Allergic and nonallergic rhinitis. Diagnosis and management

A controlled study on the effectiveness of loratadine in combination with flunisolide in the treatment of nonallergic rhinitis with eosinophilia (NARES)

BACKGROUND

Nonallergic rhinitis with eosinophilia (NARES), accounting for some 15% of perennial rhinitis, is a nasal disorder whose main features are eosinophil counts in nasal smear higher than 10% and negative IgE tests. The mainstay of treatment is topical corticosteroids.

OBJECTIVE

To evaluate the adjunctive effect of loratadine, a non-sedating antihistamine with anti-allergic activity, on nasal symptoms and eosinophil counts in nasal secretions in patients with NARES.

METHODS

Thirty patients with NARES were divided in two groups, half receiving flunisolide two 25 microg puffs per nostril morning and night plus loratadine 10 mg u.i.d. and half the same doses of flunisolide plus placebo, according to a double-blind fashion, for 3 weeks. The effectiveness of the treatment in the two groups was evaluated by comparing symptom scores and eosinophil counts, and safety was assessed by comparing the adverse effects.

RESULTS

The loratadine treated group had better results both in nasal symptoms, with a decrease in sneezing (P < 0.000001) and rhinorrhoea (P < 0.006), respectively, corresponding with 73.4% and 66.7% with respect to 46.6% and 26.7% in the control group, and in eosinophil counts which decreased by 20% compared with 14.3% in patients treated with placebo and flunisolide. As to safety, only nasal irritation in two patients, one in each group, was reported.

CONCLUSION

Loratadine improves the effectiveness of flunisolide in treatment of NARES with no change in safety, and with no sedation.

A study of clinical and allergic aspects of rhinitis patients in Riyadh

Eighty consecutive patients presenting with variable nasal symptoms were investigated. Fifty-three (66.25%) were identified as allergic and 27 (33.5%) as having nonallergic rhinitis. Medical history and clinical examination alone seemed to be inadequate in establishing a diagnosis, since the main complaints, i.e., nasal itching, sneezing and runny rose, occurred with the same frequency in both groups. However, alternating nasal blockage and sneezing were prominent in the allergic group (80.40%), while perennial symptoms were more evident in the nonallergic group (68%). There were no striking differences between the two groups in the occurrence of nasal septal deviation or in evidence of nasal polyps. In the allergic groups, sensitivities to indoor allergens, i.e., cockroaches, cat fur, house dust, as well as to pollens, were very prominent. Among the nonspecific provoking factors, dust, strong smells, smoke and stress seem to be important.

Comparative bioavailability of d-pseudoephedrine from a conventional d-pseudoephedrine sulfate tablet and from a repeat action tablet

The bioavailability of a single dose of d-pseudoephedrine sulfate administered to male volunteers in repeat action tablet form (60 mg d-pseudoephedrine sulfate in the coat and 60 mg d-pseudoephedrine sulfate in the core) was compared with the bioavailability of an equivalent quantity of the drug given as two 60 mg conventional tablets, one given at 0 hour and the second 6 hours later. There was no significant difference (P less than 0.10) between the conventional tablets and the repeat action tablet formulation in area under the plasma concentration-time curve and the maximum plasma concentration of d-pseudoephedrine. Based on the data, we conclude that the repeat action tablet formulation and the conventional tablet are bioequivalent.