Muharrem DAĞLI, Engin DURSUN, Celil GÖÇER, Adil ERYILMAZ, Hayriye KARABULUT, Ayşe İRİZ

Mevsimsel allerjik rinitte topikal azelastin HCL ile triamsinolone asetonide kullanımının semptomlar üzerine etkisinin araştırılması

Amaç: Mevsimsel alerjik rinitte intranazal kortikosteroid ve intranazalantihistaminik kullanımı çok yaygındır. Bu çalışma sistemik antihistaminikle kombine kullanılan intranazal Azelastine HCL ve TriamsinoloneAcetonid ‘nin mevsimsel alerjik rinit semptomları üzerindeki etkilerininarastırılması amaçlanmıştır. Gereç ve Yöntem: Mevsimsel alerjik rinit şikayeti olan ve bu nedenleyapılan prick test sonucu 3 ve 4 pozitif polen alerjisi taspit edilen yaşları18-45 arasında bulunan 20 hasta çalışmaya alındı. Hatalara sistemik antihistaminik olan Levosetrizin 2-HCL ile beraber yarısına intranazal Azelastine HCL sprey, kalan yarısına da intranazal Triamsinolone Acetonide sprey kullanıldı. Hastaların şikayetleri 1 ay boyunca total semptom skorunu belirleyen bir anket ile günlük olarak değerlendirildi. Tüm hastalara tedaviye başlamadan önce bazal semptom değerlendirilmesi yapıldı. Bulgular: Sonuçta Azelastine nazal spreyin başlangıca göre şikayetleriazaltmadığı hatta artırdığı görüldü. Buna karşılık Triamsinolone Acetonidnazal spreyin semptomlar arasında istatistiksel olarak anlamlı belirgin düzelmeye sebep olduğu gözlenmiştir. Sonuç: Sonuç olarak mevsimsel alerjik rinitli hastaların kliniği üzerindetopikal steroid kullanımının sistemik antihistaminik ve topikal antihistaminik spreyden daha fazla etkili olduğu gözlenmiştir.

The effect of the use of azelastine HCL and triamcinolone acetonide on symptoms in patients with seasonal allergic rhinitis

Purpose: The use of antihistamine and topical nasal steroids representsthe cornerstone of the pharmacologic treatment of allergic rhinitis. Antihistamines can be used topically or orally. This study compared the efficiency of intranasal azelastine HCl and intranasal triamcinolone acetonideon symptoms in patients with seasonal allergic rhinitis. Materials and Methods: A total 20 adult patients 18-45 years old wereenrolled in the study. Prick test results of all patients were highly positive.All patients took oral levocetirizine 2-HCl, with the first 10 patients takingtopical azelastine HCl and the other 10 patients taking topical triamcinolone acetonide. We determined total symptom scores of all patients throughdaily questionnaires. Analysis of patient based symptom scores and dailysymptom scores for the first and last 15 days were evaluated. Results: Azelastine topical spray was ineffective on the symptoms of patients with seasonal allergic rhinitis. However, topical triamcinolone acetonide achieved greater relief of allergic rhinitis’ symptoms in the firstand last 15 days. Conclusion: The use of topical corticosteroids is more effective than thatof topical antihistamines.

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1- Lieberman P, Kaliner MA,Wheeler WJ. Open-label evaluation of azelastine nasal sprey in patient with seasonal allergic rhinitis and nonallergic rhinitis. Current Medical Research and Opinion 2005; 21: 611-618.
2- Meltzer EO. Nasal citological chenges following pharmacological intervention. Allergy 1995; 50:15-20.
3- Braniuk JN. Pathogenesis of allergic rhinitis. J Allergy Clin Immunol 1997; 99: 763-772.
4- Weiler JM, Meltzer EO, Benson PM, et al. A dese-ranging study of the efficiency and safety of azelastine nasal sprey in the treatment of seasonal allergic rhinitis with an acute model .J Allergy Clin Immunol 1994; 94: 972-980.
5- Stempel DA,Thomas M. Therentment of allergic rhinitis:an evidense-based evaluation of nasal corticosteroids versus nonsedating antihistamines.Am J Manag Care 1998; 4: 89-96.
6- Stoms W, Pearlman DS,Chervinsky P. Effectivenes of azelastine nasal sprey solutionin seasonal allergic rhinitis. Ear Nose Thoat J 1994; 73: 382-394.
7- Konno S, Asano K, Okamato K, et al. Inhibition of cytokine production from humen peripheral blood lecocytes by antiallergic agents in vitro. Eur J Pharmacol 1994; 264:265-268
8- Hamamoto Y, Nagai K, Muto M, et al. Inhibitory effect of azelastine, a potent antiallergic agent,on releas of tumor necrosis factor-alpha from activated humen peripheral blood mononuclear cells and U937 cells. Exp Dermatol 1993; 2: 231-235.
9- Nishihira J, Hayakawa T, Suzuki K. et al. Effect of azelastine on leukotriene synthesis in murine peritoneal cells and on thromboxane synthesis in human platelets. Int Arch Allergy Appl Immunol 1989; 90: 285-290.
10- Horak F, Zieglmayer UP, Zieglmayer R, et al. Azelastine nasal sprey and desloratadine tablets in polen-indused seasonal allergic rhinitis:a pharmacodinamic study of onsed of action and efficiancy. Curr Med Res Opin 2006; 22(1): 151-157.
11- Golden S, Teets SJ, Lehman EB, et al. Effect of topical nasal azelastine on the symptoms of rhinitis, sleep and daytime somnolance in perenneal allergic rhinitis. Ann Allergy Asthma Immunol 2000; 85(1): 53-7.
12- Berger W, Hampel FG, Bernstein J. Impact of azelastine nazal sprey on semptoms and quality of life compared with cetirizine oral tablets in patienta with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2006; 97(3): 375-381.
13- Weiler JM, Meltzer EO. Azelastine nasal sprey as adjunctive therapy to azelastine tablets in the manegement of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 1997; 79(4): 327-332.
14- Joshua MB, Stenley J, Golden MS. Efficacy of a steroid nasal sprey compered with an antihistamine nasal sprey in the treatment of perennial allergic rhinitis. J Am Osteopath Assoc 2000;100: 8-13.
15- Simons FER, Simons KJ. Optimum pharmacological menagement of chronic rhinitis. Drugs 1989; 38: 313-31.
16- Madry RL. Topical pharmacotherapy for allergic rhinitis: new agents. Sounth Med J 1992; 85: 149-154.
17- Mabry RL. Corticosteroids in otolaryngology:nasal aerosols. Otolaryngol Head Neck Surg 1989;100: 636-637.
18- Simons FER, Simons KJ. Second-generation H1 receptor antagonists. Med Clin North Am 1991; 66: 5-19.
19- Badhwar AK, Druc HM. Allergic rhinitis: Clinical allergy. Med Clin North Am1992; 76: 789-803.
20- Gawchik SM, Lim J. Comparison of intranasal triamcinolone acetonide with oral loratadine in the treatment of seasonal ragweed-induced allergic rhinitis. Am J Manag Care 1997; 3(7): 1052-8.
21- Chin-Jaan T, Pa-Chun W. Comparison of two intranasal corticosteroid preparetions in treating allergic rhinitis. Am J Man Care 1997;3: 1052-1058
22- Condemi J, Schulz R, Lim J. Triamcinolone acetonide aqueous nasal spray versus loratadine in seasonal allergic rhinitis: efficacy and quality of life. Ann Allergy Asthma Immunol 2000; 84(5): 533-8.