An evaluation of short-term corticosteroid response in perennial allergic rhinitis using histamine and adenosine monophosphate nasal challenge

Abstract

Aims: To evaluate the role of AMP nasal challenge as a measure of short-term treatment response in patients receiving intranasal corticosteroids. Adenosine monophosphate (AMP) challenge has been shown to be a good inflammatory surrogate in the lower airways, but it has not been properly evaluated as a nasal challenge test.

Methods: Fourteen patients with perennial allergic rhinitis (PAR) were randomized to receive 2 weeks treatment with placebo (PL) or 200 microg intranasal mometasone furoate (MF) once daily in a randomized single-blind crossover study. AMP (25-800 mg ml-1) and histamine (0.25-8 mg ml-1) nasal challenge testing were performed after each treatment period with 30% decrease in minimal cross-sectional area (MCA). Domiciliary symptom data were collected.

Results: There was a significant (P < 0.05) improvement in PC30 MCA and nasal volume with AMP but not with histamine comparing MF vs PL. This amounted to a 2.8 (95% CI 1.5, 4.0) and 0.7 (95% CI -0.5, 1.9) doubling-dose change for AMP and histamine challenges, respectively. There were significant (P < 0.05) improvements in nasal symptoms and quality of life.

Conclusions: AMP nasal challenge using acoustic rhinometry may be a useful test to assess short-term treatment response in patient with PAR.

Figures

Figure 1

Scatter plots showing individual values for baseline mean cross-sectional area (MCA) measured by acoustic rhinometry after therapy with mometasone furoate (MF) and placebo (PL) but before the nasal challenge testing with (a) adenosine monophosphate (AMP) and (b) histamine. Lines join the values for the same person. There was no significant difference between the baseline values after MF compared with PL before either the AMP or histamine nasal challenge.

Figure 2

Scatter plot showing individual values for (a) adenosine monophosphate (AMP) and (b) histamine provocation concentration causing a 30% fall in minimum cross-sectional area PC30 (mg ml−1) after 2 weeks treatment with placebo (PL) or intranasal mometasone furoate (MF) 200 µg once daily (MF) (○). Lines join the results for the same person. Geometric mean values (SE) are also shown (•). There was a significant improvement with AMP but not with histamine nasal challenge

Figure 2

Scatter plot showing individual values for (a) adenosine monophosphate (AMP) and (b) histamine provocation concentration causing a 30% fall in minimum cross-sectional area PC30 (mg ml−1) after 2 weeks treatment with placebo (PL) or intranasal mometasone furoate (MF) 200 µg once daily (MF) (○). Lines join the results for the same person. Geometric mean values (SE) are also shown (•). There was a significant improvement with AMP but not with histamine nasal challenge