Wirkung von Cetirizin und Fluticasonpropionat- Nasenspray auf Symptome und Entzündungsmediatoren der saisonalen allergischen Rhinitis

Abstract

Antihistamines and topical corticosteroids represent the established first-line therapy of allergic rhinitis. We compared the effects of oral cetirizine versus fluticasone propionate nasal spray on symptoms and concentrations of inflammatory mediators in nasal secretions of patients with seasonal allergic rhinitis during the pollen season. In a randomized double-blind study, 30 patients with birch and grass allergy received either 10 mg cetirizine p.o. (CET) and a placebo nasal spray or 200 μg fluticasone propionate nasal spray (FP) and a placebo tablet OD for ca. 4.5 months covering the birch and grass pollen season. Daily nasal and eye symptoms were registered using a diary card and were analyzed under consideration of daily pollen load. Nasal secretion was collected by the filter paper-disc method and concentrations of histamine and ECP were measured by ELISA. Regarding the total symptom score made up of nasal and eye symptoms throughout the study, no significant difference between the 2 patient groups was found. In contrast, the analysis of the total nasal symptom score (TNSS) showed significantly better results for the FP group in the course of the season, if only days with a pollen count > 20/m 3 were evaluated (p = 0.0197). Cetirizine, on the other hand, showed a clear tendency to stronger effects on eye symptoms using the same method of evaluation (p = 0.0584). Concentrations of histamine and ECP in nasal secretions were significantly lower under medication with FP. The study demonstrates that by separately analyzing nasal and ocular symptoms under consideration of the intensity of the pollen flight a more differentiated assessment of the effects of anti-SAR medications is possible. Especially in regions characterized by a rather fluctuating pollen flight, evaluation only of those days with high pollen load may yield an essential gain of information. The results on liberation of inflammatory mediators confirmed the greater anti-inflammatory effect of the topical glucocorticosteroid. It can be suggested that a combination of the 2 therapeutic principles is reasonable for subjects with moderate to severe nasal and ocular symptoms.