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3D-visualization Of The Nasal Flow After Allergen Challenge And The Effect Of Mometasone Furoate Nasal Spray (MFNS)
Abstracts S135
J ALLERGY CLIN IMMUNOL VOLUME 123, NUMBER 2
3D-visualization Of The Nasal Flow After Allergen Challenge And The Effect Of Mometasone Furoate Nasal Spray (MFNS) R. Mosges1, M. Meinke2, A. Lintermann2, K. Henkel1, B. Wein3; 1Institute of Medical Statistics, Informatics and Epidemiology, Ko¨ln, Germany, 2 Institute of Aerodynamics; RWTH Aachen, Aachen, Germany, 3Center of Radiology, Aachen, Germany. RATIONALE: The purpose of this investigation was to 3D visualize the spatial distribution of mucosal swelling in the nasal cavity to demonstrate the protective effect of Mometasone furoate nasal spray (MFNS) on exposure to allergens. METHODS: One subject with a history of allergic rhinitis proven by skin prick tests and specific IgE underwent nasal challenge tests before and after two weeks of treatment with MFNS, two puffs per nostril OD. Both tests were conducted during the symptom free winter season, however a ‘‘minimal persistent inflammation’’ could be assumed. High resolution MRimaging was used to capture, visualize and process the geometrical data of the nasal cavity immediately following the challenge tests. Additionally, a baseline MRI was conducted without prior allergen provocation. Based upon these MRI data we computed the nasal airflow using state-of-the-art methods of computational fluid dynamics (CFD). The CFD-models with the streamlines and the pressure distributions of the associated flows were finally visualized in 3D. Rhinomanometry and acoustic rhinometry were used to validate the results. RESULTS AND CONCLUSIONS: At baseline the nasal airflow, as calculated from the CFD-model and measured by rhinomanometry, was within the normal range. 20 minutes after the first allergen challenge nasal symptoms were pronounced with a significant reduction of the nasal flow due to a widespread mucosal swelling in the nasal cavity, documented in the 3D-MRI-model. After 14 days of treatment with MFNS, the baseline nasal flow was again within the normal range and decreased only slightly after allergen challenge. The 3D-visualization demonstrated that the nasal flow remained undisturbed.
513
Is Levocetirizine Less Sedating than Cetirizine? D. B. Tzanetos, K. Buchholz, J. M. Fahrenholz; Vanderbilt University, Nashville, TN. RATIONALE: Levocetirizine, the R-enantiomer of cetirizine, has been found to be less sedating relative to placebo than was cetirizine in separate trials. We examined whether patients who did not tolerate cetirizine due to sedation were able to tolerate levocetirizine. METHODS: A retrospective chart review was completed for 471 patients seen at our university allergy clinic who were prescribed levocetirizine between January 1, 2008 and June 30, 2008. A subset of patients who had been switched to levocetirizine due to sedation with cetirizine was identified. When necessary, we telephoned these patients for clarification. RESULTS: Of 53 patients identified who were switched from cetirizine to levocetirizine due to sedation, 50 of them were reached by phone or chart confirmed (94.3%). Of these 50 patients, 38 were able to tolerate levocetirizine (76%). CONCLUSIONS: In this retrospective chart review and phone survey, levocetirizine was subjectively less sedating than cetirizine the majority of the time. One might have expected that if patients experienced sedation with cetirizine (the parent compound), that they would experience sedation with levocetirizine. That this was not the case for most patients might be due to the fact that without the L-enantiomer present there is significantly less sedation due to the lower dose. We plan to perform a follow up RDBPCT comparing levocetirizine, cetirizine, and placebo in regards to sedation and allergy symptom scores.
514
Efficacy Of A Combination Of Desloratadine And Mometasone Furoate Nasal Spray In Subjects With Cough Associated With Persistent Allergic Rhinitis B. M. Omarjee, B. Tanguy; CHR Felix Guyon, Saint denis, Reunion. RATIONALE: Persistent Allergic Rhinitis (PAR) is the most common form of allergic rhinitis in Re´union Island (a tropical country). Cough is commonly associated with PAR. Allergic inflammation might contribute to cough by producing post nasal drip and by increasing pharyngeal irritability. This study assessed a combination of 5 mg of Desloratadine (DL) and 200 mg of Mometasone Furoate Nasal Spray (MFNS) vs DL 5 mg monotherapy in the treatment of cough associated with PAR. METHODS: The clinical study was performed in our Allergy Outpatient Clinic on patients (mean age 30.4 6 10.5 years) with a > 1 year history of PAR symptoms, positive skin test to indoor allergens, moderate nasal symptoms and moderate cough. Patients were treated for 30 days with DL 5 mg/MFNS 200 mg/day (n 5 146) or DL 5 mg qd (n 5 144). Patients recorded cough and nasal symptoms using a 4 point scale (where 0 5 no symptoms and 3 5 severe symptoms). RESULTS: Total nasal symptoms improved significantly with DL 5 mg/ MFNS 200 mg treatment. Overall (cough 1 total nasal)symptom scores also improved significantly compared with DL at endpoint (P < 0.05). Treatments were well tolerated, with no significant differences in the incidence of adverse events. CONCLUSIONS: The association of DL/MFNS is a valuable treatment of Persistent Allergic Rhinitis due to indoor allergens. This combination showed an important effect on cough with PAR, that was not alleviated by an antihistamine alone.
515
The Effect of Desloratadine on Quality of Life and Nasal Symptoms in Subjects with Perennial Allergic Rhinitis and Asthma A. Carvalho1, U. Brito2, J. Cunha3, S. Torres4, P. Duarte5, D. Pereira6; 1 Centro Hospitalar de Vila Nova de Gaia/Espinho, E.P.E., Vila Nova de Gaia, Portugal, 2Hospital de Faro, E.P.E., Faro, Portugal, 3Hospital de Sa˜o Marcos, E.P.E., Braga, Portugal, 4Hospital Distrital de Viseu, Viseu, Portugal, 5Hospital de Sa˜o Bernado, Setu´bal, Portugal, 6Hospital do Divino Espı´rito Santo, Ponta Delgada, Portugal. RATIONALE: An association between allergic rhinitis and allergic asthma has been established through numerous clinical trials and was the basis of the Allergic Rhinitis and its Impact on Asthma guidelines, as evidence suggests that active rhinitis is a risk factor of uncontrolled asthma. METHODS: This was an open-label study of desloratadine 5 mg QD for 29 days in 22 adults with a 2-year history of perennial allergic rhinitis (PAR) and concomitant asthma with clinical symptoms of PAR at entry. Efficacy variables included nasal symptom score (NSS), nasal congestion score (NCS), total nonnasal score (TNNSS), total nasal 1 nonnasal score (TSS), total asthma score, Asthma Quality of Life Questionnaire (AQLQ), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and bronchodilator use. RESULTS: At the final visit, there were significant reductions in mean NSS, NCS, TNNSS, TSS, total asthma score, and bronchodilator use (all measures, P < 0.001). There was a significant improvement from baseline in overall AQLQ score from 4.95 to 5.78 (P < 0.001) and all AQLQ subdomains (P 0.001) and in overall RQLQ score from 2.16 to 1.39 (P 5 0.003) and subdomains of sleep, practical problems, nasal symptoms, and eye symptoms (P 0.023). Over 80% of subjects reported marked/ complete therapeutic response in PAR and asthma symptoms. Two subjects (9%) reported one adverse event each (anxiety and somnolence); only the case of somnolence was judged potentially treatment related Conclusion: Subjects with symptomatic PAR and stable asthma treated with desloratadine 5 mg QD for 29 days showed a marked improvement in AQLQ and RQLQ scores and in nasal symptoms including congestion.
SUNDAY
512
J ALLERGY CLIN IMMUNOL VOLUME 123, NUMBER 2
3D-visualization Of The Nasal Flow After Allergen Challenge And The Effect Of Mometasone Furoate Nasal Spray (MFNS) R. Mosges1, M. Meinke2, A. Lintermann2, K. Henkel1, B. Wein3; 1Institute of Medical Statistics, Informatics and Epidemiology, Ko¨ln, Germany, 2 Institute of Aerodynamics; RWTH Aachen, Aachen, Germany, 3Center of Radiology, Aachen, Germany. RATIONALE: The purpose of this investigation was to 3D visualize the spatial distribution of mucosal swelling in the nasal cavity to demonstrate the protective effect of Mometasone furoate nasal spray (MFNS) on exposure to allergens. METHODS: One subject with a history of allergic rhinitis proven by skin prick tests and specific IgE underwent nasal challenge tests before and after two weeks of treatment with MFNS, two puffs per nostril OD. Both tests were conducted during the symptom free winter season, however a ‘‘minimal persistent inflammation’’ could be assumed. High resolution MRimaging was used to capture, visualize and process the geometrical data of the nasal cavity immediately following the challenge tests. Additionally, a baseline MRI was conducted without prior allergen provocation. Based upon these MRI data we computed the nasal airflow using state-of-the-art methods of computational fluid dynamics (CFD). The CFD-models with the streamlines and the pressure distributions of the associated flows were finally visualized in 3D. Rhinomanometry and acoustic rhinometry were used to validate the results. RESULTS AND CONCLUSIONS: At baseline the nasal airflow, as calculated from the CFD-model and measured by rhinomanometry, was within the normal range. 20 minutes after the first allergen challenge nasal symptoms were pronounced with a significant reduction of the nasal flow due to a widespread mucosal swelling in the nasal cavity, documented in the 3D-MRI-model. After 14 days of treatment with MFNS, the baseline nasal flow was again within the normal range and decreased only slightly after allergen challenge. The 3D-visualization demonstrated that the nasal flow remained undisturbed.
513
Is Levocetirizine Less Sedating than Cetirizine? D. B. Tzanetos, K. Buchholz, J. M. Fahrenholz; Vanderbilt University, Nashville, TN. RATIONALE: Levocetirizine, the R-enantiomer of cetirizine, has been found to be less sedating relative to placebo than was cetirizine in separate trials. We examined whether patients who did not tolerate cetirizine due to sedation were able to tolerate levocetirizine. METHODS: A retrospective chart review was completed for 471 patients seen at our university allergy clinic who were prescribed levocetirizine between January 1, 2008 and June 30, 2008. A subset of patients who had been switched to levocetirizine due to sedation with cetirizine was identified. When necessary, we telephoned these patients for clarification. RESULTS: Of 53 patients identified who were switched from cetirizine to levocetirizine due to sedation, 50 of them were reached by phone or chart confirmed (94.3%). Of these 50 patients, 38 were able to tolerate levocetirizine (76%). CONCLUSIONS: In this retrospective chart review and phone survey, levocetirizine was subjectively less sedating than cetirizine the majority of the time. One might have expected that if patients experienced sedation with cetirizine (the parent compound), that they would experience sedation with levocetirizine. That this was not the case for most patients might be due to the fact that without the L-enantiomer present there is significantly less sedation due to the lower dose. We plan to perform a follow up RDBPCT comparing levocetirizine, cetirizine, and placebo in regards to sedation and allergy symptom scores.
514
Efficacy Of A Combination Of Desloratadine And Mometasone Furoate Nasal Spray In Subjects With Cough Associated With Persistent Allergic Rhinitis B. M. Omarjee, B. Tanguy; CHR Felix Guyon, Saint denis, Reunion. RATIONALE: Persistent Allergic Rhinitis (PAR) is the most common form of allergic rhinitis in Re´union Island (a tropical country). Cough is commonly associated with PAR. Allergic inflammation might contribute to cough by producing post nasal drip and by increasing pharyngeal irritability. This study assessed a combination of 5 mg of Desloratadine (DL) and 200 mg of Mometasone Furoate Nasal Spray (MFNS) vs DL 5 mg monotherapy in the treatment of cough associated with PAR. METHODS: The clinical study was performed in our Allergy Outpatient Clinic on patients (mean age 30.4 6 10.5 years) with a > 1 year history of PAR symptoms, positive skin test to indoor allergens, moderate nasal symptoms and moderate cough. Patients were treated for 30 days with DL 5 mg/MFNS 200 mg/day (n 5 146) or DL 5 mg qd (n 5 144). Patients recorded cough and nasal symptoms using a 4 point scale (where 0 5 no symptoms and 3 5 severe symptoms). RESULTS: Total nasal symptoms improved significantly with DL 5 mg/ MFNS 200 mg treatment. Overall (cough 1 total nasal)symptom scores also improved significantly compared with DL at endpoint (P < 0.05). Treatments were well tolerated, with no significant differences in the incidence of adverse events. CONCLUSIONS: The association of DL/MFNS is a valuable treatment of Persistent Allergic Rhinitis due to indoor allergens. This combination showed an important effect on cough with PAR, that was not alleviated by an antihistamine alone.
515
The Effect of Desloratadine on Quality of Life and Nasal Symptoms in Subjects with Perennial Allergic Rhinitis and Asthma A. Carvalho1, U. Brito2, J. Cunha3, S. Torres4, P. Duarte5, D. Pereira6; 1 Centro Hospitalar de Vila Nova de Gaia/Espinho, E.P.E., Vila Nova de Gaia, Portugal, 2Hospital de Faro, E.P.E., Faro, Portugal, 3Hospital de Sa˜o Marcos, E.P.E., Braga, Portugal, 4Hospital Distrital de Viseu, Viseu, Portugal, 5Hospital de Sa˜o Bernado, Setu´bal, Portugal, 6Hospital do Divino Espı´rito Santo, Ponta Delgada, Portugal. RATIONALE: An association between allergic rhinitis and allergic asthma has been established through numerous clinical trials and was the basis of the Allergic Rhinitis and its Impact on Asthma guidelines, as evidence suggests that active rhinitis is a risk factor of uncontrolled asthma. METHODS: This was an open-label study of desloratadine 5 mg QD for 29 days in 22 adults with a 2-year history of perennial allergic rhinitis (PAR) and concomitant asthma with clinical symptoms of PAR at entry. Efficacy variables included nasal symptom score (NSS), nasal congestion score (NCS), total nonnasal score (TNNSS), total nasal 1 nonnasal score (TSS), total asthma score, Asthma Quality of Life Questionnaire (AQLQ), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and bronchodilator use. RESULTS: At the final visit, there were significant reductions in mean NSS, NCS, TNNSS, TSS, total asthma score, and bronchodilator use (all measures, P < 0.001). There was a significant improvement from baseline in overall AQLQ score from 4.95 to 5.78 (P < 0.001) and all AQLQ subdomains (P 0.001) and in overall RQLQ score from 2.16 to 1.39 (P 5 0.003) and subdomains of sleep, practical problems, nasal symptoms, and eye symptoms (P 0.023). Over 80% of subjects reported marked/ complete therapeutic response in PAR and asthma symptoms. Two subjects (9%) reported one adverse event each (anxiety and somnolence); only the case of somnolence was judged potentially treatment related Conclusion: Subjects with symptomatic PAR and stable asthma treated with desloratadine 5 mg QD for 29 days showed a marked improvement in AQLQ and RQLQ scores and in nasal symptoms including congestion.
SUNDAY
512