Double-blind study of intranasal ipratropium bromide in nonallergic perennial rhinitis.

We undertook this trial to determine whether ipratropium bromide nasal spray 0.03% (IB) reduced the nasal hypersecretion associated with nonallergic perennial rhinitis (NAPR) without causing excessive dryness or irritation of the nasal mucosa. We compared two drug doses of IB (21 micrograms and 42 micrograms per nostril) to a placebo, administered as two sprays to each nostril twice daily. The study design consisted of a 1-week screening period without treatment, a 1-week single-blind placebo period, a 4-week double-blind treatment comparison period, and a 1-week follow-up period without medication to evaluate nasal rebound. One hundred fifty-two patients were entered and 140 completed the trial. Both doses of IB reduced the severity and duration of rhinorrhea compared with placebo (P = .05 and .03, respectively). Treatment differences were noticeable during the first week of therapy, continued to widen during the second week, and then remained stable throughout the next 2 weeks. There was no evidence of nasal rebound observed during the week after treatment. The drug was well tolerated with side effects limited to infrequent nasal adverse events of nasal dryness, blood-tinged mucus, and epistaxis occurring in 2% to 6% of patients. We conclude that IB is a safe and effective therapy for control of rhinorrhea associated with NAPR.

Antibodies to human epidermal cytoplasmic antigens: incidence, patterns, and titers.

Serum or plasma specimens were assayed in indirect immunfluorescence tests on cryostat sections of normal human skin for the presence and titer of antibodies reactive with human epidermal cytoplasmic antigens. A polyvalent fluorescein-labeled goat anti-human immunoglobulin antiserum was used in all tests. Three distinct staining patterns were noted: upper epidermal cytoplasmic fluorescence, U-CYT, produced by antibodies reactive with antigen present in cells of the upper and middle layers of the epidermis; general cytoplasmic fluorescence, G-CYT, produced by antibodies reactive with antigens present in cells throughout the epidermis; and basal cell cytoplasmic fluorescence, BCL, produced by antibodies reactive with components present only in basal cells. Sera from 8% of 52 normal blood donors produced the U-CYT pattern at dilutions greater than 1:10. The incidence of antibodies reactive with epidermal cytoplasmic antigens in patients with a clinical history of not more than 2 basal cell carcinomas of the skin was 5%, compared to an incidence of 89% in those individuals with 3 or more separate instances of skin neoplasms. There was no difference in the frequency with which cryosurgery was used in the treatment of skin neoplasms in either of these 2 groups. Antibodies to epidermal cytoplasmic antigens were also detected in 10% of patients with nondermatologic, nonpulmonary neoplasms, in 43% of patients with pulmonary neoplasms and in 1 of 11 patient with nonneoplastic diseases. Positive sera yielded titers ranging from 1:16 to 1:1024. The most common staining patterns noted in all of these cases were the U-CYT and G-CYT patterns; the BCL staining pattern was noted in only one instance.