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73. Nasal, serum, and skin-fixed IgE in perennial rhinitis patients treated with flunisolide (FL)
American
Academy
of Allergy
of flunisolide nasal spray in with seasonal allergic rhinitis. rem, MOD., S. Austrian, .D., Sty Paul, Minn.
J. ALLERGY CLIN. iMMUN@i. MABCH 1978
E. L.
M.D., and G. Geller,
This 6-wk trial studied the effectiveness and safety of 0.025% flnnisolide nasal spray in the management of children 6 to 14 yr of age with ragweed hay fever. During the peak pollen season in August, 48 children were assigned in a random, double-blind fashion to either flunisolide or placebo. Dosage used was one spray per nostril 3 times a day (total = 6 sprays/day: an estimated 1.50 pg/day of flunisolide).J Patients in the placebo group received the same vehicle solution used with flunisolide but without the active drug. Patients recorded daily the duration of sneezing? stuffy nose, runny nose, eye itch, and throat itch. The specific nasal symptoms were of significantly shorter duration and less severity in the flunisolide group than in the placebo group (p values ranged from 0.004 to 0.04). An overall evaluation of symptom control showed flunisolide to be significantly superior to placebo (p = 0.001 I). The llunisolide group also showed a decrease in the use of concomitant medications for control of nasal symptoms while the vehicle group showed a slight increase (p = 0.008). Total or substantial control of nasal symptoms was reported by 66.7% of the flunisolide group, while only 25% of the placebo group had similar benefit. No serious side effects were encountered during the trial. In conclusion, flunisolide 0.025% solution was found to be effective and well tolerated for the control of the nasal symptoms of ragweed hay fever in children. The nasal symptoms were of shorter duration and less severity than those reported by a comparable placebo control group.
2. Eosinophilic pneumonia in association ith the use of beclomethasone propionate aerosol. H. Friedman, M.D., F. J. .D., l-4. E. Voss, M.D., and M. Coleman, Tworag, M.D., Hanover, P-4.H., Boston, Mass., and Stamford# Corm. Three more asthmatic patients developing eosinophilic pneumonias in association with the use of beclomethasone dipropionate bting the number of reported cases to 7. Two of the latest patients had previous histories of the pulmonary infiltrates with eosinophilia syndrome responsive to systemic steroids. Substitution of beclomethasone aerosol for oral prednisone resulted in dramatic recrudescence of the pneumonias. Appreciation of the true clinical situation was dependent on the chest x-ray. The first patient had pulmonary infiltrates associated with a worsening of the asthma. The second was virtually asymptomatic except for a complaint of shoulder pain. A third had a low grade fever, abdominal pain, anorexia, weight loss, and, only later, a cough and t-ales but no wheezing. Lung biopsies in 2 of the
3 patients confirmed the diagnosis. The histories in at least 3 of the 7 patients in the combined series suggest that systemic steroid withdrawal rather than a hypersensitivity to the beclomethasone or components of the vehicle led to the appearance of the esoinophilic pneumonias. The course of these patients supports the concept that beclomethasone acts topically in endobronchial disease but has no efficacy i9 suppressing eosinophilic pneumonia, an alveolar disease.
73. Nasal, serum, and skin-fixe perennial rhinitis patients treat flunisolide (FL). M. Schatz, M.D., G. lncaudo, M.D., F. Yamamoto, M.D., S. Crepea, Mellon, M.D., San Diego, Calif.
M.
Total and specific IgE was measured in 56 patients undergoing a trial of intranasal FL. IgE in nasal secretions (nIgE) against 4 antigens was evaluated with tbe use of a modified radioallergosorbent (RA§T) test. Also analyzed were corresponding puncture skin tests (ST), serum PAST (sIgE), serum total IgE (tIgE), nasal eosinophilia (NE), and benefit from FL in the combined double-blind and open studies. nIgE against at least 1 antigen was found in 17 of 44 patients studied (40%), and 29 of 173 total tests (17%) were positive. Concordance between nIgE and corresponding ST was found in 79% of tests, although 18% had positive §T but no nIgE. Concordance between nIgE and corresponding sIgE was 91%, with 8% of tests demonstrating nIgE without sIgE. nIgE was demonstrated to only 1 antigen in 1 patient without a corresponding positive ST or sIgE. The mean tIgE was significantly higher in the patients with nIgE (p < 0.006), sIgE (p = O.OOOl), and positive ST (p < 0.001). NE was also significantly higher in patients with nIgE (p = O.Ol), sIgE (p = 0.02), and positive ST (p < 0.04). Benefit from FL correlated with the presence of nIgE (p = 0.02) and sIgE (p = 0.09) and with the level of tIgE (p < 0.007) and NE (p < 0.02). These data show that nIgE correlates generally with positive ST and better with sIgE, is found in patients with higher tIgE and NE, but is rarely found in the absence of specific IgE demonstrable in at least one other site. The data also show that benefit from intranasal FL correlates with increased total serum or specific nasal IgE.
74. Effect of alternate-day mo beclomethasone aerosol (BAI function. J. Mazza, MD., J. H. Toog B. Jennings, B.A., D. Haines, M.D., an M.D., London, Ontario, Canada. We observed persisting suppression of plasma cortisol after 1 yr in 34 severe asthmatic patients despite reducing
Academy
of Allergy
of flunisolide nasal spray in with seasonal allergic rhinitis. rem, MOD., S. Austrian, .D., Sty Paul, Minn.
J. ALLERGY CLIN. iMMUN@i. MABCH 1978
E. L.
M.D., and G. Geller,
This 6-wk trial studied the effectiveness and safety of 0.025% flnnisolide nasal spray in the management of children 6 to 14 yr of age with ragweed hay fever. During the peak pollen season in August, 48 children were assigned in a random, double-blind fashion to either flunisolide or placebo. Dosage used was one spray per nostril 3 times a day (total = 6 sprays/day: an estimated 1.50 pg/day of flunisolide).J Patients in the placebo group received the same vehicle solution used with flunisolide but without the active drug. Patients recorded daily the duration of sneezing? stuffy nose, runny nose, eye itch, and throat itch. The specific nasal symptoms were of significantly shorter duration and less severity in the flunisolide group than in the placebo group (p values ranged from 0.004 to 0.04). An overall evaluation of symptom control showed flunisolide to be significantly superior to placebo (p = 0.001 I). The llunisolide group also showed a decrease in the use of concomitant medications for control of nasal symptoms while the vehicle group showed a slight increase (p = 0.008). Total or substantial control of nasal symptoms was reported by 66.7% of the flunisolide group, while only 25% of the placebo group had similar benefit. No serious side effects were encountered during the trial. In conclusion, flunisolide 0.025% solution was found to be effective and well tolerated for the control of the nasal symptoms of ragweed hay fever in children. The nasal symptoms were of shorter duration and less severity than those reported by a comparable placebo control group.
2. Eosinophilic pneumonia in association ith the use of beclomethasone propionate aerosol. H. Friedman, M.D., F. J. .D., l-4. E. Voss, M.D., and M. Coleman, Tworag, M.D., Hanover, P-4.H., Boston, Mass., and Stamford# Corm. Three more asthmatic patients developing eosinophilic pneumonias in association with the use of beclomethasone dipropionate bting the number of reported cases to 7. Two of the latest patients had previous histories of the pulmonary infiltrates with eosinophilia syndrome responsive to systemic steroids. Substitution of beclomethasone aerosol for oral prednisone resulted in dramatic recrudescence of the pneumonias. Appreciation of the true clinical situation was dependent on the chest x-ray. The first patient had pulmonary infiltrates associated with a worsening of the asthma. The second was virtually asymptomatic except for a complaint of shoulder pain. A third had a low grade fever, abdominal pain, anorexia, weight loss, and, only later, a cough and t-ales but no wheezing. Lung biopsies in 2 of the
3 patients confirmed the diagnosis. The histories in at least 3 of the 7 patients in the combined series suggest that systemic steroid withdrawal rather than a hypersensitivity to the beclomethasone or components of the vehicle led to the appearance of the esoinophilic pneumonias. The course of these patients supports the concept that beclomethasone acts topically in endobronchial disease but has no efficacy i9 suppressing eosinophilic pneumonia, an alveolar disease.
73. Nasal, serum, and skin-fixe perennial rhinitis patients treat flunisolide (FL). M. Schatz, M.D., G. lncaudo, M.D., F. Yamamoto, M.D., S. Crepea, Mellon, M.D., San Diego, Calif.
M.
Total and specific IgE was measured in 56 patients undergoing a trial of intranasal FL. IgE in nasal secretions (nIgE) against 4 antigens was evaluated with tbe use of a modified radioallergosorbent (RA§T) test. Also analyzed were corresponding puncture skin tests (ST), serum PAST (sIgE), serum total IgE (tIgE), nasal eosinophilia (NE), and benefit from FL in the combined double-blind and open studies. nIgE against at least 1 antigen was found in 17 of 44 patients studied (40%), and 29 of 173 total tests (17%) were positive. Concordance between nIgE and corresponding ST was found in 79% of tests, although 18% had positive §T but no nIgE. Concordance between nIgE and corresponding sIgE was 91%, with 8% of tests demonstrating nIgE without sIgE. nIgE was demonstrated to only 1 antigen in 1 patient without a corresponding positive ST or sIgE. The mean tIgE was significantly higher in the patients with nIgE (p < 0.006), sIgE (p = O.OOOl), and positive ST (p < 0.001). NE was also significantly higher in patients with nIgE (p = O.Ol), sIgE (p = 0.02), and positive ST (p < 0.04). Benefit from FL correlated with the presence of nIgE (p = 0.02) and sIgE (p = 0.09) and with the level of tIgE (p < 0.007) and NE (p < 0.02). These data show that nIgE correlates generally with positive ST and better with sIgE, is found in patients with higher tIgE and NE, but is rarely found in the absence of specific IgE demonstrable in at least one other site. The data also show that benefit from intranasal FL correlates with increased total serum or specific nasal IgE.
74. Effect of alternate-day mo beclomethasone aerosol (BAI function. J. Mazza, MD., J. H. Toog B. Jennings, B.A., D. Haines, M.D., an M.D., London, Ontario, Canada. We observed persisting suppression of plasma cortisol after 1 yr in 34 severe asthmatic patients despite reducing