(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 Sneezing

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

This was a prospective double blind comparative study on 40 patients. It compared the effects of the leukotriene receptor antagonist montelukast and beclomethasone nasal spray on the post-operative course of patients with sinonasal polyps. All patients underwent endoscopic sphenoethmoidectomy and were randomized post-operatively into two groups. Group I: 20 patients (9 females and 11 males) age 17 to 67 (32.4 +/- 9.5 years), receiving 10 mg montelukast orally daily and Group II: 20 patients (6 females and 14 males) age 17 years to 57 years (33.5 +/- 11.9 years), receiving 400 ug beclomethasone local sprays daily. All patients were followed up for 1 year and a symptom score was recorded throughout this period. There was a significant reduction in symptom scores in both groups throughout the study period. In the montelukast group improvement was more marked in itching, post-nasal discharge and headache. The control of sneezing and rhinorrhea was comparable in both groups with a marginal advantage of montelukast. Steroids had a more marked effect on smell disturbances and obstruction. There was no difference in the recurrence rate or in the need for rescue medications between both groups. Both drugs seem to have a complementary action and further studies are needed to determine which patients should receive which treatment.

Topics: Acetates; Adolescent; Adult; Aged; Anti-Asthmatic Agents; Beclomethasone; Chi-Square Distribution; Cyclopropanes; Double-Blind Method; Female; Glucocorticoids; Headache; Humans; Leukotriene Antagonists; Male; Middle Aged; Nasal Polyps; Olfaction Disorders; Postoperative Care; Postoperative Complications; Prospective Studies; Pruritus; Quinolines; Sneezing; Sulfides

Previous investigations have suggested that nasal secretions, obtained by lavage or scraping, and the nasal submucosa, sampled by biopsy, are two distinct compartments. We investigated the effect of intranasal corticosteroids on antigen-induced eosinophil influx into both compartments. We performed a double-blind, placebo-controlled study in 15 patients with seasonal allergic rhinitis. Beclomethasone dipropionate, 84 microg twice a day, was delivered to one nostril while the other nostril received placebo for 1 wk. Subjects were then challenged with grass or ragweed extracts on each inferior turbinate. Nasal scrapings from both inferior turbinates were obtained before and 24 h after challenge, and bilateral inferior turbinate biopsies were obtained 24 h after challenge, with the subjects still receiving treatment. Intranasal steroids led to a significant reduction in sneezes and eosinophil influx in nasal secretions without affecting the number of eosinophils in the submucosa. Furthermore, intranasal steroids had no effect on the numbers of submucosal EG2+ (activated eosinophils) or CD25+ (IL-2-receptor-bearing) cells, nor did they decrease the endothelial expression of vascular cell adhesion molecule-1 (VCAM-1). These data show that pretreatment with intranasal steroids successfully inhibited the clinical response to allergen and reduced eosinophils in the superficial compartment of the nasal mucosa, but it had no effect on inflammation in the deeper compartment. This might be related to a different distribution of the active medication and antigen into the nasal mucosa or to a specific effect of the active medication on the epithelium resulting in inhibited migration of eosinophils across this layer.

Topics: Administration, Intranasal; Adult; Allergens; Anti-Inflammatory Agents; Beclomethasone; Biopsy; Cell Movement; Chemotaxis, Leukocyte; Double-Blind Method; Eosinophilia; Epithelium; Female; Glucocorticoids; Humans; Immunization; Leukocyte Count; Male; Middle Aged; Nasal Lavage Fluid; Nasal Mucosa; Placebos; Poaceae; Receptors, Interleukin-2; Rhinitis, Allergic, Seasonal; Sneezing; Turbinates; Vascular Cell Adhesion Molecule-1

Intranasal budesonide and beclomethasone dipropionate (BDP), each administered as aqueous, aerosol formulations at dosages of 200 micrograms twice a day, morning and evening, were compared over a 3-week period in a randomized, parallel group study of 88 adults with seasonal allergic rhinitis. Budesonide treatment produced significantly lower mean symptom scores for the whole study compared with BDP for runny nose, itchy nose and sneezing (P < 0.05). The difference in nasal symptom scores produced by budesonide in comparison with BDP was particularly great towards the end of the treatment period. The budesonide-treated group also had lower scores for nasal blockage and two eye symptoms (runny and sore eyes), but the differences noted were not significant. Adverse events recorded by both groups were mild and transient. In conclusion, aqueously administered budesonide is likely to be of more clinical value than BDP for the control of seasonal allergic rhinitis.

Topics: Administration, Intranasal; Adolescent; Adult; Aerosols; Anti-Inflammatory Agents; Beclomethasone; Budesonide; Endophthalmitis; Female; Glucocorticoids; Humans; Male; Medical Records; Middle Aged; Nasal Obstruction; Pregnenediones; Pruritus; Rhinitis; Rhinitis, Allergic, Seasonal; Single-Blind Method; Sneezing

The aim of the study was to compare the efficacy and side-effects of oral antihistamine and nasal glucocorticoid therapy in seasonal allergic rhinitis. In a double-blind, double-dummy, group-comparative study, 60 birch and grass pollen allergic patients were treated with either loratadine (10 mg daily) or beclomethasone dipropionate (BDP) (100 micrograms in each nostril twice daily) during a 3 weeks' study period. Grading of 4 nasal and 3 non-nasal symptoms was performed at 4 weekly visits, and patients recorded daily symptoms and possible adverse experiences in a diary. Patients treated with BDP showed significantly less nasal blockage than those receiving loratadine (P less than 0.05), but there was no difference (P greater than 0.05) in other nasal symptoms (sneezing, itching and discharge). Patients treated with loratadine showed a statistically significantly greater relief in eye symptoms as compared with BDP (P less than 0.05). The side-effects caused by the 2 treatments were few and insignificant. We conclude that loratadine and intranasal BDP were effective in the treatment of seasonal allergic rhinitis, but the spectrum of individual symptoms controlled was different for the 2 drugs.

Topics: Administration, Intranasal; Administration, Oral; Adult; Aged; Beclomethasone; Cyproheptadine; Double-Blind Method; Eye; Female; Histamine Antagonists; Histamine H1 Antagonists; Humans; Loratadine; Male; Middle Aged; Nose; Poaceae; Pollen; Pruritus; Rhinitis, Allergic, Seasonal; Sneezing; Time Factors; Trees

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 order to evaluate the effects of flunisolide and beclomethasone dipropionate nasal sprays on seasonal allergic rhinitis, 45 patients were included in an open parallel comparative trial. The study design was open because of the different dosage schedules for the two preparations. Strict criteria were set up for patient selection, and all patients were carefully examined and assessed before and after the 4-week trial period. Throughout the whole treatment each patient kept a detailed daily record. A substantial or complete control of symptoms was achieved in 18 of the 21 patients on flunisolide and in 20 of the 22 on beclomethasone dipropionate. No serious side effects were observed. Thus it can be concluded that both test drugs are effective and well tolerated in the treatment of seasonal allergic rhinitis.

Topics: Administration, Intranasal; Adolescent; Adult; Analysis of Variance; Beclomethasone; Clinical Trials as Topic; Fluocinolone Acetonide; Histamine H1 Antagonists; Humans; Nasal Mucosa; Rhinitis, Allergic, Seasonal; Sneezing

Topics: Administration, Topical; Adolescent; Adult; Aerosols; Aged; Anti-Inflammatory Agents; Beclomethasone; Chronic Disease; Clinical Trials as Topic; Epistaxis; Female; Glucocorticoids; Histamine H1 Antagonists; Humans; Male; Middle Aged; Nasal Mucosa; Placebos; Respiratory Therapy; Rhinitis, Allergic, Seasonal; Sneezing; Time Factors

Although nasal challenge with allergen has often been used to evaluate the efficacy of therapeutic modalities used for the treatment of allergic rhinitis, the reproducibility of this model in quantitatively evaluating efficacy has not been rigorously examined.. To examine the reproducibility of the suppressive effects of an intranasal corticosteroid on the clinical and biochemical outcomes of a nasal allergen challenge during two identical treatment periods using the same subjects.. In a single-blind study, 25 seasonal allergic subjects with positive skin tests to grass or ragweed were studied outside of their pollen season. Subjects underwent a baseline, three-dose allergen challenge. Beginning 1 week later, subjects received two 7-day courses of intranasal beclomethasone (168 microg b.i.d.) separated by a 1-month washout period. Nasal challenges with allergen were performed after each treatment period. The nasal allergic response was evaluated by counting sneezes, recording symptom scores and measuring levels of albumin (an index of vascular permeability), lysozyme (an index of serous glandular secretion) and kinins (proinflammatory peptides) in recovered nasal lavages.. Compared with the baseline challenge, each course of beclomethasone significantly reduced sneezing, symptom scores, albumin and kinins, but not lysozyme. Reproducibility analysis of the net changes from diluent challenge in the two beclomethasone treatment periods, showed the following intraclass correlation coefficients: sneezing (0.92), lysozyme (0.82), symptom scores (0.72), albumin (0.64) and kinins (0.28).. We conclude that the nasal challenge model is a reproducible method to evaluate the efficacy of anti-allergic medications. For nasal corticosteroid trials, sneezing, symptom scores and albumin levels are recommended as the most reproducibly suppressive outcome measures.

Topics: Administration, Intranasal; Adult; Albumins; Allergens; Ambrosia; Anti-Asthmatic Agents; Beclomethasone; Clinical Trials as Topic; Female; Glucocorticoids; Humans; Kinins; Male; Muramidase; Nasal Lavage Fluid; Nasal Provocation Tests; Poaceae; Reproducibility of Results; Rhinitis, Allergic, Seasonal; Sneezing; Treatment Outcome

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

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