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A double blind study of triamcinolone acetonide nasal spray in allergic rhinitis
VOL.
33,
NO.
JANUARY-FEBRUARY,
ORIGINAL
1 1962
ARTICLES
A DOUBLE BLIND STUDY OF TRIAMCINOLONE NASAL SPRAY IN ALLERGIC RHINITIS
ACETONIDE
T
HB; si+xi) is alwi~~x present for improvement of the symptomat,ic medication of patients. The ideal is therapeutic efficacy without toxicity, undesirable side cfftwts, or acclimation of the patient to the t,hcrapcutic agent. Clinical trial in man is always necessary as animal work is rarely transposable directly and c~t~nlplt+4~-to human beings. Clinical trial without gross bias on the part of eitlscr the t~sperimcntcr or thv subject, is mandatory, although rarely obtainable absolut~cly. No one technique is foolproof in this regard but the randomized tloublc blind tt~chniqno which ntilizes three solutions-a placebo, a standard solution, and the test I,rt’l)aration-tlliinirlatcs positive bias though not nccessarily nt‘gati\rt) hias. Such a schn;~ is superior to the t,wo solution study which wnsists of a standard solution and new test solution but without a placebo. ‘l%ougli there are criticisms both pro and con of patient selection for clinical stlldy, one obviously needs to make srlrctions of test subjects on the basis of Irwd, applicability of type of nlcdic~ation to clinical symptoms, correctness Of clinical diagnosis, and the ability of thr suhjert to discern small differences in tlrc cffwts of diffcrcnt medications.’ Thus patients with a hi~ller-than-average intelligcncc level were chosen from a private allerg l)racticc. Automatic cooperation was assured that all starting the study would cornplt~te it. Their symptoms consisted primarily of ll;lsal l~lockagc dnc to allergic* rhinitis, bccnnse nose drops or sprays arc most of~wtivt~ in this group. Haviny iwd many local nasal preparations over a Iwriotl of >-claw, thtw patients had a firm foundation for reporting comparison clata accuratcl;\-. A publication of the H. T. F. Research Foundation made possible through the gracious mowration of John T. Groel, M.D., Squibb Institute of Medical Research, New Brunswick, S. J. Received for publication March 27, 1961. *Address : 43; North Roxbur>Drive, Beverly Rills, Calif. 1
2Ulergic Ulergic Allergic hllergic hllergic ,Ulergic Allergic Xlergie Xllergic allergic disease -1llergic iillergic iillergic hllergic .Illergic -1llergic hllergic dllergic -1llrrgic Allergic hllergic-
32
45 63 16 58 9 8 44 li 49
23 29 30
20 21 22 23 24 25 26
Ei.
tit
ii.:.
EC+ M: R: E. M. J. M.
D. T. R. M.
R. M.
c’.:: B: I,. II. B.
E. F.
J. 8. H. R. E. G.
14 15 16 17
11 12 13
10
A\llergic hllergie .%llcrgic Xlergic ,Wergic
54 34 9 39 53
B. 8.
J. M.
Allergic
31
R. S.
li
;:
ii: 39 9 33 51
10 46
34
Bronchial Bronchial
4
j P&l\IAKY
N. A.
SEX
3
53 11
/
J. G. s. TV.
AGF,
1 2
/
) PATIENT
NO.
rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis
rhinitis crphalgia rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis vestibular
rlrinitis
rhinitis rhinitis rhinitis rhinitis rhinitis
rhinitis
asthma asthma
DlAoNOSIS
TABLE
/
I.
dermatitis
Bronchial Bronchial Bronchial Bronchial
Bronchial
Bronchial
asthma asthma asthma asthma asthma asthma -
1Iyasfhenia gravis Bronchial asthma Bronchial asthma Complete hlockagc Bronchial aStha Bronchial asthma i\llcrgic rephalgia -
respiratory
asthma conjunctivitis
dcutc upper infection
Bronchial ~Ulergic
Pollen dermatitis Bronchial asthma
Contact
/
RESULTS
1)IARSOSTS
BLIND
Ulrrgic rhini t is .illergic rhinitis : smog ~lisease
SECOXl)AKY
DOUBLE
value
than
help
Slight value Slight value Fair Some help Some help Some help Some help No help No help No help Slight hell)
some help Excellent Good Fair Fair Exwllent Some value No value No value
Some
Better than Better than No value Slight value lnetfwtual
I,ittlc
Bettw
Better than No valuc~
SoLI:TTOS
C C
C
C
-4
/
B
Some relief Excellent Excellent Good results Good results Best of three Best of three Slight value Slight value No help Some valur. pills
Rest ant1 a~lrqnatc Somc~ help Excellent, Excellent Excellent Excellent Best (‘VW used Fair. ; some relief Relieves vertigo
lxttcr
Helps blockage; no rhinorrhea Best and adequate
Excrllmt
value
Fair ; lilts Seosynephrinc~ better Best so far, well like{1 Best and atlequate Some help, noi much
Best one, not excellent Senwl purpose well
SOI>T:TIOh-
value
value value
~aluc
value value value value raluc
No No No No So No No X0 No No No
value value! value value value raluc value value value value value
No value No value No value No value No value So value No value No value No value
so
No No No No So
x-0 value
So
No No
--_^__ SOr>UTIOx
c
z > z
2 2 E-7 v?-
‘7 2 5
2
3
tiolume 33 Number I
TRIAMCINOLONE
ACETONIDE
NASAL
SPRAY
3
No definitive studies in man have ever been performed on the extent or rate of absorption of nasal medication from the nasal mucosa in its normal, inflamed, or allergic edema states. This lack exists because of the inability to use physiologic indicators that can be accurutc~ly quantitated in the laboratory. Studies on 3 patients with forced usage of up to 20 cc. in 11 days (0.03 mg. per day) of triamcinolone acctonide produced no changes in glucose tolerance or plasma, 17-h~-droxycortic~oste~~or~~~ lcvcls as was to bcr esp~~ctrtl.
Three coded nasal sprays in identical plastic squeeze: bottles, labeled ;I, K, and C, were used. The identit>- of their contents were withheld from the: author until the completion of the study. The bottles were given out, in consecutive weeks in a randomized manner so that 3 weeks wc~‘e recluired to study all three solutions in any one patient. The data WI results were recorded at weekly intervals. C’ritcbria of recording results were no relief, some relief (but incomplete), and complete relict of b1ock;lgi.c with rcWrn of t,he olfactory sense. Thirty subjects were studied from February to June, 1960, inclusive. There were 16 males from 9 to 53 years of age and 1-C females aged from 4 to 68 years. All subjects were not studied simult;rneonsl~- so that two separate but blended pollen seasons were included in the st,udy. KESULTS
Solution A contained phenylephrine 0.5 per cent, neomycin sulfate 0.5 prr cent (equivalent to 0.35 per cent neomycin base) and gramicidin 0.005 per cent; solution B contained phenylephrine 0.5 per cent, neomJ-tin sulfate 0.5 per cent, gramicidin 0.005 per cent, and triamcinolone acetonide 0.0167 per cent; and SO~Ution C was the placebo vehicle. As can be seen from Table I, solution A of phenylephrine, neomycin, and gramicidin gave excellent results in 3 patients, some effect in 17, and no therapeutic action in 10. Solution B of phcnylcphrine, mlomycin, gramicidin, and triamcinolone acetonide gave excellent relief in 19, some relief in 9, and was a failure in 2; solution C of the placebo vehicle gave excellent relief in none, some relief in none, and no effects in 30. The advantages of three solutions over a two-solution study were validated, as total absence of therapeutic action of solution C in all test subjects ruled out the presence of any placebo reactors and thus augmented and strengthened the results on the comparative values of solutions A and B. One patient reported B as the best solution but inferior to 0.25 per cent phenylephrine. Another All the rest preferred solution patient liked B best but pret’errcd naphazoline. B to any previously locally used nasal medication for the relief of blockage. Requests are persistently repeated hr\; all patients who have used this preparation. The duration of action is from 4 to 8 hours in different subjects. There was no evidence obtained of rebound blockage in any patient. One of the patients had severe allergic cephalgia in addition to nasal blockage and one had vest,ibular disease with vertigo when nasal blockage was present. Both. these patients had cxccllent relief of either headache or vertigo with solution B, fair results with solution .4, and no relief from solution C.
DISCUSSION
Under the format of selected patients in a privat,c practiw with nasal blockage ot’ allergic or&n which was rev(~rsibI(~ in nature, a solution of 0.5 per cent plienylephrint~, 0.5 per cent nwrn~.cill sutfatc~, 0.005 pc’r (wit grainiAdin, and 0.0167 per crnt tri;llncinolont, awtonidc was clfYrctiw in 90 IJU ccwt of the patients. There were no adverw l*c;:ctiofls; this inc~tudt~clrcbountl l)llc~lloillenoll. This figure is far higher than that wportchd 1,?- IL~gratltni” in 1960 I’or naphazoline nit,rate with oithcr cortison(~, ll~~dl~o~oi~tist,rlc,01’ pwdnisotol~c~ or li~docortisonc snuff in similar patiwts. B~glXtlllli 'S ser+s \VilS Of il similar llllllltW~, il@ span, and sex diffcrcntiat and the sam( tloublc blind tc~chniqw was nscd. Hc also reported market1 nasa I mcmbran~ i~~ritatioir in all st1bjccts. ( )gdc11 ~lild A4ndcrson,3 in 1955, used 30 pi>tic’nts in il tloul)t(~ l)tintl study of ttlrcY~ solutions. t,wo of which cwntained diiCrcnt ~ollc~c~llt~,~ttic,Irs 01’ I”.cldllisolotlc~. Thwc authors had no placebo reactors so tllat their study was wsentiatty similar to the present study. Ogden’s results with the therapcntic~ (‘ffiCac!T of 0.05 1)~“’ (acnt pre~lnisolone nasal SI)l'ily was 80 prr cent. a prior similar study of three solutions niad(> tliwing the fall pollen wason of 1957 showed the efficacy of gramicidin and nwm\-tin’ in 25 Clinic patients This corrohorat (‘(1 the findings of O&n and at the IIarbor Central Hospital. Anderson3 in their 1956 study on gramicidin iltld tyrocitlinc ilS to Si1fCty and choice of concentration. No patients had any objective or subjcctivc indications of a rhinitis medicamentosa during the original study and, of the 4 subjects chosen for laboratory controls of effects of tramcinolone acetonide on plasma glucose and 17-hpdroxycorticosterone, one (R. G.) developed anosmia which persisted for 3 months LYalkcr” in 195’3 reported 20 cases of rhinitis a,nd then resolved completely. medicamentosa, with 3 due to 1 pc’r cent phcnylc~phrinc and 17 to naphazoline. This present study utilized a 0.5 per writ l)llenr-lcpllrinc, solution. Pediatricians prefer now drops in t.11~sm;~ll infant and nasal sprays in the older child and arc accustomed to losing 0.25 [WY cellt ph~~l1!.lcll)llr,illc SO~Ution. Nine children of 4 to 10 years ot’ a~(’ WCI’C iir this stltdy gronl) of 30 and no untoward effects of escitcnwnt, or insottlnia \~clre notrd, won when the> spray, a 0.5 per cent phenvlephrin~~ solut ioli. ~vas used in the cw~rlitip or at bedtime. It is fortunate that no placebo reactors werrt noted in this scriw. All fulfilled the qualifications of Modelll in distinguishing and evaluating small and
TRTAMCINOLONE
AC‘ETONI
I)E
NAS.41,
SPRBY
5
large differences of ~~lrar~rnacodynamic actions of similar type preparations. Thus the absonec of plncclro reactors proved and gave crcdcncc to the value of patient sclcction.
‘l’riamcirtoiorie acctonidc 0.0167 per cent in phcnylephrine 0.5 per cent, neomycin sulfate 0.5 per cent, and gramicidin 0.005 per cent was an effective nasal spray in 90 per cent of 30 patients with nasal blockage and allergic rhinitis studied in the double Mind technique. Tlrcw were no untoward cffccts from 0.5 per cent ~)lrcrrylcplrrirrc in 21 iItlUltS Nld 9 childrwi. Ko cffccts on plasma 17-lr?-dros?-co~ticoste~orre , glucosc, or glucose tolerance was noted in 4 patients with the masinml use of 2 mg. of triamcinolonc acctonidc in 7 day or 4 mg. in 14 da-s. There was onl,v one adverse rwction of anosmia in 30 test suh,jects.
Triarncinolone acetonidc with phcn~lcphrine, ncomwin, and gramicidin pears to lx a safe and worthy addition to the thcrapeut~ic armamentarium allergic rhinitis with Mockage.
in Man, Clin. Pharmacol. W.: The Sensitivity and Validity of Dru, w F:valuations Therap. 1: 769-776, 1960. Bagratuni, L.: A Comparative Study of Topical Steroitls, Antihistamines and Pollen Vaccines in the Treatment of Hay Fcvcr and Hay Asthma, Ann. Allergy 18: 859865, 1960. Ogden, H. D., and Anderson, J. R.: Controlled Studios of Topical IVIadication in Nasal Allergy, Ann. Allergy 15: 414-419, 1956. Friedman, H. T.: Unpublished data, 1957. Walker, J. S.: Rhinitis Medicamentosa, J. ALLKRGP 23: 183-186, 1932.
1. Modell, 2. 3. 4. 5.
ap for
33,
NO.
JANUARY-FEBRUARY,
ORIGINAL
1 1962
ARTICLES
A DOUBLE BLIND STUDY OF TRIAMCINOLONE NASAL SPRAY IN ALLERGIC RHINITIS
ACETONIDE
T
HB; si+xi) is alwi~~x present for improvement of the symptomat,ic medication of patients. The ideal is therapeutic efficacy without toxicity, undesirable side cfftwts, or acclimation of the patient to the t,hcrapcutic agent. Clinical trial in man is always necessary as animal work is rarely transposable directly and c~t~nlplt+4~-to human beings. Clinical trial without gross bias on the part of eitlscr the t~sperimcntcr or thv subject, is mandatory, although rarely obtainable absolut~cly. No one technique is foolproof in this regard but the randomized tloublc blind tt~chniqno which ntilizes three solutions-a placebo, a standard solution, and the test I,rt’l)aration-tlliinirlatcs positive bias though not nccessarily nt‘gati\rt) hias. Such a schn;~ is superior to the t,wo solution study which wnsists of a standard solution and new test solution but without a placebo. ‘l%ougli there are criticisms both pro and con of patient selection for clinical stlldy, one obviously needs to make srlrctions of test subjects on the basis of Irwd, applicability of type of nlcdic~ation to clinical symptoms, correctness Of clinical diagnosis, and the ability of thr suhjert to discern small differences in tlrc cffwts of diffcrcnt medications.’ Thus patients with a hi~ller-than-average intelligcncc level were chosen from a private allerg l)racticc. Automatic cooperation was assured that all starting the study would cornplt~te it. Their symptoms consisted primarily of ll;lsal l~lockagc dnc to allergic* rhinitis, bccnnse nose drops or sprays arc most of~wtivt~ in this group. Haviny iwd many local nasal preparations over a Iwriotl of >-claw, thtw patients had a firm foundation for reporting comparison clata accuratcl;\-. A publication of the H. T. F. Research Foundation made possible through the gracious mowration of John T. Groel, M.D., Squibb Institute of Medical Research, New Brunswick, S. J. Received for publication March 27, 1961. *Address : 43; North Roxbur>Drive, Beverly Rills, Calif. 1
2Ulergic Ulergic Allergic hllergic hllergic ,Ulergic Allergic Xlergie Xllergic allergic disease -1llergic iillergic iillergic hllergic .Illergic -1llergic hllergic dllergic -1llrrgic Allergic hllergic-
32
45 63 16 58 9 8 44 li 49
23 29 30
20 21 22 23 24 25 26
Ei.
tit
ii.:.
EC+ M: R: E. M. J. M.
D. T. R. M.
R. M.
c’.:: B: I,. II. B.
E. F.
J. 8. H. R. E. G.
14 15 16 17
11 12 13
10
A\llergic hllergie .%llcrgic Xlergic ,Wergic
54 34 9 39 53
B. 8.
J. M.
Allergic
31
R. S.
li
;:
ii: 39 9 33 51
10 46
34
Bronchial Bronchial
4
j P&l\IAKY
N. A.
SEX
3
53 11
/
J. G. s. TV.
AGF,
1 2
/
) PATIENT
NO.
rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis
rhinitis crphalgia rhinitis rhinitis rhinitis rhinitis rhinitis rhinitis vestibular
rlrinitis
rhinitis rhinitis rhinitis rhinitis rhinitis
rhinitis
asthma asthma
DlAoNOSIS
TABLE
/
I.
dermatitis
Bronchial Bronchial Bronchial Bronchial
Bronchial
Bronchial
asthma asthma asthma asthma asthma asthma -
1Iyasfhenia gravis Bronchial asthma Bronchial asthma Complete hlockagc Bronchial aStha Bronchial asthma i\llcrgic rephalgia -
respiratory
asthma conjunctivitis
dcutc upper infection
Bronchial ~Ulergic
Pollen dermatitis Bronchial asthma
Contact
/
RESULTS
1)IARSOSTS
BLIND
Ulrrgic rhini t is .illergic rhinitis : smog ~lisease
SECOXl)AKY
DOUBLE
value
than
help
Slight value Slight value Fair Some help Some help Some help Some help No help No help No help Slight hell)
some help Excellent Good Fair Fair Exwllent Some value No value No value
Some
Better than Better than No value Slight value lnetfwtual
I,ittlc
Bettw
Better than No valuc~
SoLI:TTOS
C C
C
C
-4
/
B
Some relief Excellent Excellent Good results Good results Best of three Best of three Slight value Slight value No help Some valur. pills
Rest ant1 a~lrqnatc Somc~ help Excellent, Excellent Excellent Excellent Best (‘VW used Fair. ; some relief Relieves vertigo
lxttcr
Helps blockage; no rhinorrhea Best and adequate
Excrllmt
value
Fair ; lilts Seosynephrinc~ better Best so far, well like{1 Best and atlequate Some help, noi much
Best one, not excellent Senwl purpose well
SOI>T:TIOh-
value
value value
~aluc
value value value value raluc
No No No No So No No X0 No No No
value value! value value value raluc value value value value value
No value No value No value No value No value So value No value No value No value
so
No No No No So
x-0 value
So
No No
--_^__ SOr>UTIOx
c
z > z
2 2 E-7 v?-
‘7 2 5
2
3
tiolume 33 Number I
TRIAMCINOLONE
ACETONIDE
NASAL
SPRAY
3
No definitive studies in man have ever been performed on the extent or rate of absorption of nasal medication from the nasal mucosa in its normal, inflamed, or allergic edema states. This lack exists because of the inability to use physiologic indicators that can be accurutc~ly quantitated in the laboratory. Studies on 3 patients with forced usage of up to 20 cc. in 11 days (0.03 mg. per day) of triamcinolone acctonide produced no changes in glucose tolerance or plasma, 17-h~-droxycortic~oste~~or~~~ lcvcls as was to bcr esp~~ctrtl.
Three coded nasal sprays in identical plastic squeeze: bottles, labeled ;I, K, and C, were used. The identit>- of their contents were withheld from the: author until the completion of the study. The bottles were given out, in consecutive weeks in a randomized manner so that 3 weeks wc~‘e recluired to study all three solutions in any one patient. The data WI results were recorded at weekly intervals. C’ritcbria of recording results were no relief, some relief (but incomplete), and complete relict of b1ock;lgi.c with rcWrn of t,he olfactory sense. Thirty subjects were studied from February to June, 1960, inclusive. There were 16 males from 9 to 53 years of age and 1-C females aged from 4 to 68 years. All subjects were not studied simult;rneonsl~- so that two separate but blended pollen seasons were included in the st,udy. KESULTS
Solution A contained phenylephrine 0.5 per cent, neomycin sulfate 0.5 prr cent (equivalent to 0.35 per cent neomycin base) and gramicidin 0.005 per cent; solution B contained phenylephrine 0.5 per cent, neomJ-tin sulfate 0.5 per cent, gramicidin 0.005 per cent, and triamcinolone acetonide 0.0167 per cent; and SO~Ution C was the placebo vehicle. As can be seen from Table I, solution A of phenylephrine, neomycin, and gramicidin gave excellent results in 3 patients, some effect in 17, and no therapeutic action in 10. Solution B of phcnylcphrine, mlomycin, gramicidin, and triamcinolone acetonide gave excellent relief in 19, some relief in 9, and was a failure in 2; solution C of the placebo vehicle gave excellent relief in none, some relief in none, and no effects in 30. The advantages of three solutions over a two-solution study were validated, as total absence of therapeutic action of solution C in all test subjects ruled out the presence of any placebo reactors and thus augmented and strengthened the results on the comparative values of solutions A and B. One patient reported B as the best solution but inferior to 0.25 per cent phenylephrine. Another All the rest preferred solution patient liked B best but pret’errcd naphazoline. B to any previously locally used nasal medication for the relief of blockage. Requests are persistently repeated hr\; all patients who have used this preparation. The duration of action is from 4 to 8 hours in different subjects. There was no evidence obtained of rebound blockage in any patient. One of the patients had severe allergic cephalgia in addition to nasal blockage and one had vest,ibular disease with vertigo when nasal blockage was present. Both. these patients had cxccllent relief of either headache or vertigo with solution B, fair results with solution .4, and no relief from solution C.
DISCUSSION
Under the format of selected patients in a privat,c practiw with nasal blockage ot’ allergic or&n which was rev(~rsibI(~ in nature, a solution of 0.5 per cent plienylephrint~, 0.5 per cent nwrn~.cill sutfatc~, 0.005 pc’r (wit grainiAdin, and 0.0167 per crnt tri;llncinolont, awtonidc was clfYrctiw in 90 IJU ccwt of the patients. There were no adverw l*c;:ctiofls; this inc~tudt~clrcbountl l)llc~lloillenoll. This figure is far higher than that wportchd 1,?- IL~gratltni” in 1960 I’or naphazoline nit,rate with oithcr cortison(~, ll~~dl~o~oi~tist,rlc,01’ pwdnisotol~c~ or li~docortisonc snuff in similar patiwts. B~glXtlllli 'S ser+s \VilS Of il similar llllllltW~, il@ span, and sex diffcrcntiat and the sam( tloublc blind tc~chniqw was nscd. Hc also reported market1 nasa I mcmbran~ i~~ritatioir in all st1bjccts. ( )gdc11 ~lild A4ndcrson,3 in 1955, used 30 pi>tic’nts in il tloul)t(~ l)tintl study of ttlrcY~ solutions. t,wo of which cwntained diiCrcnt ~ollc~c~llt~,~ttic,Irs 01’ I”.cldllisolotlc~. Thwc authors had no placebo reactors so tllat their study was wsentiatty similar to the present study. Ogden’s results with the therapcntic~ (‘ffiCac!T of 0.05 1)~“’ (acnt pre~lnisolone nasal SI)l'ily was 80 prr cent. a prior similar study of three solutions niad(> tliwing the fall pollen wason of 1957 showed the efficacy of gramicidin and nwm\-tin’ in 25 Clinic patients This corrohorat (‘(1 the findings of O&n and at the IIarbor Central Hospital. Anderson3 in their 1956 study on gramicidin iltld tyrocitlinc ilS to Si1fCty and choice of concentration. No patients had any objective or subjcctivc indications of a rhinitis medicamentosa during the original study and, of the 4 subjects chosen for laboratory controls of effects of tramcinolone acetonide on plasma glucose and 17-hpdroxycorticosterone, one (R. G.) developed anosmia which persisted for 3 months LYalkcr” in 195’3 reported 20 cases of rhinitis a,nd then resolved completely. medicamentosa, with 3 due to 1 pc’r cent phcnylc~phrinc and 17 to naphazoline. This present study utilized a 0.5 per writ l)llenr-lcpllrinc, solution. Pediatricians prefer now drops in t.11~sm;~ll infant and nasal sprays in the older child and arc accustomed to losing 0.25 [WY cellt ph~~l1!.lcll)llr,illc SO~Ution. Nine children of 4 to 10 years ot’ a~(’ WCI’C iir this stltdy gronl) of 30 and no untoward effects of escitcnwnt, or insottlnia \~clre notrd, won when the> spray, a 0.5 per cent phenvlephrin~~ solut ioli. ~vas used in the cw~rlitip or at bedtime. It is fortunate that no placebo reactors werrt noted in this scriw. All fulfilled the qualifications of Modelll in distinguishing and evaluating small and
TRTAMCINOLONE
AC‘ETONI
I)E
NAS.41,
SPRBY
5
large differences of ~~lrar~rnacodynamic actions of similar type preparations. Thus the absonec of plncclro reactors proved and gave crcdcncc to the value of patient sclcction.
‘l’riamcirtoiorie acctonidc 0.0167 per cent in phcnylephrine 0.5 per cent, neomycin sulfate 0.5 per cent, and gramicidin 0.005 per cent was an effective nasal spray in 90 per cent of 30 patients with nasal blockage and allergic rhinitis studied in the double Mind technique. Tlrcw were no untoward cffccts from 0.5 per cent ~)lrcrrylcplrrirrc in 21 iItlUltS Nld 9 childrwi. Ko cffccts on plasma 17-lr?-dros?-co~ticoste~orre , glucosc, or glucose tolerance was noted in 4 patients with the masinml use of 2 mg. of triamcinolonc acctonidc in 7 day or 4 mg. in 14 da-s. There was onl,v one adverse rwction of anosmia in 30 test suh,jects.
Triarncinolone acetonidc with phcn~lcphrine, ncomwin, and gramicidin pears to lx a safe and worthy addition to the thcrapeut~ic armamentarium allergic rhinitis with Mockage.
in Man, Clin. Pharmacol. W.: The Sensitivity and Validity of Dru, w F:valuations Therap. 1: 769-776, 1960. Bagratuni, L.: A Comparative Study of Topical Steroitls, Antihistamines and Pollen Vaccines in the Treatment of Hay Fcvcr and Hay Asthma, Ann. Allergy 18: 859865, 1960. Ogden, H. D., and Anderson, J. R.: Controlled Studios of Topical IVIadication in Nasal Allergy, Ann. Allergy 15: 414-419, 1956. Friedman, H. T.: Unpublished data, 1957. Walker, J. S.: Rhinitis Medicamentosa, J. ALLKRGP 23: 183-186, 1932.
1. Modell, 2. 3. 4. 5.
ap for