A Comparison of Intranasal and Oral Flunisolide in the Therapy of Allergic Rhinitis

Kwaselow, A.; McLean, James A.; Busse, William W.; Bush, Robert K.; Reed, Charles E.; Metzger, W. James; Richerson, Hal B.; Shulan, David J.; Koshiver, John E.; Chaplin, M. D.

doi:10.1111/j.1398-9995.1985.tb00248.x

Cited by 31 publications

(6 citation statements)

References 8 publications

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“…(17,25,26) In addition, the use of topical nasal drugs, such as intranasal steroids, has become standard of care for treatment of nasal diseases (such as allergic rhinitis and chronic sinusitis) due to decreased systemic side effects with similar or improved local control when compared to systemic corticosteroid dosing. (27)(28)(29)(30) The morphology of the nasal and paranasal sinuses is considered a factor that influences penetration of particle transport in the airspace. Sinonasal anatomy is characterized by variations across individuals, and these variations can be exaggerated by underlying pathology.…”

Section: Introductionmentioning

confidence: 99%

A Computational Study of Nasal Spray Deposition Pattern in Four Ethnic Groups

Keeler

Patki

Woodard

et al. 2016

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Background: Very little is known about the role of nasal morphology due to ethnic variation on particle deposition pattern in the sinonasal cavity. This preliminary study utilizes computational fluid dynamics (CFD) modeling to investigate sinonasal airway morphology and deposition patterns of intranasal sprayed particles in the nose and sinuses of individuals from four different ethnic groups: African American (Black); Asian; Caucasian; and Latin American. Methods: Sixteen subjects (four from each ethnic group) with ''normal'' sinus protocol computed tomography (CT) were selected for CFD analysis. Three-dimensional reconstruction of each subject's sinonasal cavity was created from their personal CT images. CFD simulations were carried out in ANSYS Fluent TM in two phases: airflow phase was done by numerically solving the Navier-Stokes equations for steady state laminar inhalation; and particle dispersed phase was solved by tracking injected (sprayed) particles through the calculated airflow field. A total of 10,000 particle streams were released from each nostril, 1000 particles per diameter ranging from 5 lm to 50 lm, with size increments of 5 lm. Results: As reported in the literature, Caucasians (5.31 -0.42 cm

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Section: Introductionmentioning

confidence: 99%

A Computational Study of Nasal Spray Deposition Pattern in Four Ethnic Groups

Keeler

Patki

Woodard

et al. 2016

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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“…Flunisolide (FLU) FLU has a high bioavailability when administered to normal subjects (50% of an inhaled dose reaches the systemic circulation) [45] . To the best of our knowledge, no study is available on the effect of nasal FLU on HPA axis function.…”

Section: Budesonidementioning

confidence: 99%

Intranasal Corticosteroids and Adrenal Suppression

Bruni¹,

Luca²,

Venturoli³

et al. 2009

Neuroimmunomodulation

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Allergic rhinitis is a common condition that frequently coexists with asthma and atopic dermatitis. It is commonly treated with intranasal corticosteroids which may increase the potential inception of side effects of the same type of drugs used for the treatment of other allergic diseases. A method to assess the systemic effect of corticosteroids is the evaluation of their effect on the hypothalamic-pituitary-adrenal (HPA) axis. However, it is not clear which test is best for detection of clinically relevant HPA axis suppression in children Morning plasma cortisol levels are twice that of late afternoon and evening values and a delay in the time of onset in peak cortisol levels has been observed in children treated with inhaled corticosteroids. Single morning cortisol level has a low sensitivity for detecting adrenal insufficiency in children. 24-Hour plasma cortisol is a good test because it is a non-invasive measure of the biologically active free cortisol levels for the entire day. For research purposes, the 24-hour integrated concentration plasma cortisol test is preferred. Studies that have looked at HPA axis suppression with intranasal corticosteroids indicate that overall, intranasal corticosteroids have a minimal effect on the HPA axis. A review of the literature reveals one study in which there was a decreased output of urinary cortisol during treatment with either budesonide or fluticasone propionate in adults. Other studies with fluticasone propionate or budesonide have shown no effect on the HPA axis in children. Beclomethasone dipropionate was shown to affect urinary cortisol output in one study on healthy volunteers. However, in a long-term study in children, no effect on the HPA axis was found. Mometasone furoate has been extensively studied in more than 20 trials of adults and children. No effects on the HPA axis were detected in either children or adults. Fluticasone furoate nasal spray was not associated with HPA axis suppression. It is unlikely that children are more sensitive to corticosteroids than adults. There is no reason to perform routine monitoring of adrenal function in children who are treated with intranasal corticosteroid unless those drugs are used concomitantly with inhaled corticosteroids and/or steroid ointments for the possible concomitant presence of asthma and/or atopic dermatitis.

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“…Convincing clinical proof comes from the marked effect on nasal symptoms in seasonal allergic rhinitis, together with the absence of or the poor effect on eye symptoms [21,22]. It was previously believed that the difference between topical and systemic activity was due to a lack of absorption from the nose.…”

Section: Topical Versus Systemic Mode Of Actionmentioning

confidence: 99%

Topical glucocorticosteroids in rhinitis: clinical aspects

Mygind

Andersson

2006

Acta Oto-Laryngologica

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The introduction of nasal glucocorticosteroids, 30 years ago, has been the most important therapeutic progress in rhinitis management since the introduction of the first generation of antihistamines. Our knowledge of the mode of action of glucocorticosteroids in the nose has improved as the airway mucous membrane of the nose is easily accessible for investigation. However, the exact mechanism behind the marked clinical effect remains unclear. Topical glucocorticosteroids are highly effective in diseases characterized by eosinophil-dominated inflammation (allergic rhinitis, nasal polyposis), but not in diseases characterized by neutrophil-dominated inflammation (common cold, infectious rhinosinusitis). Experience for 30 years and a long series of controlled studies have shown that the treatment is highly effective and that the side effects are few and benign. Intranasal glucocorticosteroids can therefore be considered as first-line treatment for allergic and non-allergic, non-infectious rhinitis and nasal polyps.

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A Comparison of Intranasal and Oral Flunisolide in the Therapy of Allergic Rhinitis

Cited by 31 publications

References 8 publications

A Computational Study of Nasal Spray Deposition Pattern in Four Ethnic Groups

A Computational Study of Nasal Spray Deposition Pattern in Four Ethnic Groups

Intranasal Corticosteroids and Adrenal Suppression

Topical glucocorticosteroids in rhinitis: clinical aspects

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