SYMPTOM-GUIDED APPROACH FOR ALLERGIC RHINITIS TREATMENT AUGMENTED WITH POWDER METHYLCELLULOSE SEALANT

Abstract

Introduction Powder methyl-cellulose (hydroxyl-propyl-methyl-cellulose powder, pHPMC) insufflated intra-nasally in subjects with rhinitis symptoms used after other locally applied drugs prolongs and enhances their pharmacological effects. Based on this approach on objective measures of efficacy, we propose an algorithm to manage patients with moderate/severe allergic rhinitis. Methods 22 patients sensitized to grass pollen had their in-season symptoms treated by intra-nasal drugs following a set of simple recommendations: squirt oxymetazoline if the nose is totally plugged; squirt azelastine if rhinorrhea/itching/sneezing are prevalent; squirt mometasone if all symptoms are present. Patients could also make a mix of any of the drugs. They were randomized to use after any drug application a puff of either HPMC or powder lactose (placebo). Symptoms were assessed by visual-analogue scale (VAS). The pre- and in-season objective outcomes were peak nasal expiratory flow (PNIF), saccharine test (ScchT) and exhaled breath temperature (EBT, a surrogate marker of airway inflammation). The before-/in-season differences were computed and compared. Results The before-/in-season differences for PNIF and EBT favored the HPMC group vs. placebo: PNIF -53.3±0.06 (mean±s.e.m.) vs. - 26.5±0.04[L/min], P=0.037; EBT 0.24±0.15 vs. -0.46±0.20[°C], P=0.010. There was no statistical difference for ScchT (P=0.448). HPMC appears to augment the local therapeutic responses by suppressing symptoms, nasal congestion (PNIF) and airway inflammation (EBT), while still preserving normal cilia beat (ScchT). Conclusions Proper patient instructions on to how manage their symptoms using HPMC as a sealant for nasal drugs significantly improves seasonal allergic rhinitis management.