Intranasal beclomethasone reduces allergen-induced symptoms and superficial mucosal eosinophilia without affecting submucosal inflammation.

Previous investigations have suggested that nasal secretions, obtained by lavage or scraping, and the nasal submucosa, sampled by biopsy, are two distinct compartments. We investigated the effect of intranasal corticosteroids on antigen-induced eosinophil influx into both compartments. We performed a double-blind, placebo-controlled study in 15 patients with seasonal allergic rhinitis. Beclomethasone dipropionate, 84 microg twice a day, was delivered to one nostril while the other nostril received placebo for 1 wk. Subjects were then challenged with grass or ragweed extracts on each inferior turbinate. Nasal scrapings from both inferior turbinates were obtained before and 24 h after challenge, and bilateral inferior turbinate biopsies were obtained 24 h after challenge, with the subjects still receiving treatment. Intranasal steroids led to a significant reduction in sneezes and eosinophil influx in nasal secretions without affecting the number of eosinophils in the submucosa. Furthermore, intranasal steroids had no effect on the numbers of submucosal EG2+ (activated eosinophils) or CD25+ (IL-2-receptor-bearing) cells, nor did they decrease the endothelial expression of vascular cell adhesion molecule-1 (VCAM-1). These data show that pretreatment with intranasal steroids successfully inhibited the clinical response to allergen and reduced eosinophils in the superficial compartment of the nasal mucosa, but it had no effect on inflammation in the deeper compartment. This might be related to a different distribution of the active medication and antigen into the nasal mucosa or to a specific effect of the active medication on the epithelium resulting in inhibited migration of eosinophils across this layer.

CD4+ lymphocytes are increased in the sinus mucosa of children with chronic sinusitis.

OBJECTIVES: To quantitate lymphocyte subtypes in sinus tissues harvested from children with chronic sinusitis and coexisting asthma, allergies, and cystic fibrosis during functional endoscopic sinus surgery and compare them with those in normal adult sphenoid sinus mucosa. DESIGN: Immunohistochemical staining of surgical specimens with monoclonal antibodies against CD4 and CD8 surface antigens. SETTING: Tertiary medical center. PATIENTS: Thirty-two children who underwent functional endoscopic sinus surgery for chronic sinusitis refractory to medical treatment (median age, 8 years; range, 2-13 years) were divided into 3 groups: 10 with asthma, 15 without asthma, and 7 with cystic fibrosis. Sphenoid sinus mucosa obtained from 10 adults (median age, 70 years) undergoing transsphenoidal hypophysectomy was used as control tissue. MAIN OUTCOME MEASURES: Numbers of CD4+ and CD8+ cells in the lamina propria and epithelium of surgical specimens. RESULTS: Significantly more CD4+ cells were in the sinus mucosa of patients with chronic sinusitis than in the normal sinus mucosa (P < .01), but there was no significant difference in the number of CD8+ cells (P = 4). Patients with chronic sinusitis with asthma, without asthma, and with cystic fibrosis all had increased numbers of CD4+ cells compared with sphenoid mucosa, with the difference reaching statistical significance only in the subgroup with chronic sinusitis without asthma (P < .001). The numbers of CD4+ cells were higher in patients with chronic sinusitis than in the sphenoid mucosa irrespective of allergic status. Significantly more CD4+ than CD8+ cells were in tissues from the patients with chronic sinusitis irrespective of concomitant diseases or allergic status. CD4+ and CD8+ cells were more numerous in the apical portion of the submucosa (immediately beneath the epithelium) than in the basal portion both in patients with chronic sinusitis and in normal sphenoid tissue. CONCLUSIONS: Children with chronic sinusitis have predominance of CD4+ cells in the sinus mucosa as compared with normal sphenoid tissue. This contrasts with published results in adults with chromic sinusitis, in whom CD8+ cells predominate in nasal polyps and the submucosa, possibly reflecting a difference in the immunologic response of children and adults.

Duration of action of intranasal atropine on methacholine-induced nasal secretions.

OBJECTIVE: To evaluate the duration of the inhibitory action of intranasal atropine on the secretory response to nasal challenge with methacholine. DESIGN: Double-blind, placebo-controlled, four-way crossover trial. SUBJECTS: Twelve volunteers with perennial allergic rhinitis. INTERVENTIONS: Subjects were treated intranasally with placebo or 100, 200, and 400 micrograms of atropine in each nostril. They were then challenged 30 minutes after administration of the nasal spray and hourly for 6 hours with 0.19 mg of methacholine. The weight of nasal secretions generated by methacholine challenge served as an indicator of the secretory response. The nasal challenges and the collection of nasal secretions were performed using filter paper disks. RESULTS: After placebo treatment, the response to methacholine was similar at each time point. In contrast, all doses of atropine significantly reduced the response to methacholine stimulation at the 30-minute, 1-hour, and 2-hour time points. CONCLUSIONS: Our data show that the anticholinergic activity of intranasal atropine lasts at least 2 hours with no significant difference in the duration of inhibitory action between the doses used. The results suggest that intranasal atropine could become a therapeutic modality for patients in whom glandular hypersecretion is a major symptom.

Characteristics of cerumen in diabetic patients: a key to understanding malignant external otitis?

Malignant externa otitis is a potentially fatal disease in diabetic and other immunocompromised patients. Cerumen contains defense properties that protect the patient against infection. We tested the hypothesis that patients with diabetes mellitus have abnormalities in their cerumen that affect the environment of their external auditory canals and may predispose them to malignant externa otitis.