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326 Nasal septal perforation in patients using intranasal beclomethasone depropionate (BDP)
325
PHARMACODYNAMICS OF BROMPHENXRAMINE AND PSEUDOEPHEDJUNEIN TREATMENTDF PERENNIAL RHINITIS. D.D. Shen PhD. R.Milsap PhD and J.W.Georgitis MD, Seattle, Wash.,Buffalo. NY and Winston-Salem NC. Brompheniramine maleate (EM) and pseudoephedrine hydrochloride (PE) in slow release bid dose (SR) and immediate release qid dose (IR) were compared for the effect on nasal symptom-scores, airway resistance (Rn) and nasal sensitivity to histamine (HNS).In a cross-over design, subjects took a daily dose of 32mg BM-IR, 480mg PE-IR, 32/480mg BM/PE-IR, 24/24Omg BM/PE-SR or 18/18Omg BM/PE-SR for 7 days.Daily symptoms and adverse reactions were recorded.Rn and HNS were performed on day 7 and correlated with serum drug levels. Ten patients with moderate to severe perennial rhinitis completed the 10 week study.There was no difference between SR and IR preparations on symptoms-scores except for sneezing.The PE dose resulted in higher symptom scores in 6/10 pts compared to SR doses. All 10 patients reported frequent side effects with > 24mg/day of BM. No side effects were noted with lower BM dose (18mg/ day) or the PE dose (48Omg/day). Patient mean Rn was significantly reduced with the BM doses compared to the PE dose. The level of histamine sensitivity was also lower with the BM doses versus the PE dose. Correlations of nasal function and serum drug levels will be presented. These findings indicate that low daily doses of BM (18mg/day) are as clinically effective as higher doses (> 24mg/day) and more importantly cause fewer side effects. The addition of PE to antihistamine preparations does not improve nasal function compared to an antihistamine alone.
327
THE ROLE OF NASAL MUCOSAIN SOMECASES OF ALLERGIC CONJUNCTIVITIS AND THE EFFECTS OF DISODIIJM CROMOGLYCATE (DSCG). Dr. M. Pelikan, M.D. and Dr. 2. Pelikan, M.D., Breda, The Netherlands. The 31 conjunctivitis patients with suspect allergy component, resistant to the usual therapy, were examined by routine procedure, including nasal challenges with allergens. Of the 31 patients 19 developed positive immediate nasal responses (NR) and distinct increase in ocular complaints (OC) after the nasal challenge. The other 12 patients did not develop any nasal response, however in 7 of them the OC increased distinctly after the nasal challenge. The 7 patients with negative NR and increase in OC and 5 patients with positive NR and increase in CC were treated only with 2% DSCGin saline, 6 x 2 eye drops daily. The other 14 patients with positive NR and increase in OC were treated with DSCGeye drops and with intranasal DSCG, 4x10 mg daily, for 8 months. In all 14 patients treated with DSCGin eye drops and intranasal DSCG, the OC improved fully. In 9 of the 12 other patients the OC did not improve after DSCGeye drops only. After addition of intranasal DSCGthe OC improved significantly in all 9 patients. Conclusion: 1) The nasal mucosa can play a role in the allergic conjunctivitis of some patients; 2) In such cases, the nasal challenges with allergens can be of diagnostic value and the combination of DSCG in eye drops with intranasal DSCGcan lead to better therapeutical effects.
326
NASAI, SEPTAL PERFORATIONIN PATIENTS USING INTRANASAL BECZOMETHASONE DEPROPIONATE(BDP). N.C. C. CaForce, M.D., V. Davis, Chapel Hill, Two patients are described with nasal septal Perforation (NSP) after prolonged use of BDP. Patient 1, a 32 y.o. white male with perennial allergic rhinitis (PAR) and nasal polyposis developed a 1 cm diameter anterior NSP after 24 mos. of chronic intermittent BDP Patient had documented use (200-300 ngiday). IgE sensitivity to pollen, dust mite and mold by prick test and underwent concomitant immunotherapy. No interval history of trauma, infection or drug abuse could be elicited. Patient 2, a 9 y.o. white male with PAR due to dust mite developed a 5 mm anterior NSP after 14 mos. of BDP administration at Patient 2 underwent concomitant 200 rig/day. immunotherapy and had no interval history of trauma or infection. Neither patient experienced nasal bleeding or stinging with BDP. Both NSPs were and discovered on routine asymptomatic followup exam. Both patients demonstrated improper technique applying BDP directly to nasal septum instead of in the sagittal plane. BDP aerosol cannisters may be associated with NSP after prolonged use and technique of administration may be an important causative factor.
328
DEVELOPMENTOF AN ANIMAL MODEI, FOR HDM.\NGIANT PAPILLARY CONJUNCTIVITIS. A.H. Cornell-Hell, Ph.R. L.E. Ham, B.S., K.J. Bloch, M.D., M.R. Allansmith, M.D., Boston, Massachusetts Vernal conjunctivitis and contact lens-associated giant papillary conjunctivitis are charac. terized by large papillae and infiltration of hasophils, neutrophils and eosinophils into the stroma of the upper tarsal conjunctiva. We sought to induce a similar lesion in the guinea Guinea pigs (n=6/group)were injected into Pig. the flank on day 0 with 200 pg keyhole limpet hemocyanin (KLH). Cmday 6,animals were injected into the upper tarsal conjunctiva of one eyewith doses of KLH ranging from 0.1 to 200 pg/!Ql PBS and with PBS alone in the other eye. Tissues were removed and processed at 24 hrs. On-micron thick sections of stroma were examined and mast cells, eosinophils, basophils, neutrophils and macrophages in ten adjacent fields (lOOOxmagnification) were enumerated. An imflanunatory response occurred beneath the conjunctiva at the site of antigen challenge. The 50 pg challenge dose of KLH was most effective: it induced an infiltration of basophils (mean=71), eosinophils (mean=ZO) and neutrophils (mean=lgO). These numbers were significantly greater (*0.005) than those obtained with control tiss;es which contained few basophils (mean=W). There was no difference in numhersof aastcellsor macrophagea If these cellular infiltrates are subsequently accompanied by hypertrophic changes, then the guinea pig model will prove useful for the study of giant papillary conjunctivitis. supported
186
by EYO5263
PHARMACODYNAMICS OF BROMPHENXRAMINE AND PSEUDOEPHEDJUNEIN TREATMENTDF PERENNIAL RHINITIS. D.D. Shen PhD. R.Milsap PhD and J.W.Georgitis MD, Seattle, Wash.,Buffalo. NY and Winston-Salem NC. Brompheniramine maleate (EM) and pseudoephedrine hydrochloride (PE) in slow release bid dose (SR) and immediate release qid dose (IR) were compared for the effect on nasal symptom-scores, airway resistance (Rn) and nasal sensitivity to histamine (HNS).In a cross-over design, subjects took a daily dose of 32mg BM-IR, 480mg PE-IR, 32/480mg BM/PE-IR, 24/24Omg BM/PE-SR or 18/18Omg BM/PE-SR for 7 days.Daily symptoms and adverse reactions were recorded.Rn and HNS were performed on day 7 and correlated with serum drug levels. Ten patients with moderate to severe perennial rhinitis completed the 10 week study.There was no difference between SR and IR preparations on symptoms-scores except for sneezing.The PE dose resulted in higher symptom scores in 6/10 pts compared to SR doses. All 10 patients reported frequent side effects with > 24mg/day of BM. No side effects were noted with lower BM dose (18mg/ day) or the PE dose (48Omg/day). Patient mean Rn was significantly reduced with the BM doses compared to the PE dose. The level of histamine sensitivity was also lower with the BM doses versus the PE dose. Correlations of nasal function and serum drug levels will be presented. These findings indicate that low daily doses of BM (18mg/day) are as clinically effective as higher doses (> 24mg/day) and more importantly cause fewer side effects. The addition of PE to antihistamine preparations does not improve nasal function compared to an antihistamine alone.
327
THE ROLE OF NASAL MUCOSAIN SOMECASES OF ALLERGIC CONJUNCTIVITIS AND THE EFFECTS OF DISODIIJM CROMOGLYCATE (DSCG). Dr. M. Pelikan, M.D. and Dr. 2. Pelikan, M.D., Breda, The Netherlands. The 31 conjunctivitis patients with suspect allergy component, resistant to the usual therapy, were examined by routine procedure, including nasal challenges with allergens. Of the 31 patients 19 developed positive immediate nasal responses (NR) and distinct increase in ocular complaints (OC) after the nasal challenge. The other 12 patients did not develop any nasal response, however in 7 of them the OC increased distinctly after the nasal challenge. The 7 patients with negative NR and increase in OC and 5 patients with positive NR and increase in CC were treated only with 2% DSCGin saline, 6 x 2 eye drops daily. The other 14 patients with positive NR and increase in OC were treated with DSCGeye drops and with intranasal DSCG, 4x10 mg daily, for 8 months. In all 14 patients treated with DSCGin eye drops and intranasal DSCG, the OC improved fully. In 9 of the 12 other patients the OC did not improve after DSCGeye drops only. After addition of intranasal DSCGthe OC improved significantly in all 9 patients. Conclusion: 1) The nasal mucosa can play a role in the allergic conjunctivitis of some patients; 2) In such cases, the nasal challenges with allergens can be of diagnostic value and the combination of DSCG in eye drops with intranasal DSCGcan lead to better therapeutical effects.
326
NASAI, SEPTAL PERFORATIONIN PATIENTS USING INTRANASAL BECZOMETHASONE DEPROPIONATE(BDP). N.C. C. CaForce, M.D., V. Davis, Chapel Hill, Two patients are described with nasal septal Perforation (NSP) after prolonged use of BDP. Patient 1, a 32 y.o. white male with perennial allergic rhinitis (PAR) and nasal polyposis developed a 1 cm diameter anterior NSP after 24 mos. of chronic intermittent BDP Patient had documented use (200-300 ngiday). IgE sensitivity to pollen, dust mite and mold by prick test and underwent concomitant immunotherapy. No interval history of trauma, infection or drug abuse could be elicited. Patient 2, a 9 y.o. white male with PAR due to dust mite developed a 5 mm anterior NSP after 14 mos. of BDP administration at Patient 2 underwent concomitant 200 rig/day. immunotherapy and had no interval history of trauma or infection. Neither patient experienced nasal bleeding or stinging with BDP. Both NSPs were and discovered on routine asymptomatic followup exam. Both patients demonstrated improper technique applying BDP directly to nasal septum instead of in the sagittal plane. BDP aerosol cannisters may be associated with NSP after prolonged use and technique of administration may be an important causative factor.
328
DEVELOPMENTOF AN ANIMAL MODEI, FOR HDM.\NGIANT PAPILLARY CONJUNCTIVITIS. A.H. Cornell-Hell, Ph.R. L.E. Ham, B.S., K.J. Bloch, M.D., M.R. Allansmith, M.D., Boston, Massachusetts Vernal conjunctivitis and contact lens-associated giant papillary conjunctivitis are charac. terized by large papillae and infiltration of hasophils, neutrophils and eosinophils into the stroma of the upper tarsal conjunctiva. We sought to induce a similar lesion in the guinea Guinea pigs (n=6/group)were injected into Pig. the flank on day 0 with 200 pg keyhole limpet hemocyanin (KLH). Cmday 6,animals were injected into the upper tarsal conjunctiva of one eyewith doses of KLH ranging from 0.1 to 200 pg/!Ql PBS and with PBS alone in the other eye. Tissues were removed and processed at 24 hrs. On-micron thick sections of stroma were examined and mast cells, eosinophils, basophils, neutrophils and macrophages in ten adjacent fields (lOOOxmagnification) were enumerated. An imflanunatory response occurred beneath the conjunctiva at the site of antigen challenge. The 50 pg challenge dose of KLH was most effective: it induced an infiltration of basophils (mean=71), eosinophils (mean=ZO) and neutrophils (mean=lgO). These numbers were significantly greater (*0.005) than those obtained with control tiss;es which contained few basophils (mean=W). There was no difference in numhersof aastcellsor macrophagea If these cellular infiltrates are subsequently accompanied by hypertrophic changes, then the guinea pig model will prove useful for the study of giant papillary conjunctivitis. supported
186
by EYO5263