cosyntropin and Rhinitis--Allergic--Seasonal

In adults, morning plasma cortisol levels are twice that of late afternoon and evening values. In children, a delay in the time of onset in peak cortisol levels has been observed in those treated with inhaled corticosteroids. Consequently, the single morning cortisol level has a low sensitivity for detecting adrenal insufficiency in children. It is not clear which test is best for detection of clinically relevant hypothalamic-pituitary-adrenal (HPA) axis suppression in children; 24-hour plasma cortisol is a good test because it measures biologically active, free cortisol levels for the entire day and is noninvasive. For research purposes, the 24-hour integrated concentration plasma cortisol test is preferred. Studies that have looked at HPA axis suppression with intranasal corticosteroids indicate that overall, intranasal corticosteroids have minimal effect on the HPA axis. A review of the literature reveals one study in which there was a decreased output of urinary cortisol during treatment with either budesonide or fluticasone propionate in adults. Other studies of fluticasone propionate or budesonide have shown no effect on the HPA axis in children. Beclomethasone dipropionate was shown to affect urinary cortisol output in one study of healthy volunteers. However, in a long-term study in children, no effect on the HPA axis was found. Mometasone furoate has been extensively studied in more than 20 trials of adults and children. No effects on the HPA axis were detected in either children or adults. It is unlikely that children are more sensitive to corticosteroids than are adults. There seems to be little point in performing routine monitoring of adrenal function in children who are treated with intranasal corticosteroid treatment.

Topics: Administration, Intranasal; Adrenal Cortex Hormones; Adult; Anti-Allergic Agents; Anti-Inflammatory Agents; Child; Clinical Trials as Topic; Cosyntropin; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Insulin; Metyrapone; Pituitary-Adrenal Function Tests; Pituitary-Adrenal System; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Intranasal mometasone furoate (MF) has been extensively studied in adults and has been found to be safe and effective therapy for the treatment of allergic rhinitis. Several studies have now been conducted on pediatric patients. In all, 990 pediatric patients given mometasone furoate nasal spray (MFNS) have been studied in phase I, II, and III clinical trials. In a dose-ranging study, 5 doses of nasal spray (25, 100, and 200 microg MFNS daily and 168 microg beclomethasone dipropionate daily) were compared with placebo. The 100- and 200-microg daily doses of MFNS were found to be more effective than 168 microg beclomethasone dipropionate or 25 microg MFNS given daily. MFNS (100 microg once daily) was chosen as the appropriate dose. In clinical efficacy and safety trials, MFNS was given to 381 patients 3 to 11 years of age for 4 weeks (357 patients received 100 microg MFNS daily for 6 months) and was found to decrease symptom scores from baseline significantly better than placebo. The long-term safety of MFNS was also studied in 166 patients treated for one year; no significant changes in intraocular pressure were detected. Cosyntropin stimulation showed no decreases in cortisol. In adults, nasal mucosa showed improvement in appearance of epithelium and reduction of inflammatory infiltrates, and there were no signs of nasal atrophy.

Topics: Administration, Intranasal; Anti-Allergic Agents; Anti-Inflammatory Agents; Child; Child, Preschool; Clinical Trials as Topic; Cosyntropin; Dose-Response Relationship, Drug; Humans; Hydrocortisone; Mometasone Furoate; Pregnadienediols; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Time Factors

A multicenter double-blind, randomized, parallel group study was conducted to evaluate the once daily administration of fluticasone propionate, a potent, new corticosteroid preparation, for the treatment of seasonal allergic rhinitis. Adult patients (n = 227) were treated for 2 weeks with fluticasone propionate aqueous nasal spray 200 micrograms QD or 100 micrograms BID or matching placebo during the autumn pollen season. Overall, the administration of fluticasone propionate once daily in the morning was as effective as the twice daily dosage regimen, and either regimen was more effective than placebo. Improvement in clinician-rated and patient-rated nasal symptom scores, including morning nasal obstruction, was evident within three days of fluticasone propionate therapy and continued throughout the treatment period. Fewer patients receiving fluticasone propionate used rescue medication and had nasal eosinophilia compared with patients receiving placebo. Adverse events were similar in frequency and nature in all three treatment groups. Morning plasma cortisol concentrations and response to cosyntropin stimulation were similar across groups and offered no evidence of HPA axis suppression. We conclude that fluticasone propionate aqueous nasal spray administered once daily is a safe and effective treatment for seasonal allergic rhinitis. The convenience of a once daily regimen may encourage better compliance.

Topics: Administration, Intranasal; Adolescent; Adult; Androstadienes; Cosyntropin; Female; Fluticasone; Humans; Hydrocortisone; Male; Middle Aged; Nose; Placebos; Respiratory Function Tests; Rhinitis, Allergic, Seasonal

Following a short-term clinical trial reported elsewhere, beclomethasone dipropionate aerosol has been given to 15 children with asthma for between 2 1/2 and 3 years except for a short placebo period after the first year. Month-by-month records of wheezing, peak flow rate, and other treatments used are presented for the first 17 months, adrenocortical function tests are reported for the first 2 years, and growth is recorded for 2 1/2-3 years. The short-term clinical benefits of the treatment are confirmed in the longer term, adrenocortical function appears to be unchanged, and growth proceeds along expected lines. The main disadvantage seems to be worsening of eczema and allergic rhinitis in those children who have ceased using corticotrophin or oral steroids for the control of asthma. It is concluded that in the long term beclomethasone dipropionate aerosol provides safe and effective day-to-day control of asthma in children, although occasional recourse to systemic steroid therapy cannot be avoided. Oral candidasis has not been a clinical problem.

Topics: Adolescent; Adrenal Cortex Function Tests; Aerosols; Asthma; Beclomethasone; Body Height; Body Weight; Child; Clinical Trials as Topic; Cosyntropin; Female; Humans; Male; Methylprednisolone; Placebos; Rhinitis, Allergic, Seasonal

A double-blind comparison of betamethasone valerate and sodium cromoglycate both given by the nasal route was carried out in forty patients with seasonal rhinitis caused by grass pollen. All patients kept daily symptom score cards, and half of them measured both oral and nasal peak expiratory flow rates twice daily. Adrenal function was monitored in thirty-one patients and found to be normal throughout. Sixteen of those patients receiving the steroid aerosol recorded success and two failure of treatment. By contrast, of those receiving sodium cromoglycate there were only two treatment successes and twelve failures. The total symptom score recorded in the group receiving betamethasone valerate was about half that recorded by the sodium cromoglycate group (P less than 0.01). No difference was observed between the two treatments in respect of nasal peak flow rate; specific IgE blood levels and weal sizes following prick tests were not significantly altered throughout the period of the trial, although total IgE was significantly increased. These results suggest that nasal betamethasone valerate offers patients with allergic rhinitis marked symptomatic benefit without the disadvantages previously associated with steroids.

Topics: Administration, Intranasal; Adrenal Cortex Function Tests; Antibody Formation; Betamethasone; Betamethasone Valerate; Clinical Trials as Topic; Cosyntropin; Cromolyn Sodium; Female; Humans; Immunoglobulin E; Male; Peak Expiratory Flow Rate; Periodicity; Poaceae; Rhinitis, Allergic, Seasonal