Effects of intranasal fluticasone and salmeterol on allergen-induced nasal inflammation and nasal electrical potential in allergic rhinitis

RationaleCombination of inhaled steroid and long-acting beta-agonists have synergistic effects in asthma. There is no information on whether such benefits are observed in patients with allergic rhinitis.MethodsThe effects of intranasal treatment with fluticasone MDI (50μg bid), salmeterol MDI (25μg bid), their combination, and placebo, on nasal symptoms, eosinophil differential cell count and albumin in nasal lavage fluid (measures of inflammation and leakage respectively) and nasal electrical potential difference (measure of epithelial integrity) were studied in 11 atopic subjects with rhinitis, in a randomized, double-blind, cross-over study. The measurements were made at baseline, at the end of 1 week of treatment (pre-allergen) and immediately after a nasal allergen provocation.ResultsAllergen-induced sneeze, post-nasal drip and nasal obstruction were significantly reduced by fluticasone, but not by salmeterol. Eosinophil count in post-allergen nasal lavage was significantly less after fluticasone treatment (3.5%) compared to salmeterol (10.1%) and placebo (20.8%) treatments. Compared to placebo, both fluticasone and salmeterol attenuated allergen-induced drop in nasal potential (mean change from baseline −18.5%, +0.4% and −7.2% respectively) and the increase in nasal albumin (171, 118, and 133 ng/ml respectively). Combination treatment did not have any additional benefits over the individual therapies.ConclusionsAlthough salmeterol has anti-inflammatory properties, intranasal salmeterol or its combination with fluticasone do not offer any added benefit over intranasal fluticasone alone for allergic rhinitis.