Effects of Serum Vitamin D and Efficacy of Subcutaneous Immunotherapy in Adult Patients With Allergic Rhinitis

Immunotherapy is the standard of treatment for long-life relief of symptoms of allergic rhinitis. Vitamin D may affect the outcomes of treatment. This study evaluated the clinical efficacy of subcutaneous allergen immunotherapy in adult patients with allergic rhinitis based on the serum level of vitamin D. Patients with persistent allergic rhinitis and positivity for skin prick test were evaluated by Sino-nasal Outcome Test (SNOT-22) and Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) before subcutaneous allergen immunotherapy and during the maintenance phase to assess the relation of the serum level of vitamin D and the clinical efficacy of immunotherapy. After immunotherapy, the greatest reduction in SNOT-22 scores were reported in patients with vitamin D sufficiency (39.0 ± 9.2), followed by vitamin D suboptimal provision (35.1 ± 12.1), insufficiency (25.0 ± 7.5), and deficiency (18.3 ± 6.0) (P < 0.001). The MiniRQLQ reduction in patients with vitamin D sufficiency, suboptimal provision, insufficiency, or deficiency was 30.7 ± 8.7, 27.1 ± 8.7, 20.0 ± 8.6, or 17.4 ± 7.1, respectively (P < 0.001). Both of SNOT-22 and MiniRQLQ scores decreased significantly following immunotherapy in patients with different levels of vitamin D. However, these effects were more pronounced when the level of vitamin D was sufficient.

Isolation of aspergillus species from nasal cavity and bedroom of healthy volunteers and patients with allergic rhinitis in Mashhad, Iran

The purpose of this study was to investigate the presence, frequency and comparison of Aspergillus spp. in nasal cavity and bedroom of healthy volunteers and patients with allergic rhinitis. In this cross-sectional study, a group of patients with allergic rhinitis [N=50] were selected based on positive skin prick test. Healthy volunteers were chosen to be in the comparison group by matching in age, gender, and no history of respiratory system disease. Samples from nasal cavity and different parts of bedroom were collected and cultured. Cultured Aspergillus spp. was identified by standard mycological techniques. The most common species isolated from all samples of healthy volunteers was A. flavus [88%], followed by A. niger [76%] and A. fumigatus [74%]. A. flavus [56%] was the predominant species isolated from all samples of patients, followed by A. niger [34%] and A. fumigatus [6%]. A. flavus was the most prevalent species of Aspergillus both healthy volunteers and patients. The presence of Aspergillus in homes does not necessarily imply a cause and effect relationship with illness, but we speculate that A. flavus may be a major source of aeroallergens along with A. niger and A. fumigatus; and should alert physicians and healthcare professionals to do more vigorous environmental testing

Effect of a new synbiotic mixture on atopic dermatitis in children: a randomized-controlled trial

Atopic dermatitis [AD] is the most common chronic relapsing skin disease seen in infancy and childhood. The intestinal microbiota play an important role in immune development and may play a role in the development of allergic disorders. Manipulation of the intestinal microbiota by synbiotics may therefore offer an approach to the prevention or treatment of AD and allergic diseases. We studied the clinical and immunologic effects of a new symbiotic [a mixture of seven probiotic strains of bacteria and Fructooligosaccharide] in infants and children with AD. In a randomized, double-blind, placebo-controlled study, 40 infants and children aged 3 months to 6 years with AD received either a synbiotic or placebo for 8 weeks. The Severity Scoring of Atopic Dermatitis [SCORAD] index was recorded at baseline and also at 4 and 8 weeks of treatment. There was no significant difference between the probiotic and placebo group in baseline characteristics including sex, age, family history, corticosteroid usage and prick testing. Mean age was 23 months. The synbiotic group showed a significantly greater reduction in SCORAD than did the placebo group [P=0.001]. No specific effect was demonstrated of the probiotics employed on cytokine profile [P=0.4, P=0.6]. Egg white was the most common [45%] allergen followed by peanut and cow's milk. This study provides evidence that a mixture of seven strains of probiotics and Fructooligosaccharide can clinically improve the severity of AD in young children. Further studies are needed to investigate the effects on underlying immune responses and the potential long term benefits for patients with AD

Evaluation of polymerase chain reaction for diagnosis of "tuberculous pleurisy"

Differential diagnosis between tuberculous pleurisy [TBP] and non-tuberculosis pleural effusion represents a critically important clinical problem. In recent years, several noninvasive methods have been found for diagnosis of tuberculous pleurisy. This study aimed to evaluate the value of detection of the genome of Mycobacterium tuberculosis [MTB] by polymerase chain reaction [PCR] method for the diagnosis of tuberculous pleurisy and compare the results with those of conventional methods. In this cross-sectional study, we studied 62 patients [42 men and 20 women] with pleural effusion in Ghaem Hospital, affiliated to Mashhad University of Medical Sciences from January 2006 to June 2007. A total of 20 patients had tuberculous pleurisy [45.4%], 15 patients had malignant pleural effusion [34%], 3 patients had pleural effusion with various "non-tuberculosis non-malignant" etiologies [6.8%] and 6 patients had transudative pleural effusion [13.6]. The sensitivity, specificity, positive predictive value and negative predictive value of PCR in tuberculous pleurisy were 85%, 100%, 100% and 88.8%, respectively. The value of PCR test and pleural biopsy was similar in the diagnosis of TBP. However, PCR detected MTB in pleural effusion when conventional pleural biopsy failed to do so

Association of HTLV-I with autoimmune thyroiditis in patients with myelopathy/tropical spastic paraparesis and in HTLV-I carriers

There are some reports about the association of autoimmune thyroid diseases with human T cell leukemia virus type I [HTLV-I] infection. The objective of this study was to estimate the seroprevalence rates of anti-thyroid antibodies in HTLV-I carriers and HTLV-I associated myelopathy/tropical spastic paraparesis [HAM/TSP] patients in Mashhad, north east of Iran, to determine any association between HTLV-I infection and Hashimoto's thyroiditis [HT. A total of 46 HTLV-I infected patients [24 patients with HAM/TSP and 22 asymptomatic carriers] and 40 HTLV-I seronegative healthy individuals were screened for the presence of thyroid autoantibodies. The diagnosis of HT was based on the presence of positive thyroid autoantibodies [Anti thyroid peroxidase and/or Anti thyroglobulin] and at least one of two additional criteria [hypothyroidism and/or goiter]. Analysis of data was done, using Fisher-Exact test by statistical software SPSS version 13.0. A P value below 0.05 was considered statistically significant. Positivity for thyroid autoantibodies was found in 14 [63.6%] of 22 asymptomatic carriers, 6 [25%] of 24 patients with HAM/TSP and 3 [7.5%] of 40 HTLV-I seronegative healthy individuals. HT found in 45.4% of asymptomatic carriers, 25% of HAM/TSP patients and 5% of seronegative healthy individuals. This study demonstrates a high prevalence of HT in the HAM/TSP patients and the HTLV-I carriers in Mashhad. Our findings suggest an association between HTLV-I infection and HT in our region

Comparison of two flow cytometric methods for detection of human invariant natural killer T cells [iNKT]

Invariant natural killer cells [iNKT] are an important immunoregulatory T cell subset. Currently several flow cytometry-based approaches exist for the identification of iNKT cells, which rely on using the 6B11 monoclonal antibody or a combination of anti-V alpha 24 and anti-V beta 11 antibodies. The aim of this study was to compare the ability of two flow cytometry-based methods for detecting the frequency of circulating iNKT cells. The frequency of iNKT cells was detected in the peripheral blood of 37 healthy adult donors by flow cytometry using the 6B11 antibody or a combination of anti-V alpha 24 and anti-V beta 11 antibodies. The frequency of iNKT cells detected by 6B11 antibody or by combination of anti-V alpha 24 and anti-V beta 11 antibodies was significantly different [0.54% vs. 0.31%, respectively, p<0.001] but the values were highly correlated [Spearman r=0.742, p<0.0001]. The results of this study indicate that different combinations of mAbs detect different frequencies of peripheral blood iNKT cells and a consensus in the field needs to be established to allow better assessment of iNKT-related studies and suggest using different methods for accurate identification of iNKT cells

[Role of cytokines in patients with arthritis and low back pain brucellosis]

Cytokines are secreted as the molecular products of different cells in particular T-Lymphocyte which contribute in the processes of immune responses. Therefore, the study may provide valuable information regarding the function of cell-mediated immunity [CMI] in this disease. This study was performed in the medical centers of Mashhad University of Medical Science. 40 Patients with brucellosis and 40 normal samples took part in this investigation. Diagnosis of the disease was based on case history clinical examination and serological tests. The levels of TNF-alpha, IL-2, IFN-gamma, IL-4, and IL-10 in serum were measured using ELISA method. The levels of the random variables IL-2 and IL-10 were tested by Kolmogrov Smirnov test and shown to be normal [p<0.05]. Other cytokines including IL-4, IFN-gamma, and TNF-alpha of patients serum were not normal. The results indicated that the levels of IL-10 in the sera of patients had increased [p<0.001]. IFN-gamma level showed it has increased in patients [p<0.05]. The level of IL-2 and IL-4 and TNF-alpha in the sera of patients did not show any appreciable difference with those of normal controls [p>0.1]. Kruskal-Wallis test showed a significant difference in IFN-gamma in the two groups. Our results would suggest a definite role of IFN-gamma, and IL-10 in sera of patients with arthritis and low bake pain brucellosis

[Case presentation of a patient with hyper immunoglobulin E syndrome]

IgE syndrome, also known as Job's syndrome, is a very rare cause of immunodeficiency. It is presented with recurrent staphylococcal abscesses in the skin, lungs, and other organs as well as itching dermatitis since the early stages of life. Significant increase serum level of IgE, eosinophilia, and normal serum levels of other immunoglobulines are the major features of this abnormality. Our patient was a 12 month old girl with presenting symptoms of itching dermatitis and recurrent skin and lung infections. She also had the history of umbilical chord infection as well as several attacks of dysentery. On physical examination she was pale and had a coarse face. She also had symptoms of mild malnutrition and several erythematous papules covered her body. Serum level of IgE was more than 150 IU/ml, while serum levels of the other immunoglobulines and complement were within normal limits. These findings established the diagnosis of hyper IgE syndrome for the patient. Combination of itching dermatitis, recurrent skin and lung infections, and nail dystrophy as well as significant increase in serum IgE level, suggests hyper IgE syndrome as the most likely diagnosis

Association of the expression of IL-4 and IL-13 genes, IL-4 and IgE serum levels with allergic asthma

Immune and inflammatory responses mediated by cytokines, play important roles in the pathophysiology of asthma. These responses are associated with overexpression of Th2 cytokines such as IL-4 and IL-13. These two cytokines use common receptors for signaling that lead to identical immunological effects and regulation of the Th1/Th2 balance. The aim of this study was to determine whether patients with allergic asthma display overexpression of IL-4 and IL-13 genes. Using RT-PCR, we examined the expression of IL-4 and IL-13 genes in twenty asthmatic cases and twenty normal individuals. Total levels of serum IgE and IL-4 were also determined by ELISA method. Expression of IL-13 gene in 70% of patients with allergic asthma was higher than controls [P=0.01]. There was no correlation between the expression of IL-13 gene and total level of serum IgE [P=0.07]. Expression of IL-4 gene was detected in 30% of the patients and none of the normal individuals as determined by RT-PCR [P=0.01]. Mean of serum IgE levels in patients and controls were 84.9 IU/ml and 62.2 IU/ml, respectively. Level of serum IgE was more than 100 IU/ml in 30% of patients [P=0.03]. Mean of serum IL-4 levels in patients and controls were 15.73 pg/ml and 13.07 pg/ml, respectively. There was a relation between levels of serum IgE and IL-4 in 73% of cases. The results showed that there was a correlation between the expression of IL-4 gene and the level of serum IL-4. Levels of serum IgE and IL-4 were considerably higher in asthmatics than nonasthmatic controls

Assessment of the immune system activity in Iranian patients with major depression disorder [MDD]

Major Depression Disorder [MDD] is a common disorder with prevalence of 15% among men and up to 25% among women. In recent years the association of immune system alterations and MDD has been investigated. Assessments of immunologic and inflammatory responses in these patients enhance our knowledge of the etiology and pathogenesis of this disease. To investigate the changes in immunoglobulin and cytokine serum levels and lymphocyte subsets in patients with MDD. We studied 37 adult patients with MDD, diagnosed based on DSM-IV diagnostic criteria, and 15 healthy controls matched with the patients. Plasma concentration of interleukin-4 [IL-4], IL-10, TNF alpha, and IFN gamma were measured by ELISA and serum immunoglobulins by SRID. Total number of NK cells [CD16 and CD56], B cells [CD19], and T cells [CD8, CD4, and CD3] were determined by flow cytometry. We found no significant differences in plasma concentration of IL-4, IL-10, TNF-alpha, IFN-gamma, and immunoglobulins as well as total number of NK cells, B cells, and T cells between major depressed patients and healthy control subjects. We conclude that in our patients, there were no significant differences in immune system activity between MDD patients and controls

Association between the polymorphisms of IL-4 gene promoter [-590C>T], IL-13 coding region [R130Q] and IL-16 gene promoter [-295T>C] and allergic asthma

Allergic asthma is a multifactorial disease, influenced by genetic and environmental factors. Recent family-based studies have revealed evidence for linkage of human chromosomes 5q31-33, 12ql5-24, Ilql3 and 15q23.6 as regions likely to contain genes related to asthma. Among the candidate genes in these regions are the genes encoding for human interleukin-4, interleukin-13 and interleukin-16. To evaluate this linkage, we examined an Iranian population of patients with asthma. A total of 30 patients with allergic asthma and 50 normal subjects were studied. Allergic asthma was confirmed using skin prick test and spirometry. DNA was extracted from blood cells and IL-4 [-590C>T], IL-13 [R130Q] and IL-16 [-295T>C] polymorphisms were determined by PCR-RFLP method. Out of 30 patients with allergic asthma, the following genotypes for IL-4, IL-13 and IL-16 cytokines were found: IL-4 genotypes consisted of 17 [56.7%] CC, 8 [26.7%] CT and 5 [16.7%] TT; IL-13 genotypes consisted of 11 [36.7%] GG, 13 [43.3%] GA and 6 [20%] AA; IL-16 genotypes consisted of 23 [76.7%] TT and 7 [23.3%] CT. No patient showed CC genotype for IL-16. A higher proportion of case subjects with the C allele for the IL-4, G allele for the IL-13 and T allele for the IL-16 polymorphisms was found compared with the T, A and C alleles, respectively. These results suggest an influence of genetic variability at the promoter of IL-4 gene [-590C>T] and a coding region of IL-13 gene [R130Q] on the occurrence of allergic asthma and no relationship between IL-16 promoter polymorphism [-295T>C] and this disease

Association between HLA-DRB1 *01 and HLA-Cw*08 and outcome following HTLV-I infection

Human T cell lymphotropic virus type I [HTLV-I]-associated rnyelopa-thy/tropical spastic paraparesis [HAM/TSP] is an inflammatory disease which occurs in less than 2% of HTLV-I -infected individuals. High proviral load, high HTLV-I-specific CD8[+] cytotoxic T lymphocyte frequency [CTL] and host genetic factors such as HLA all appear to be associated with HTLV-I infection. Previous studies have shown that HLA-DRB1*01 increases the risk of HAM/TSP in Japanese HTLV-1 infected individuals. To investigate the association between HLA class II DRB1 alleles and HLA class I alleles [HLA-Cw*08, B54, A*02 and A-30] in HTLV-I infected individuals in Mashhad. Here we determined the frequency of HLA class II DRBl, using INNO-LIPA reverse hybridization line probe assay, and HLA class I alleles [HLA-Cw*08,B54, A*02 and A-30] by PCR-SSCP method in healthy controls, HAM/TSP patients and HTLV-I infected individuals born and resident in Mashhad. The frequency of HLA-DRB1*01 alleles in this population was different from other areas of Iran. The frequency of HLA-DRB1*01 was significantly increased in HAM/TSP patients compared with carriers [p 0.028; OR=9.4]. The frequency of HLA-Cw*08 was also significantly increased in HAM/TSP patients compared with controls [p=0.03; OR=13.5]. Our results may suggest that possession of HLA-DRB1*01 increases the risk of HAM/TSP in HTLV-I-infected individuals and HLA-Cw*08 correlates with low CTL immune response in HAM/TSP patients

Study of alpha1-antitrypsin phenotypes frequencies in patients with primary antibody deficiency

Primary antibody deficiencies are the most frequent primary immunodeficiency disorders. Bronchiectasis as a feature of these disorders may be developed due to some factors such alpha-1-antitrypsin deficiency. In order to determine the prevalence of two common alpha-1-antitrypsin deficiency alleles [PI*Z and PI*S] in Iranian patients with antibody deficiency, this study was performed. The prevalence of PI*M, PI*S, and PI*Z allele combinations was determined in 40 patients with primary antibody deficiency [with and without bronchiectasis] and compared with 60 healthy control subjects. Phenotyping was performed by isoelectric focusing. The phenotype frequencies among patients were as follow: M in 92.5%, S in 2.5% and Z in 5%. There was not any significant difference in distribution of alleles or phenotypes between patients and control subjects. Moreover, no significant difference was found between patients with and without bronchiectasis. We did not find evidence to support an association between alpha-1-antitrypsin phenotypes and primary antibody deficiencies in a small, controlled study. Larger studies will be required to clarify the relationship between alpha-1-antitrypsin genotype and susceptibility to bronchiectasis in patients with antibody deficiency

Association between the polymorphism of TGF- beta 1 gene promoter [-509C>T] and idiopathic chronic Urticaria

Idiopathic Chronic Urticaria [ICU], the most common form [70-80%] of chronic urticaria is supposed to have immune basis causes. It is speculated that the promoter polymorphism of TGF- beta 1 gene may be involved in ICU. This condition is thought to affect at least 0.1% of the population and often can be severe and difficult to treat. A total of 40 patients with ICU and 41 normal subjects were studied. DNA was extracted from whole blood and TGF- beta 1 promoter -509C>T polymorphism was determined by PCR-RFLP method. Out of the 40 patients with ICU, 11 [27.5%] had CC, 26 [65%] had CT and 3 [7.5%] had TT genotypes. A higher proportion of case subjects with the C allele [CT type or CC type] was found compared with the T allele. These results do suggest an influence of genetic variability at the promoter of TGF- beta 1 gene [-509C>T] on the occurrence of ICU. This polymorphism has been shown as a useful genetic change in our study. Further work is required to confirm this result

HTLV-I infection: virus structure, immune response to the virus and genetic association studies in HTLV-I-infected individuals

Although the structure of human T lymphoptropic virus type I [HTLV-I] has been known well, the function of some proteins encoded by HTLV-I PX region is not fully understood. Furthermore, the responses of the immune system to HTLV-I remain still unknown. Most of HTLV-I infected individuals show a strong and persistently activated cytotoxic T-cell [CTL] response to the virus. The frequency of HTLV-I specific CTL is higher in patients with HTLV-I -associated myelopathy/ tropical spastic paraparesis [HAM/TSP] compared with HTLV-I carriers. However, the efficacy of the immune response determines the outcome of HTLV-I-associated diseases. Among the risk factors which contribute to the observed differences between HAM/TSP patients and HTLV-I carriers, the interaction between different genes and/or environmental factors seem to be important. These factors may also involve in outcome of HTLV-I infection in infected- individuals

Evaluation of six years allergen immunotherapy in allergic rhinitis and allergic asthma

Allergen immunotherapy involves the administration of gradually increasing quantities of specific allergens to patients with IgE-mediated conditions until a dose is reached that is effective in reducing disease severity from natural exposure. In the present study we evaluated a period of six years immunotherapy allergic rhinitis and allergic asthma patients with positive skin prick test of common aeroallergen. The immunotherapy was performed on 156 patients. One hundred twenty of the cases were allergic rhinitis [80%], 29 cases had allergic asthma and 7 cases were mixed [4.5%]. 70% in allergic rhinitis group, 75% in allergic asthma group and 42.8% in mixed group completely improved. Immunotherapy, an older therapeutic method, has now been updated, and with appropriate indications, precautions and methods, has been clearly shown to be effective in the treatment of allergic rhinitis and in some cases of asthma and insect hypersensitivity

Effect of aerobic exercise training on pulmonary function and tolerance of activity in asthmatic patients

The aim of the present study was to examine the effects of a course of aerobic exercise on pulmonary function and tolerance of activity in asthmatic patients. Among the asthmatic patients, 36 patients [M= 16, F= 20] were chosen after clinical examinations, pulmonary function test, skin prick test [SPT] for aeroallergen and a six minute walk test [6MWT] on their own free will. A patient was said to have Exercise Induced Asthma [EIA] when he/she fulfilled the following criteria; [1] FEV[1] < 80%, [2] 12% increase or more in FEV[1] or PEF after short-acting [beta][2] agonist prescription and [3] 15% decrease in FEV[1] or PEF after 6MWT with 70% or 80% of maximum heart rate. The patients were randomly put into two groups of case [M=8, F=10, Mean age=27] and control [M=8, F=10, Mean age=29]. Case group participated in eight week aerobic exercise plan, while control group had no plan of exercise. Pulmonary function tests were done before and after the course of exercise. There were significant changes in FEV1, FVC, PEF, FEF[25-75%], MVV, RF and 6MWT between asthmatic patients of the two groups [P

Serum level of selenium, IL-4, IL-10 and IFN-gamma in patients with allergic asthma, allergic rhinitis and healthy controls

Background: Allergic diseases have increased during the past decade I worldwide. Th2 type lymphocyte response is known to play an important j role in the process of allergic inflammation. IL-4, a mediator of type II I cytokine response increases IgE synthesis and Interferon gamma, a cytokirie I of type I response interferes with IL-4 and inhibits IgE production. Selenium j is an essential component of glutathione peroxides and changes in its plasma I level has been proposed to be associated with allergic diseases

Materials and Methods: This study comprised of 21 cases of allergic asthma [AA], I 33 cases of allergic rhinitis [AR] whose age and sex were matched with 28 healthy controls. IL-4, IL-10, IFN-y levels were tested by ELISA assay, I and serum selenium was measured by atomic absorption spectorphotometery I method

Results: Mean serum selenium level of AA and AR groups were I lower than controls

Conclusion: Mean serum IL-4 level of AA was higher than the AR I group. Mean serum IL-4 level of AA and AR group were higher than I controls. The results of this study indicate that low selenium | level may have a role in the pathogenesis of allergic diseases

prevalence allergic rhinitis among 11-15 Years-old children in Shiraz

Allergic rhinitis is one of the most common forms of allergic disorders affecting children. The prevalence rate of allergic rhinitis differs among countries and even among regions within the same country. To determine the prevalence of childhood allergic rhinitis and the presence and significance of eosinophilia in nasal secretions. 4584 children aged 11-15 years-old of both sexes with allergic rhinitis were studied. The study was done during a four-season period. After physical examination of the nose, smear was taken from nasal secretions and it was stained. The results compared with nasal smears related to 340 healthy children controls. 445 cases [9.7%] were diagnosed as having allergic rhinitis, on the basis of clinical criteria. Significant nasal eosinophilia was present in 274 [62%] of children with allergic rhinitis. 226 students [5.8%] of Shiraz school children had proven or classic allergic rhinitis. Allergic rhinitis is one of the major health problems among children in Shiraz. Eosinophilia of nasal secretions had a diagnostic specificity of 96% and sensitivity of 62%and seems to be having a moderate value as screening test for nasal allergy

Evaluation of fluticasone [flixonase] nasal spray versus beclomethasone [beconase] nasal spray in the treatment of allergic rhinitis

Although response to intranasal steroid therapy has been reported in patients with allergic rhinitis, efficacy of some nasal steroids is noteworthy. This study was undertaken to evaluate the efficacy of a two-week course of Fluticasone [Flixonase] nasal spray vs. Beclomethasone [Beconase] nasal spray in patients with symptoms of allergic rhinitis referred to our clinic. This study reviewed sixty randomized studies with symptoms of allergic rhinitis which supported common aeroallergens with skin prick test. Patients received a total daily dose of nasal spray of Fluticasone [Flixonase] 100 mcg bid [N=30] compared with patients with allergic rhinitis who received a total daily dose of Beclomethasone [Beconase] 50mcg 2 puffs bid [N=30] patients were visited before and after therapy, and efficacy of flixonase and beconase was evaluated by the change in nasal symptoms including: nasal discharge, nasal obstruction, nasal itching, and sneezing. After two weeks of treatment nasal symptoms of blockage, discharge, sneezing and itching were significantly better in the group treated with fluticasone nasal spray 65%, 82%, 67%, 79% respectively [p<0.001] but after treatment with beconase nasal spray lower benefits in the nasal symptoms includes: 50%, 71%, 51%, 57% respectively. After two weeks of treatment no deleterious changes consequent to therapy were observed in nasal symptoms. 100 mcg bid flixonase [Fluticasone] intranasal spray is more effective than 50 mcg 2 puffs bid beconase [Beclomethasone] intranasal spray. Like asthma, allergic rhinitis is an inflammatory disease and should be managed with anti-inflammatory medication