INS, through intracellular activation of the
glucocorticoid receptor, down-regulate the recruitment and activation of inflammatory cells (T-lymphocytes, eosinophils, mast cells, basophils, neutrophils, macrophages), increase degradation of
neuropeptides, and reduce epithelial cell activity, vascular permeability, and
chemokine secretion. It is likely that more than vasoconstriction is responsible for the clinical effects of INS.Eight INS can be prescribed for
rhinitis in the US; only 4 have been studied for VMR. Seventy-four percent of patients treated with
beclomethasone dipropionate considered themselves symptom-free or greatly improved versus 31% with placebo.
Budesonide significantly reduced
rhinitis symptoms and
methacholine-induced nasal secretions compared with placebo.
Fluticasone propionate compared with placebo provided significantly greater relief from
nasal obstruction; computed tomographic scans showed significant reductions in the mucosal area of the lower turbinates.
Mometasone furoate produced numerically better
rhinitis symptom scores and, when discontinued, lower relapse rates than placebo.
CONCLUSION: