Combined mediator blockade or topical steroid for treating the unified allergic airway

Barnes, M. L., Menzies, D., Fardon, T. C., Burns, P. J., Wilson, A. M. and Lipworth, B. J. (2007) Combined mediator blockade or topical steroid for treating the unified allergic airway. Allergy, 62 (1). pp. 73-80. ISSN 1398-9995

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Abstract

Background: Asthma and allergic rhinitis are manifestations of a single unified allergic airway, for which the best treatment is uncertain. Objective: To compare the anti-inflammatory efficacy in the unified allergic airway of combined oral mediator antagonism and combined topical steroid. Methods: 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. Results: 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. Conclusion: 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.

Item Type:	Article
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Respiratory and Airways Group Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Centres > Population Health
Depositing User:	EPrints Services
Date Deposited:	25 Nov 2010 11:08
Last Modified:	28 Mar 2025 03:45
URI:	https://ueaeprints.uea.ac.uk/id/eprint/12150
DOI:	10.1111/j.1398-9995.2006.01263.x

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