Intranasal corticosteroids are well known to be efficaciousin the treatment ofallergic rhinitis. Nasal irrigation with saline, including hyp ertonic saline, has long been recommended for the treatment of sinonasal disease, and it has been shown to have a positive effect on the physiology of the nasal mucosa. Until now, no study of the clinical efficacy of intranasal hyp ertonic Dead Sea saline as a monoth erapy for seasonal allergic rhinitis has been reported. We conducted a prospective, randomized, single-blind,placebo-controlled comparison ofintranasal hypertonic Dead Sea saline sp ray and intranasal aqueous triamcinolone spray in 15patients with seasonal allergic rhinitis. Results were based on a 7-day regimen. Based on Rhinoconj unctivitis Quality of Life Questionnaire scores, clinically andstatistically significant (p < O.0001) improvements were seen in both active-treatment groups; as expected, the corticosteroid spray was the more effective of the two treatments. No significant improvement occurred in the control group. Our preliminary results not only confirm the efficacy ofintranasal corticosteroid therapy in moderate-to-severe allergic rhinitis, they also suggest that the Dead Sea saline solution can be an effective alternative in mild-to-moderate allergic rhinitis, particularly with respect to nasal and eye symptoms. The hypertonicity ofthe Dead Sea solution may have apositive effect on the physiology ofthe nasal mucosa by improving mucociliary clearance. In addition, the dominant cation in the Dead Sea solution-magnesium-probably exerts anti-inflammato ry effects on the nasal mucosa and on the systemic immune response.Dr. Cordray is an otolaryngologist in private practice. Dr. Harjo is a family physician in private practice. Dr. Miner is director of academic programs at Southern Nazarene University. All are located in Tulsa, Okla . Reprint requests: Scott Cordray, DO, Hillcrest Physicians Bldg.,

Data Mining procedures were used to analyze responses of 173 missionaries surveyed about the nature and impact of traumatic stress (TS) they may have experienced while on the field. TS was almost universal, with the most frequent types involving system failure or personal crisis; there was also a high incidence of permanent negative change in those reporting TS, and over a third of these reported continuing symptoms almost a decade post-incident. Non-catastrophic stressors and stressors involving System Failure (particularly those with peer-System Failure) had higher TS impact. Severity, as seen in Total Impact and Total Number of Symptoms, was related to permanent negative change, as was age, with younger missionaries (possibly a generational rather than age or experience issue) being more vulnerable. Both destructive and salutogenic change were associated with TS, but no predictive variables were found for the latter.

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