The effect of early radiofrequency turbinate reduction, intranasal steroid, and antihistamine H-1 on persistent allergic rhinitis: a randomized clinical trial

Abstract Objective: We aimed to evaluate the effect of radiofrequency turbinate reduction as an initial treatment on clinical improvement, inflammatory mediators, and remodeling process. Methods: Between July 2018- February 2020, 32 patients with moderate-severe persistent AR were randomly divided into 2 groups. Intervention group received radiofrequency turbinate reduction followed by intranasal steroid and Antihistamine H-1 (AH-1), control group received intranasal steroid and AH-1. Both groups were evaluated for clinical improvement (using visual analogue scale based on total nasal symptoms score, peak nasal inspiratory flow, and turbinate size using imageJ) after 4 and 8 weeks of treatment. Inflammatory mediators (ELISA from nasal secretions was performed to measure ECP, IL-5, and HSP-70) and remodeling markers (nasal biopsy followed by immunohistochemistry examination was performed to evaluate MMP-9, TIMP-1, and PAI-1) were evaluated in week 4. Results: Three patients dropped out of the study, resulting in 16 patients in intervention group and 13 patients in control group. At week 4, clinical response improved significantly in the intervention group compared to control group (Chi-Square test, p<0.05). Compared to control, intervention group experienced a reduction of IL-5 and no significant change in ECP level (Mann Whitney test, p>0.05). Reduction in the ratio of MMP-9/TIMP-1 were significantly higher in intervention group (unpaired t-test, p< 0,05). Meanwhile, increase in HSP-70 in the intervention group was slightly lower than in control group, but the difference with control group was not significant (Mann Whitney test, p>0.05). Conclusion: Early radiofrequency turbinate reduction followed by pharmacotherapy given to persistent moderate-severe AR patients give more improvement only in early clinical symptoms and reduce MMP-9/TIMP-1 ratio, thus it might be suggested as one of the adjuvant therapies for the management of moderate-severe persistent AR. However, further investigation with a larger sample size and longer follow-up period is needed. Level of evidence: 1B.

Clinical efficacy and tolerability of mometasone furoate nasal spray in perennial allergic rhinitis patients : an open multicentre study.

Mometasone furoate (MF) aqueous nasal spray has been shown to be effective and well-tolerated in the treatment of perennial allergic rhinitis (PAR). All of the sudies, however, have been conducted in Canada, UK, and Europe. Therefore, a bridging study is warranted in view of the different climatic conditions in tropical countries. To evaluate the clinical efficacy and tolerability of MF aqueous nasal spray in the treatment of PAR in a tropical country. This study was an open, non comparative, 4-week 3-centre trial in outpatients of 12 to 60 years with moderate to severe PAR of at least 2 years duration. Patients were allergic to at least one major PAR allergen, confirmed by skin prick test. They had total nasal symptom score (TNSS) of ≥ 6 and nasal congestion score (NCS) of ≥ 2 on ≥ 3 diary time points prior to baseline visit and at both screening and baseline visits. Eligible patients received MF aqueous nasal spray at baseline visit, and administered 200 µg mometasone every morning for 4 weeks. The primary clinical efficacy parameter was the mean percentage reduction of TNSS from baseline. Of 100 eligible patients, all completed this 4-week trial. The patient-evaluated TNSS (sum of the Last 3 mornings) decreased signiftcantly from baseline with a mean reduction of 60.9 % (p < 0.0001,) at week-2 and 73.6 % (p < 0.0001) at week-4. The mean reductions in physician-rated TNSS (61.7 % at week-2 and 77.8 % at week-4) were higher than those in the previous studies (43 % and 51 % at week-2, 52 % and 54 % at week-4). Similar trends were observed for nasal congestion score (NCS), other individual symptoms, total symptoms, and clinical efficacy rates. Evening symptoms were reduced similarly as morning symptoms There was no withdrawal due to adverse event. MF aqueous nasal spray, at a dose of 200 µg once daily in the morning for the treatment of moderate to severe PAR in a tropical country, was clinically effective with 24-hour control of PAR symptoms, and was well tolerated.