids are effective for the improvement of nasal airway in patients with perennial, atopic and non-atopic rhinitis.

Topics: Administration, Intranasal; Administration, Topical; Adult; Airway Resistance; Anti-Inflammatory Agents; Beclomethasone; Double-Blind Method; Fluocinolone Acetonide; Humans; Randomized Controlled Trials as Topic; Rhinitis, Allergic, Perennial

Forty-four patients, with symptoms of nasal obstruction, sneezing, itching and/or rhinorrhea, were entered into a placebo-controlled, double-blind study to evaluate the clinical efficacy of a topical antihistamine drug, levocabastine, applied 4 times a day for 14 days. At the end of the treatment the placebo patients were treated with levocabastine and the levocabastine patients were treated with beclomethasone dipropionate in a single-blind design for another 14 days. This study showed that levocabastine is significantly more active than placebo with reference to nasal discharge and sneezing. Placebo application improved the symptom score. Levocabastine could not be proved to be more effective against nasal obstruction than placebo in the double-blind trial. In the single-blind set-up, levocabastine resulted in an additional improvement in the score for obstruction, after the placebo period. Although the allergic group tended to respond better, no statistically significant difference could be detected between allergic and non-allergic patients. After treatment with levocabastine, beclomethasone dipropionate administration could not improve the results for nasal discharge and sneezing. For nasal congestion, beclomethasone dipropionate proved to be superior to levocabastine.

Topics: Administration, Intranasal; Beclomethasone; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Piperidines; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

An open cross-over trial comparing astemizole with intra-nasal aqueous beclomethasone dipropionate was carried out in forty-five perennial rhinitis patients attending a S.W. London general practice. Each drug was given for 12 weeks, separated by 4-8 weeks without medication. The principal outcome measure was a 7-day symptom diary completed by patients during weeks 4, 8 and 12. Patients were skin tested to seven common inhalant allergens. Half the patients beginning either regime failed to respond adequately within 2 weeks. Doubling the dose in these patients achieved satisfactory symptom control in an additional 67% on beclomethasone dipropionate and 45% on astemizole. Symptom diary scores showed beclomethasone dipropionate to be significantly more effective than astemizole in the treatment of skin test negative patients; but the two drugs were of equal benefit in the treatment of skin test positive patients. Sneezing and rhinorrhoea were the same on both drugs, but nasal blockage tended to be less severe on beclomethasone dipropionate. There was no significant difference between drugs in the frequency or duration of side effects. Beclomethasone dipropionate and astemizole are equally effective in the symptomatic treatment of atopic perennial rhinitis, but beclomethasone dipropionate may offer superior symptom relief in non-atopic perennial rhinitis.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Astemizole; Beclomethasone; Benzimidazoles; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Rhinitis, Allergic, Perennial

The efficacy, safety and optimal dose of TL-102, a powder mixture of beclomethasone dipropionate (BDP) and hydroxypropylcellulose (HCP) were studied in 250 patients with perennial nasal allergy in an intergroup comparative double-blind manner. Four different capsules containing respectively 30 micrograms of HCP and 1.5 micrograms, 12.5 micrograms, 25 micrograms and 50 micrograms of BDP, were prepared and the drug was applied intranasally evenly between both nostrils at a dose of 2 cap./day b.i.d. for one week. The degrees of overall improvement, usefulness, improvement of nasal symptoms (sneezing, nasal discharge, nasal blockage) and improvement of rhinoscopical findings (mucosal swelling and nasal secretion) were found to be dose-dependent. Antigen provocation reaction and nasal eosinophil count were both inhibited as compared with the TL 1.5 g group. The incidence of side effects was 4.5%, but all side effects observed were mild. Using TL-102 resulted in a therapeutic effect comparable to the conventional BDP preparations using a dose 1/4th of the normal dose of these BDP preparations. The incidence of side effects was 1/3th in comparison with conventional BDP. It was suitable to administer BDP 50 micrograms capsule containing 30 mg of HCP twice a day.

Topics: Administration, Intranasal; Beclomethasone; Cellulose; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Powders; Rhinitis, Allergic, Perennial

From the start of the Astemizole clinical investigations, until now the results of 39 trials including more than 2300 patients are available. These results show that Astemizole is an effective and safe Histamine-H1-antagonist for the therapy of hayfever, chronic allergic rhinitis, allergic conjunctivitis, chronic urticaria and allergic bronchitis in adults and children. Astemizole was superior to placebo and the classical antihistamines like Clemastine, Terfenadine, Ketotifen, Mequitazine, pheniramine and Chlorphenamine.

Topics: Astemizole; Beclomethasone; Benzimidazoles; Bronchitis; Clinical Trials as Topic; Conjunctivitis; Double-Blind Method; Drug Therapy, Combination; Histamine H1 Antagonists; Humans; Hypersensitivity; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Urticaria

We studied the efficacy and side effects of the H1-antihistamine astemizole in perennial rhinitis. We also defined subgroups of responders and examined the added effect of a steroid spray. Fifty-five adults completed a 10- to 14-week controlled trial. Astemizole reduced the number of sneezes to 41% (p less than 0.001) and the number of nose blowings to 55% (p less than 0.001) of the placebo values. The added use of beclomethasone dipropionate caused a further reduction to 14% (p less than 0.001) and 37% (p less than 0.05), respectively. Nasal blockage was only marginally affected by the antihistamine, but it was reduced to 64% by the steroid spray (p less than 0.001). "Sneezers" responded better to the antihistamine than "blockers," with "nose blowers" in an intermediate position. The effect was equal in allergic and nonallergic patients. Astemizole was completely nonsedative but increased appetite and body weight. An open 1-year study of 17 patients demonstrated that astemizole maintained its efficacy and that further weight gain did not occur. It is concluded that astemizole is a highly effective nonsedative H1-antihistamine suitable for continuous therapy of perennial rhinitis.

Topics: Adolescent; Adult; Aged; Astemizole; Beclomethasone; Benzimidazoles; Circadian Rhythm; Clinical Trials as Topic; Female; Histamine H1 Antagonists; Humans; Male; Middle Aged; Nasal Mucosa; Rhinitis; Rhinitis, Allergic, Perennial; Sneezing; Time Factors

In this 3-way crossover study, the currently marketed beclomethasone dipropionate aerosol canister was sprayed intranasally through three different delivery adapters by 48 adult patients with allergic rhinitis. The adapters were evaluated and compared for force of spray, ease of use, preferred length of nozzle, and effectiveness. While all three were considered effective for symptom relief, there was a clear preference for both of the new longer, snout-like nozzle adapters over the currently available delivery system.

Topics: Adult; Beclomethasone; Humans; Middle Aged; Patient Participation; Respiratory Therapy; Rhinitis, Allergic, Perennial

Topics: Adolescent; Adult; Beclomethasone; Clinical Trials as Topic; Female; Fluocinolone Acetonide; Humans; Immunoglobulin E; Male; Middle Aged; Nasal Provocation Tests; Rhinitis, Allergic, Perennial

The mode of action of topical steroid therapy was investigated in connection with the effects of beclomethasone nasal spray on the three important factors in allergic nasal manifestation: 1) the number of basophilic cells (blood basophils and tissue mast cells) in the nasal mucosa, 2) the sensitivity of the basophilic cells to allergen and 3) the mucosal sensitivity to histamine. The results indicated that of the three factors the inhibition in the accumulation of basophilic cells in the mucosal surface was the most important mode of action of beclomethasone nasal spray.

Topics: Administration, Intranasal; Adolescent; Adult; Basophils; Beclomethasone; Child; Clinical Trials as Topic; Female; Histamine Release; Humans; Male; Nasal Mucosa; Rhinitis, Allergic, Perennial

Topics: Adolescent; Adult; Aerosols; Beclomethasone; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Nasal Mucosa; Rhinitis, Allergic, Perennial

The etiology of perennial non-allergic rhinitis and nasal polyposis is still not properly understood. Non-specific hyperreactivity forms a major significant symptom. Topical steroids have been used in the treatment of these diseases for about ten years. Their mode of action is still largely unknown. Various test methods in clinical trials can improve our knowledge. The effect of budesonide given intranasally as an aerosol was tested in 22 patients with perennial rhinitis. In another trial the effect of beclomethasone dipropionate (BDP) was compared when given as an aerosol and as a powder. Today we know not only that budesonide and the two forms of BDP are clinically efficacious but also that intranasal steroid treatment can reduce metacholine-induced nasal secretion, reduce the sensitivity of mucosal irritant receptors, and lower the number of basophilic as well as eosinophilic cells in the nasal secretion.

Topics: Administration, Topical; Beclomethasone; Budesonide; Humans; Nasal Polyps; Nose Diseases; Pregnenediones; Respiratory Hypersensitivity; Rhinitis, Allergic, Perennial

Steroid-dependent, chronic asthmatic patients with severe rhinitis or nasal polyps are often candidates for treatment with intranasal topical corticosteroids, such as flunisolide. The possibility of additive adrenal suppression, when flunisolide, beclomethasone and prednisone are given together, has not previously been studied. The need to asses the risk is suggested by reports of additive adrenal suppression when aerosol and oral steroids are used together to treat asthma, and by the demonstrably higher systemic availability of aerosol steroid given intranasally rather than via the lung. We performed a double-blind, placebo-controlled crossover assessment of the efficacy and safety of 3 weeks of intranasal flunisolide spray treatment (300 micrograms/day) in nineteen steroid-dependent chronic asthmatic subjects, who also had nasal polyps or severe rhinitis. During the study, their doses of prednisone and beclomethasone, used for asthma, were held stable. Morning serum cortisol levels and 24-hr urinary-free cortisol excretion were essentially the same after the placebo, and the flunisolide treatments. The intranasal flunisolide improved their nasal symptoms significantly (P less than 0.05). Local complications were negligible. Given conventional steroid doses like those used in this study, there appears to be no important risk to endogenous adrenal function from combining the use of intranasal, flunisolide spray with administration of other steroids by other routes, when this is deemed clinically necessary. If higher doses are used, the possibility of some additive adrenal suppressive effect cannot be excluded.

Topics: Administration, Intranasal; Administration, Oral; Adolescent; Adult; Aerosols; Asthma; Beclomethasone; Drug Therapy, Combination; Female; Fluocinolone Acetonide; Humans; Hydrocortisone; Male; Middle Aged; Nasal Polyps; Prednisone; Rhinitis, Allergic, Perennial

The efficacy and safety of beclomethasone dipropionate (BD), 0.05 mg three times daily, sprayed in each nostril was studied in 39 adult patients with perennial rhinitis in a 12 wk, double-blind, vehicle controlled trial. Parameters of IgE-mediated reactivity, including epicutaneous skin testing, total serum IgE, specific serum IgE, and nasal eosinophilia, were assessed. All adverse reactions, including changes in serum cortisol and nasal and pharyngeal Candida infections, were monitored. Sixty-three percent of BD patients achieved total or substantial control of nasal symptoms compared with 25% of controls (p = 0.04). Eighty-three percent of BD-treated, skin test-positive patients improved, while only 14% of BD nonatopics improved (p less than 0.05). All BD patients with nasal eosinophilia improved compared with 38% without eosinophilia. Adverse reactions were frequent, minor, and equal in both groups. Serum cortisols were stable and no nasal Candida infections were documented. This study demonstrates the efficacy and safety of BD in treatment of perennial rhinitis, particularly in atopic patients with nasal eosinophilia.

Topics: Adolescent; Adult; Beclomethasone; Eosinophilia; Female; Humans; Immunoglobulin E; Male; Middle Aged; Nasal Mucosa; Radioallergosorbent Test; Rhinitis, Allergic, Perennial; Skin Tests

Twenty patients with asthma controlled by oral inhalations of beclomethasone dipropionate (400 micrograms/day) were treated for concurrent rhinitis by the addition of flunisolide nasal solution (300 micrograms/day) and its placebo for three weeks each in a randomized, double-blind, crossover trial. Flunisolide produced a statistically significant benefit for each symptom parameter: sneezing (p = 0.013), runny nose (p = 0.027), stuffy nose (p = 0.005 and over-all severity (p = 0.005). More concomitant rhinitis medication was used during placebo treatment (p = 0.069). Seventy percent of the patients had "total" or "substantial" control of nasal symptoms with flunisolide vs. 45% with placebo (p less than 0.01). Eighty percent felt that flunisolide was either the only active drug or the more active (p less than 0.01). Three morning plasma cortisol determinations during the last week of each treatment period showed no drug-related effect. No nasal cultures were positive for Candida; the incidence of positive pharyngeal; cultures did not vary significantly. Adverse reactions consisted primarily of nasal burning and stinging; none was serious. In this group of twenty patients using inhalations of beclomethasone dipropionate for asthma, accompanying perennial rhinitis was substantially controlled by 300 micrograms of flunisolide nasal solution per day without significant additive effect on plasma cortisol levels or the incidence of overgrowth of Candida.

Topics: Adult; Aerosols; Asthma; Beclomethasone; Candida albicans; Female; Fluocinolone Acetonide; Humans; Male; Middle Aged; Pharynx; Rhinitis, Allergic, Perennial

Because the simultaneous use of more than one form of topical corticosteroid involves higher cumulative doses and, therefore, more potential for absorption, this study was concerned primarily with effect on adrenal function. Seventeen adults whose asthma symptoms had been stable for at least three months on 100-400 microgram/day of beclomethasone dipropionate aerosol received flunisolide intranasal solution (200 microgram/day) combined with its intrabronchial form (1 mg/day) or with beclomethasone dipropionate bronchial aerosol (400 microgram/day). Utilizing a physician-blind, crossover design, each medication combination was administered for one month. Patient and physician evaluations revealed no significant differences in efficacy, adverse effects (complaints) or effect on adrenal function between the two combinations. Thus, the addition of intranasal flunisolide to intrabronchial flunisolide or beclomethasone did not appear to result in significant systemic absorption of corticosteroid above that which might have occurred as a result of the bronchial inhalation of corticosteroid medication alone during the pretrial period.

Topics: 11-Hydroxycorticosteroids; Administration, Intranasal; Adult; Aerosols; Asthma; Beclomethasone; Female; Fluocinolone Acetonide; Forced Expiratory Volume; Humans; Male; Middle Aged; Rhinitis, Allergic, Perennial; Vital Capacity

A double-blind crossover study has compared intra-nasal sodium cromoglycate (SCG) with beclomethasone dipropionate (BDP), and both drugs with placebo, in fifty-two chronic perennial rhinitis patients. BDP was significantly more effective in relieving symptoms than SCG (76.9% and 50% of the patients improved respectively, P < 0.01). Both drugs were more active than placebos but while BDP was very clearly more effective (P < 0.0005) SCG was only marginally better than its placebo (P < 0.05, Fisher; P = 0.068, chi 2). BDP was selected by 56% of the patients as the best agent for continuing therapy at the end of the trial. By contrast SCG was preferred by the same number of patients as chose the two placebos (11.5%).

Topics: Administration, Intranasal; Adolescent; Adult; Beclomethasone; Clinical Trials as Topic; Cromolyn Sodium; Double-Blind Method; Female; Humans; Male; Middle Aged; Rhinitis, Allergic, Perennial

Flunisolide nasal spray has been compared with placebo and with beclomethasone dipropionate in the treatment of perennial rhinitis. A double-blind, cross-over study in 26 patients comparing intranasal flunisolide (total dose 300 microgram/day) with placebo showed superiority of the active preparation in the relief of sneezing, stuffiness and runny nose. Physicians and patients significantly preferred the active spray. Side-effects on both sprays were mainly confined to transient nasal irritation. Plasma cortisol levels did not change significantly during the trial. A single-blind, cross-over study in 34 patients comparing flunisolide and beclomethasone dipropionate showed relief of sneezing, stuffiness, runny nose and nose-blowing with both medications. There were no differences between the effects of the two preparations. Physicians and patients favoured the drugs equally. Side-effects were minor.

Topics: Administration, Intranasal; Adolescent; Adrenal Cortex Hormones; Adult; Beclomethasone; Clinical Trials as Topic; Double-Blind Method; Female; Fluocinolone Acetonide; Humans; Male; Middle Aged; Rhinitis, Allergic, Perennial

An open, parallel comparison of flunisolide and beclomethasone dipropionate nasal sprays is described. Sixty patients entered the study of whom fifty-six completed the full 4 weeks' therapy. The dosage of flunisolide was two actuations (25 micrograms/actuation) into each nostril twice a day (total 200 micrograms). The dosage of beclomethasone dipropionate was one actuation (50 micrograms) in each nostril four times a day (total 400 micrograms). Both drugs produced statistically significant improvements compared with admission values in sneezing, stuffiness, runny nose, nose blowing and post-nasal drip. Both drug significantly decreased the interference by symptoms with routine life and sleep. At the end of the trial both treatment groups showed total or good control of symptoms in the majority of patients. No statistically significant difference was shown between the effects of the two drugs. Side-effects did not cause withdrawal from the trial in any patient and were mostly confined to minor headache and nose and throat complaints. In neither treatment group was there any evidence of adrenal suppression or growths of Candida from nasal swabs.

Topics: Adult; Asthma; Beclomethasone; Clinical Trials as Topic; Female; Fluocinolone Acetonide; Humans; Hydrocortisone; Male; Physician-Patient Relations; Rhinitis, Allergic, Perennial; Skin Tests

A double-blind trial comparing two dosage schedules of beclomethasone dipropinate, 200 micrograms 400 micrograms, with a placebo in the treatment of perennial rhinitis for 12 months has been undertaken in 108 patients. Both schedules of beclomethasone dipropionate were therapeutically effective but the improvement in both the nasal and conjunctival symptoms was more marked with the higher dosage. Clinical candidiasis was not observed on inspection of the nose in any of the patients before or during the trial and in only one patient was clinical candidiasis observed on inspection of the throat. Epistaxes occurred in twelve of forty patients allocated to beclomethasone dipropionate and four of twenty-three allocated to placebo who had not had them before the trial. Most of the episodes were minor but four patients, all on beclomethasone dipropionate, reduced the aerosol dosage because of epistaxes.

Topics: Administration, Intranasal; Adolescent; Adult; Aerosols; Beclomethasone; Candida albicans; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Rhinitis, Allergic, Perennial; Time Factors

It was the aim of this trial to study the effect of intranasal beclomethasone dipropionate on symptoms and signs of perennial allergic rhinitis in Japanese patients. In a multicenter trial 183 patients, children and adults, were treated with placebo or with 400 microgram beclomethasone dipropionate a day for 2 weeks. The active treatment had an effect on all nasal symptoms: sneezing, nose blowing, and blockage being reduced to 34%, 44% and 63% (P < 0.01) of the values in the placebo group. A considerable carry-over effect was found, suggesting a group comparative design to be preferable for a cross over trial for the study of intranasal steroids. The beclomethasone dipropionate therapy had a significant inhibitory effect on the immediate response to nasal allergen provocation. The number of secretion eosinophils was reduced during treatment, and the appearance of the mucous membrane tended to normalize. Local side effects were few and insignificant. It is concluded that beclomethasone dipropionate is a valuable drug for the treatment of perennial allergic rhinitis.

Topics: Administration, Intranasal; Adolescent; Adult; Aerosols; Beclomethasone; Child; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Rhinitis, Allergic, Perennial

In a double blind study the effect of intranasal beclomethasone diproprionate aerosol (BDA) on the morphology of the mucosa of the middle nasal turbinate was examined. Histological specimens were taken from 22 patients receiving BDA and from 15 patients who had received a placebo. Specimens were taken before therapy and after one year of treatment. Polypectomy and ethmoidectomy had been performed on all patients prior to the beginning of treatment. The histological changes of allergic rhinitis were diminished to a greater extent in patients receiving BDA than in the patients in the placebo group. BDA therapy did not cause atrophic rhinitis nor other detrimental changes that could be demonstrated histologically.

Topics: Administration, Intranasal; Beclomethasone; Double-Blind Method; Edema; Eosinophils; Epithelium; Humans; Metaplasia; Nasal Mucosa; Rhinitis, Allergic, Perennial; Turbinates

Topics: Administration, Intranasal; Aerosol Propellants; Aerosols; Anti-Allergic Agents; Beclomethasone; Drug Approval; Glucocorticoids; Humans; Hydrocarbons, Fluorinated; Pregnenediones; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; United States; United States Food and Drug Administration

Intranasal corticosteroids (INS) are the first line treatment for allergic rhinitis (AR). To guide clinical decision-making, we created a therapeutic index (TIX) for INS reflecting efficacy and safety.. A Medline search (1966 to June 2009) was carried out to identify all placebo-controlled randomized trials, and observational reports for safety issues, with Dexamethasone, Budesonide (BUD), Fluticasone propionate (FP), Fluticasone furoate (FF), Flunisolide, Mometasone furoate (MF), Triamcinolone (TRIAM), and Beclomethasone dipropionate (BDP) as treatment for AR. Data on three efficacy (nasal symptoms, ocular symptoms, global assessment) and three safety outcomes (epistaxis, growth, systemic ocular effects) were extracted. Meta analyses were performed for each INS and outcome and results were categorised into scores by quartiles. Scores of the three efficacy and safety outcomes were summed up to create summation scores for efficacy (ES) and side effects (AES), respectively with a maximum of 9 points. The TIX was then defined as the ratio of ES and AES.. Data of 84 studies were extracted. Based on availability of data, a TIX was calculated for 6 substances. BUD showed the highest efficacy score followed by MF and TRIAM. The lowest scores for side effects were achieved by MF and TRIAM followed by FP. These findings resulted in TIX scores of 7 and 5 for MF and TRIAM, respectively, indicating a high efficacy and low potential of adverse events. Medium scores were reached by BUD and FP and lower scores by BDP and FF.. Although safety and efficacy is proven for all available INS by multiple studies, the systematic aggregation and analysis of data allows for a differentiated summary on clinically important features.

Topics: Administration, Intranasal; Androstadienes; Anti-Inflammatory Agents; Beclomethasone; Budesonide; Fluocinolone Acetonide; Fluticasone; Glucocorticoids; Humans; Mometasone Furoate; Pregnadienediols; Rhinitis, Allergic, Perennial; Treatment Outcome; Triamcinolone

In general, steroid is mainly used as anti-inflammatory action in case of allergic diseases. As one of the side effects of inhalation steroid, a report is given below regarding buccal capsule/esophageal candidiasis. The patient came to the hospital with the chief complaint regarding passage dysphagia in the time of deglutition; pharyngitis and esophageal candidiasis were found by endoscopy of upper gastrointestinal tract.The interview after the endoscopy revealed that the patient, a 69-year-old female was diagnosed as chronic perennial allergic rhinitis a few years ago, and had been inhaling rhinenchysis Beclometasone dipropionate (BDP) before sleep every day for the past two years because using this collunarium seemed to mitigate the nasal obstruction and mucus during sleep. The patient did not report this fact before the endocsopy because she did not associate it with her subjective symptom. In this case, it was assumed that nebulized rhinenchysis BDP was accidentally swallowed to the pharynx and esophagus during sleep. As a treatment, rhinenchysis BDP was canceled and instead Azunol mouth washing (gargling/nasal douche) was used. No antifungal agent was used. In two weeks, the patient reported some improvement, and this was confirmed by reexamination of the upper gastrointestinal tract using endoscope in one month and a half. Pharyngitis was improved, and in the digital endoscopic assessment of esophageal candidiasis complicating inhaled steroid therapy the esophageal candidiasis became Grade I (mild grade). As for the later progress, the patient did not report any subjective symptoms such as nasal obstruction and dysphagia. In addition, the inflammation caused by candidiasis and found in the early examination was improved. The patient in this case was under treatment for thrombosis in the vein of lower extremity, but no complications such as diabetes mellitus or immune deficiency syndrome were observed.. Esophageal candidiasis by chronic administration of inhalation of steroid before sleep for asthmatic patients has been reported. However, there has not been a report of esophageal candidiasis by chronic administration of rhinenchysis steroid before sleep for patients with allergic rhinitis. Similarly, in the case of the use of steroid in the form of collunarium before sleep, steroid stayed in the esophagus via the transendothelial nasal cavity, and that seemed to cause, in the long run, to develop esophageal candidiasis.. One of the implications of the above case is that collunarium can go down, even when it is nebulized in the nasal cavity, to the esophagus via the nasal cavity to buccal capsule. This suggests the necessity for preventative measures in the case of chronic administration of steroid as follows. A. Blowing of the nose just after the use of collunarium B. Daily rinsing (gargling and nasal douche).

Topics: Administration, Inhalation; Aged; Beclomethasone; Candidiasis; Esophageal Diseases; Female; Glucocorticoids; Humans; Nasal Obstruction; Rhinitis, Allergic, Perennial; Sleep; Time

Allergy does not modify the symptoms of nasal polyposis, either initially or after a 1-year medical treatment.. To assess the role of allergy in the symptoms and treatment of patients presenting with the diagnosis of nasal polyposis.. Two simultaneous studies were carried out. In the first study, 180 consecutive patients with nasal polyposis (60% males, mean age = 48.4 years) were analyzed to detect whether the severity of their symptoms correlated with the presence of positive allergic tests. In the second study, 74 consecutive patients (57.5% males, mean age = 48.3 years) were analyzed to detect whether the results of a 1-year medical treatment of nasal polyposis were influenced by the presence of positive allergic tests (Phadiatop). Five nasal criteria were scored: nasal obstruction, anterior and posterior rhinorrhea, facial pain, and the loss of sense of smell. The frequency of asthma was evaluated. Treatment of nasal polyposis consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of steroid consumption (prednisolone and beclomethasone) was studied.. In the first study, mean scores of nasal symptoms did not differ between the two groups of patients with and without allergy. The prevalence of asthma (p = 0.03) was higher in the group with than without allergy. In the second study, decrease of all nasal symptoms was not statistically different in the two groups. Cumulative consumption of prednisolone and beclomethasone between baseline and year 1 were similar in the two groups.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Asthma; Beclomethasone; Bronchial Provocation Tests; Comorbidity; Cross-Sectional Studies; Drug Hypersensitivity; Follow-Up Studies; Forced Expiratory Volume; Humans; Immunoglobulin E; Methacholine Chloride; Nasal Obstruction; Nasal Polyps; Olfaction Disorders; Prednisolone; Prospective Studies; Rhinitis, Allergic, Perennial

Topics: Administration, Intranasal; Administration, Topical; Adult; Anti-Inflammatory Agents; Beclomethasone; Betamethasone; Drug Combinations; Female; Humans; Hydrocortisone; Male; Rhinitis, Allergic, Perennial; Treatment Outcome

To study the effect of combined modality therapy on perennial allergic rhinitis (PAR).. Fifty-eight cases of PAR received a 4-weeks treatment with combined beclomethasone dipropionate nasal spray (BDP), cetirizine hydrochloride, ethmoidal nerve radiofrequency treatment, and half-dose combined BDP, cetirizine hydrochlonde was used for improving the recurrence symptoms in one year follow-up.. The overall effective (excellent/good) rate was 94.83% (excellent 72.41%, good 22.41%). The recurrence rate was 51.72%, but symptoms of 27 recurrence cases were lighter than pre-treatment. All treatments were well tolerated, and no serious adverse events occurred.. The reasonable combined modality therapy is aimed at the complicated pathogenesis of PAR, and the curative effect is satisfactory, so it is a good way to treat PAR.

Topics: Administration, Intranasal; Adolescent; Adult; Beclomethasone; Catheter Ablation; Child; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Rhinitis, Allergic, Perennial

To study the effects of beclomethasone dipropionate (BDP) on the inflammatory granular leukocytes in nasal secretions of the patients with allergic rhinitis.. The change of intercellular calcium ion of the eosinophils and neutrophils in the nasal secretions were observed under the laser scanning confocal microscopy and technology of fluorescence.. The concentration of intercellular calcium ion either in eosinophils or in neutrophils significantly rose after BDP treatment.. BDP can rise the concentration of intercellular calcium ion in the granular leukocytes, which may be a factor of the anti-inflammation functions of BDP.

Topics: Anti-Inflammatory Agents; Beclomethasone; Calcium; Cells, Cultured; Eosinophils; Humans; Nasal Mucosa; Neutrophils; Rhinitis, Allergic, Perennial

To study the effects of beclomethasone dipropionate (BDP) on the inflammatory cells in nasal secretions of the patients with allergic rhinitis.. The variation of intercellular RNA and RNA/DNA ratio of the eosinophils, neutrocyte and lymphocyte in the nasal secretions were observed under the laser scanning confocal microscopy and technology of fluorescence.. The scanning images displayed that either in eosinophils or in neutrocyte, the fluorescence signal of intercellular RNA was significantly decreased after BDP treatment, and the intercellular RNA/DNA ratio was significantly reduced (eosinophils group P < 0.001, and neutrocyte group P < 0.01). The fluorescence singal of lymphocyte intercellular RNA and RNA/DNA ratio were not significantly changed (P > 0.05).. BDP can reduce the content of intercellular RNA of the eosinophils and neutrocyte. The anti-inflammation function of BDP is realized by regulating the intercellular RNA synthesize and/or RNA degradation, and by inhibiting the intercellular inflammatory medium production. BDP does not directly influence the intercellular RNA metabolize of the lymphocyte.

Topics: Adult; Aged; Anti-Inflammatory Agents; Beclomethasone; Eosinophils; Humans; Leukocytes; Lymphocytes; Middle Aged; Nasal Mucosa; Neutrophils; Rhinitis, Allergic, Perennial

Topics: Anti-Inflammatory Agents; Beclomethasone; Female; Humans; Metaplasia; Middle Aged; Nasopharynx; Rhinitis, Allergic, Perennial

In an attempt to study the pathogenesis of mucosal hypersensitivity in allergic rhinitis, we investigated the suppressive effects of cyclosporin A (CyA) and glucocorticosteroids on ovalbumin (OA)-induced hypersensitivity to topical histamine challenge.. Actively sensitized Dunkin-Hartley guinea pigs.. OA and alum were applied to guinea pigs intraperitoneally 3 times at two-week intervals. After general sensitization, OA inhalation was performed every day for 6 days as topical sensitization. Before inhalation, treatment with CyA (50 mg/kg, p.o.), glucocorticosteroids (beclomethasone propionate (1.0 mg/kg, i.p.), fluticasone propionate (FP, 0.5 mg/kg, i.p.)) or vehicle were performed, and the sensitivity to histamine was measured before and after the inhalation. Moreover, in actively (general and topical) sensitized guinea pigs, FP (0.5 mg/kg, i.p.) was applied every day for 5 days and histamine sensitivity was evaluated before and after the application.. We found that histamine sensitivity was significantly increased by nasal antigen challenge in this guinea pig model, and that the occurrence of histamine hypersensitivity was inhibited by the pretreatment with CyA and glucocorticosteroids. Although multiple administration of FP gradually reduced the histamine hypersensitivity according to the period of administration, it did not significantly alter the histamine hypersensitivity after the occurrence of hypersensitivity.. It is concluded that CyA and glucocorticosteroids suppress antigen-induced histamine hypersensitivity in a guinea pig model of allergic rhinitis.

Topics: Administration, Inhalation; Androstadienes; Animals; Anti-Allergic Agents; Anti-Inflammatory Agents; Beclomethasone; Cyclosporine; Disease Models, Animal; Drug Hypersensitivity; Fluticasone; Glucocorticoids; Guinea Pigs; Histamine; Immunosuppressive Agents; Injections, Intraperitoneal; Male; Ovalbumin; Rhinitis, Allergic, Perennial

The use of intranasal steroids for the treatment of allergic and vasomotor rhinitis has doubled during the past 5 years. The number of reported cases of nasal septum perforation has increased correspondingly. The mechanism behind this is unknown, and steroid-induced septum perforation is rarely described in the literature. In order to describe the course of events and to form an idea of the extent of the problem, we have reviewed the cases reported at our clinic and compiled reports on side-effects from the Swedish Medical Products Agency. In our department we found 32 patients with septum perforation (21 women and 11 men). The most common risk factor for septum perforation was steroid treatment, 11 cases (10 women, 1 man, average age 33 years, range 19-49 years). The information obtained from the Swedish Medical Products Agency showed that 38 cases of steroid induced septum perforation had been reported during the past 10 years. The number of side-effects per million Defined Daily Dose (DDD) was averaged to 0.21. The risk of perforation is greatest during the first 12 months of treatment and the majority of cases involves young women. We conclude that septum perforation due to nasal sprays are underreported in Sweden and that perforations are most likely to appear in young females during their first months of medication.

Topics: Administration, Intranasal; Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aerosols; Aged; Androstadienes; Anti-Inflammatory Agents; Beclomethasone; Budesonide; Child; Female; Fluticasone; Glucocorticoids; Humans; Male; Middle Aged; Nasal Septum; Nose Diseases; Retrospective Studies; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Rhinitis, Vasomotor; Sex Factors; Sweden; Time Factors

Full and accurate diagnosis of allergic rhinitis is important as a basis for treatment decisions, as many nasal disorders have similar signs and symptoms. Optimal allergen avoidance is the starting point of treatment, so causative allergens need to be identified. Oral antihistamines are effective in relieving the majority of symptoms of allergic rhinitis and allergic conjunctivitis, but provide only partial relief from nasal congestion. Topical alpha-adrenergic decongestants help to relieve congestion, but prolonged use leads to rhinitis medicamentosa. Systemic decongestants are less effective than topical agents and their use is limited by systemic and central side-effects. The value of leukotriene antagonists has yet to be fully evaluated. Intranasal ipratropium bromide helps to control watery secretions, and an aerosol may be more effective than an aqueous solution. Topical glucocorticosteroids, such as triamcinolone, are the most potent and effective agents available for treating allergic rhinitis. The available evidence indicates that there is very little systemic absorption. Sodium cromoglycate is effective in allergic rhinitis, though less so than topical steroids, and has the least adverse effects among the antiallergic agents. Immunotherapy can be effective and may be indicated in individuals who cannot avoid the causative allergen. Special considerations apply to the treatment of allergic rhinitis in elderly or pregnant patients. Finally, patients with long-standing allergic conditions should be re-assessed regularly.

Topics: Adult; Age Factors; Aged; Beclomethasone; Child; Female; Histamine H1 Antagonists; Humans; Ipratropium; Male; Middle Aged; Nasal Decongestants; Pregnancy; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Triamcinolone Acetonide

The effects of beclomethasone dipropionate (BDP) on eosinophils in nasal secretions of the patients with allergic rhinilis was assaied under the laser scanning confocal microscopy and the technology of fluoresence. The scanning images displayed that fluoresence signal of the eosinophils intracellular RNA was significantly decreased after BDP treatment. The results showed that anti-inflammation funtion of BDP was realized by controlling the intracellular DNA translate to RNA.

Topics: Anti-Inflammatory Agents; Beclomethasone; Cell Separation; Eosinophils; Humans; Microscopy, Confocal; Nasal Cavity; Rhinitis, Allergic, Perennial; RNA

On the basis of a single case report, combined antiobstructive and anti-inflammatory treatment of bronchial asthma is described. The anti-obstructive component used was a sustained-release theophylline preparation (Euphylong, 750 mg/day), and as anti-inflammatory drug, the inhalant beclomethasone diproprionate (Viarox, 300 mg/day). During the 4-week treatment period, obvious improvements in lung function parameters (FEV1 from 21 prior to to 31 after treatment; FVC from 2.81 to 3.31) were seen. At a daily dose of 750 mg theophylline, a favorable therapeutic concentration of 16.5 micrograms/ml was achieved. It was found that the combination of sustained-release theophylline and the low-dose glucocorticoid inhalant resulted in an impressive improvement in bronchial asthma.

Topics: Adult; Asthma; Beclomethasone; Drug Therapy, Combination; Female; Humans; Rhinitis, Allergic, Perennial; Theophylline

Topics: Administration, Intranasal; Aerosols; Anti-Inflammatory Agents; Beclomethasone; Fluocinolone Acetonide; Glucocorticoids; Humans; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Triamcinolone

Corticosteroids are undoubtedly the pharmacotherapeutic agents with the broadest application for the treatment of many types of rhinitis, not just those of atopic origin. However, this potent class of drugs also has the greatest potential for adverse effects and complications. Proper use requires that they be used only after failure of more conservative measures, at the smallest effective dose, for the shortest possible time, and preferably should be administered by the topical intranasal route. Topical corticosteroids, concentrated at the area involved, offer significant relief to patients with allergic rhinitis, and although only a relatively small amount of drug is taken up systemically, cautions for proper use are important. Topical steroids should be used only after accurate diagnosis. They must adequately contact the nasal mucosa, and patients should be properly instructed in their use and monitored for local and systemic side effects. Currently available topical preparations--dexamethasone, beclomethasone, flunisolide, and triamcinolone--have differing characteristics. The use of a preparation with a high margin of safety reduces the risk of undesirable systemic effects.

Topics: Administration, Intranasal; Adrenal Cortex Hormones; Aerosols; Anti-Inflammatory Agents; Beclomethasone; Dexamethasone; Drug Delivery Systems; Drug Monitoring; Fluocinolone Acetonide; Humans; Patient Education as Topic; Rhinitis, Allergic, Perennial

Paroxysmal sneezing is an uncommon condition primarily affecting adolescents. Most of the reported cases were thought to be psychogenic, and only two were felt to be due to nasal sensitivity. This paper reports two adolescents with paroxysmal sneezing, neither of whom had apparent psychologic or emotional problems. In one child the sneezing continued during sleep. The other child was successfully treated with topical nasal anesthesia. Both children were felt to have nasal sensitivity as the etiology of their paroxysmal sneezing. The evaluation of the patient with paroxysmal sneezing requires a thorough history and physical examination. One must not assume that every case of paroxysmal sneezing is of psychogenic origin. Topical nasal anesthesia should be tried for control of intractable paroxysmal sneezing.

Topics: Administration, Intranasal; Beclomethasone; Child; Cocaine; Female; Humans; Lidocaine; Prednisone; Rhinitis, Allergic, Perennial; Sneezing

Posterior rhinometric measurements of nasal resistance were conducted on two groups of patients with perennial rhinitis: those whose symptom of nasal stuffiness responded to a topical steroid spray and those in whom it did not. The anterior ends of the inferior turbinates in 48 patients were treated with either cryosurgery or cautery, and in half of the subjects the erectile tissue of the septum was also thermally ablated. Measurements were made before and 10-16 weeks after therapy. It is concluded from statistical comparison that there is no benefit to treating the septum, and that cryosurgery is more effective in those whose symptoms respond to topical steroids, while cautery works better in those who do not. Histology showed no change in the capacitance vessels (sinusoids) after either modality, and xylometazoline caused a marked decrease in nasal resistance, suggesting that vascular smooth muscle function was intact. Irrespective of the change in airway resistance, most subjects felt that there had been an improvement. The mechanism is discussed.

Topics: Adult; Airway Obstruction; Airway Resistance; Beclomethasone; Cryosurgery; Electrocoagulation; Female; Humans; Male; Manometry; Nasal Septum; Nose; Pulmonary Ventilation; Rhinitis, Allergic, Perennial; Turbinates

Allergic rhinitis is the most common of all allergic disorders. After summarising the clinical features and diagnostic approach with regard to differential diagnosis, we will discuss the therapeutic modalities. As with all long-term therapy measures, it is essential to persuade both the child and the parents to participate in the treatment and to get their co-operation.

Topics: Asthma; Beclomethasone; Child; Cromolyn Sodium; Desensitization, Immunologic; Humans; Ketotifen; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

The effect has been investigated of local administration of beclomethasone dipropionate (BDP) on cell numbers of nasal epithelial metachromatic cell (NMC) sub-populations. Twenty-one patients with perennial allergic rhinitis were studied in four groups according to the duration of treatment or after treatment with BDP. Nasal scrapings were taken after 1 week (Group 1) or 2 weeks (Group 2) of BDP treatment, or after discontinuing BDP for 1 week (Group 3) or 2 weeks (Group 4). Cells were fixed with Mota's lead acetate or 10% buffered formalin followed by toluidine blue staining to count the number of NMC and to classify these according to morphological sub-types (basophils or mast cells). Formalin-sensitive mast cells and basophils in nasal scrapings were reduced more than formalin-resistant mast cells with BDP treatment. Formalin-sensitive mast cells were also more prompt to recover from BDP than formalin-resistant mast cells. The results suggest that the formalin-sensitive NMC is a sub-population of cells which responds to BDP treatment in allergic rhinitis.

Topics: Administration, Topical; Adult; Basophils; Beclomethasone; Cell Count; Epithelial Cells; Epithelium; Formaldehyde; Histocytochemistry; Humans; Mast Cells; Nasal Mucosa; Rhinitis, Allergic, Perennial

The protective effects of disodium cromoglycate (DSCG) and beclomethasone dipropionate (BDA) on the "delayed nasal response" to allergen challenge (DNR) were investigated in 37 patients with allergic rhinitis. These thirty-seven patients, from a group of 268, developed 43 "delayed nasal responses" (DNR), 16 cases of "isolated delayed responses" (IDNR) and 27 cases of "dual delayed responses" (DDNR), where the delayed response (DLDNR) was preceded by an immediate response (INR). BDA demonstrated significant protective effects on the DNR in both its modifications; however, to a higher degree in the case of the IDNR. DSCG significantly decreased only the INR, being a part of the DDNR, while in the case of the DNR in both its modifications, DSCG was completely ineffective. It is suggested that BDA should be the drug of first choice in allergic rhinitis patients demonstrating the DNR. When immediate responses to the same or other allergens are also present, DSCG should be added at the beginning of the treatment for a temporary period of a few months.

Topics: Allergens; Beclomethasone; Cromolyn Sodium; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Intradermal Tests; Nasal Mucosa; Nasal Provocation Tests; Rhinitis, Allergic, Perennial

A total of 50 patients with hay fever of perennial rhinitis were treated for 14 days with beclomethasone dipropionate nasal spray. Dosage was one puff (50 micrograms) in each nostril four times a day to a total daily dose of 400 micrograms. Rhinomanometry was used to determine the efficacy of beclomethasone dipropionate in immediate type allergic responses provoked by a nasal challenge with either grass pollen or house dust/house mite allergen. Treatment with beclomethasone dipropionate nasal spray resulted in a significant increase in tolerance to both house dust/house mite allergen (P = 0.01) and grass pollen allergen (P = 0.005). Passive anterior rhinomanometry would seem to offer an easy suitable technique for measuring nasal resistance during nasal provocation tests.

Topics: Beclomethasone; Dust; Humans; Manometry; Nasal Provocation Tests; Pollen; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Thirty-five patients with perennial rhinitis were treated with beclomethasone dipropionate nasal aerosol three times daily for 48 weeks. There was no evidence at the end of the study of any adverse effects from the topical steroid as assessed by biopsy studies of the nasal mucus membrane and by negative nasal cultures for C. albicans.

Topics: Aerosols; Beclomethasone; Biopsy; Candida; Double-Blind Method; Drug Evaluation; Female; Humans; Male; Nasal Mucosa; Nose; Placebos; Rhinitis, Allergic, Perennial

Topics: Adolescent; Adult; Aerosols; Beclomethasone; Female; Humans; Male; Microscopy, Electron; Nasal Mucosa; Rhinitis, Allergic, Perennial

Allergic rhinitis unresponsive to conservative therapy with antihistamines, decongestants, and environmental control may require the use of corticosteroids for symptomatic relief, even while hyposensitization is being carried out. Such therapy may be given orally, intramuscularly, as a nasal aerosol, or by intraturbinal injection. This discussion deals with the characteristics and appropriate use of each modality.

Topics: Administration, Oral; Adrenal Cortex Hormones; Adult; Aerosols; Beclomethasone; Child; Dexamethasone; Fluocinolone Acetonide; Humans; Injections; Injections, Intramuscular; Rhinitis, Allergic, Perennial; Turbinates

Topics: Aerosols; Asthma; Beclomethasone; Humans; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

This study deals with the comparative investigation of the protective effects of disodium cromoglycate (DSCG) Rynacrom, Intal and beclomethasone dipropionate aerosol (BDA); Aldecin Beconase on the immediate nasal mucosa response to allergen challenge due to the immediate hypersensitivity (Type I allergy) in 50 patients suffering from allergic rhinitis. DSCG demonstrated distinct protective effects on the immediate nasal mucosa response to allergen challenge in all patients investigated, while BDA failed to demonstrate any protective effects on the immediate nasal mucosa response to allergen challenge in any of the patients studied.

Topics: Administration, Intranasal; Allergens; Beclomethasone; Cromolyn Sodium; Humans; Hypersensitivity, Immediate; Nasal Mucosa; Nasal Provocation Tests; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Skin Tests

Beclomethasone dipropionate as a pressurized aerosol is effective in nasal polyposis, but the efficacy is only moderate. In these partly-blocked noses, it seems possible that the insufflated drug in powder form is better distributed over the mucous membrane than the pressurized aerosol. To test this hypothesis, we treated forty-two patients with nasal polyposis with intranasal beclomethasone dipropionate as a powder and as a pressurized aerosol in a double-dummy, cross-over design. There was no difference between the treatments in sixteen patients, while in twelve cases there was a preference for beclomethasone dipropionate as aerosol, and in fourteen, for the powder form. Fourteen found the aerosol most irritating and nineteen, the powder. Thus, in a group of polyp patients there were no significant differences between the two application forms, but possibly there is a need for both aerosol and powder, as there appeared to be differences in the individual responsiveness to the two types of intranasal medication. Blind microscopy of wiped nasal-smears before and after beclomethasone dipropionate treatment showed a reduction of basophilic cells, and counting of sneezes after medication demonstrated a reduction in the number of sneezes. These results suggest that a reduction of epithelial mediator-cells and of irritant receptor-sensitivity are of importance for the efficacy of topical steroids in rhinitis.

Topics: Adult; Aerosols; Aged; Beclomethasone; Double-Blind Method; Female; Humans; Male; Middle Aged; Nasal Polyps; Powders; Rhinitis, Allergic, Perennial

Topics: Aminophylline; Asthma; Autoantibodies; Beclomethasone; Cromolyn Sodium; Histamine H1 Antagonists; Humans; Immune Complex Diseases; Myasthenia Gravis; Plasmapheresis; Receptors, Neurotransmitter; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

A double-blind crossover trial comparing the clinical efficacy of intranasal beclomethasone dipropionate and intranasal sodium cromoglycate was carried out in fourteen patients with perennial rhinitis due to animal danders. Intranasal beclomethasone dipropionate was significantly more effective than intranasal sodium cromoglycate in relieving nasal obstruction, nasal discharge and sneezing. Eleven patients reported preference for beclomethasone dipropionate and three had no preference for either drug.

Topics: Adolescent; Adult; Airway Obstruction; Beclomethasone; Cough; Cromolyn Sodium; Double-Blind Method; Female; Humans; Male; Middle Aged; Nasal Mucosa; Rhinitis, Allergic, Perennial; Sneezing

Forty-eight perennial rhinitis patients completed a six weeks' open trial of intranasal beclomethasone dipropionate aerosol. Each received a daily dose of 400 micrograms. Thirty-five responded excellently, seven reported satisfactory improvement and six failed. This study indicated that patients with a demonstrable allergic component responded favorably. However, due to the wide margin of safety the authors suggest that it be tried on the non-infective perennial rhinitis with no demonstrable allergic component as well.

Topics: Administration, Intranasal; Adolescent; Adult; Asthma; Beclomethasone; Eosinophils; Female; Humans; Immunoglobulin E; Male; Middle Aged; Nasal Mucosa; Nose; Radiography; Rhinitis, Allergic, Perennial; Skin Tests

Topics: Adolescent; Adult; Beclomethasone; Child; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Nose Diseases; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

The effect of intranasal beclomethasone dipropionate on adrenal function was assessed in patients with allergic rhinitis. Beclomethasone dipropionate is an effective preparation and therapeutic doses of 400 microgram/day do not cause adrenal suppression after 12 weeks of use.

Topics: Adrenal Glands; Adult; Beclomethasone; Humans; Hydrocortisone; Male; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal