Nasal nitric oxide and nasal eosinophils decrease with levocetirizine in subjects
with perennial allergic rhinitis.
Author(s): Bautista AP, Eisenlohr CP, Lanz MJ.
Affiliation(s): Department of Allergy, Asthma, and Rhinosinusitis, AAADRS Clinical Research
Center, Coral Gables, Florida 33134, USA.
Publication date & source: 2011, Am J Rhinol Allergy. , 25(6):383-7
BACKGROUND: Allergic rhinitis is commonly treated with antihistamines. Monitoring
improvement of airway inflammation noninvasively using nasal nitric oxide (nNO)
would be clinically useful. To determine the anti-inflammatory effect of oral
levocetirizine dihydrochloride (LC), we measured nNO and nasal eosinophils (nEos)
in perennial allergic rhinitis (PAR) subjects.
METHODS: A randomized double-blind placebo-controlled crossover design was used.
Inclusion criteria consisted of subjects having a PAR history, exam and diary
scores consistent with active symptoms, and positive skin testing. Subjects
taking allergy medications 1 month before the study were not enrolled. After
consenting, 31 subjects (24 female subjects; mean age, 29 years) were randomized
to either oral LC (5 mg) or matching placebo for 2 weeks. After 2 week washout,
subjects started the other 2-week treatment. At each visit, nNO was measured by
aspiration at each nare using a nasal kit from NIOX (Aerocrine, Sweden) in parts
per billion; nEos was collected from nasal smears and measured by microscopy
using the scoring system (0-4+) and symptoms were self-reported using the
allergic Rhinitis Quality of Life Questionnaire (RQLQ). Daily allergy symptom
scores (total symptom score [TSS] 4) were collected at each visit.
RESULTS: During LC, mean baseline nNO was 807 ± 317 parts per billion (ppb; left)
and 831 ± 332 ppb (right) and decreased significantly to 688 ± 266 ppb and 702 ±
286 ppb, respectively (p < 0.05). No significance was found during placebo
treatment (778 ± 270 ppb, 808 ± 299 ppb to 802 ± 271 ppb, 813 ± 273 ppb). The
mean nNO change was also significant compared with placebo (-125 ppb versus +14
ppb; p < 0.05). There was a significant decrease in nEos with LC compared with
placebo (3.1-2.5 versus 2.9-2.6; p < 0.05). RQLQ scores were significantly
improved with LC only. In TSS-4 scoring, a trend toward improvement during LC and
significant worsening during placebo was found. Baseline nNO predicted changes in
nasal eosinophils (nEos) and RQLQ.
CONCLUSION: We showed that oral LC therapy decreased objective markers of
rhinitis inflammation, nNO and nEos, in patients with PAR. Improvement in symptom
scoring was also found with LC treatment.
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