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Review Article Effects of Glucocorticoid Therapy on Nasal Conditions and Inflammatory Factors in Patients with Allergic Rhinitis

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Review Article Effects of Glucocorticoid Therapy on Nasal Conditions and Inflammatory Factors in Patients with Allergic Rhinitis Int J Clin Exp Med 2020;13(4):2154-2162 www.ijcem.com /ISSN:1940-5901/IJCEM0106130 Review Article Effects of glucocorticoid therapy on nasal conditions and inflammatory factors in patients with allergic rhinitis Huihe Wang1, Yanlei Zuo1, Jingyu Li1, Weiyi Wang2 1Department of Otolaryngology, Chengyang District People’s Hospital, Qingdao, Shandong Province, China; 2Post- Graduate Students of Nasopharynx and Otorhinolaryngology, Affiliated Provincial Hospital of Shandong First Medi- cal University, Jinan, Shandong Province, China Received December 9, 2019; Accepted January 3, 2020; Epub April 15, 2020; Published April 30, 2020 Abstract: Objective: To investigate the effects of glucocorticoid therapy on nasal condition and inflammatory fac- tors in patients with allergic rhinitis. Methods: A total of 200 patients with allergic rhinitis were selected, of which 90 patients were treated with glucocorticoid, budesonide through nasal spray as Group A, and 110 patients were treated with common nasal decongestant, oxymetazoline hydrochloride spray, as Group B. The total effective rate and incidence of adverse reactions in the patients were analyzed after 7 days of treatment, and their nasal pH value was detected after 14 days of treatment. The nasal symptoms and life quality of the patients were scored using the visual analog scale (VAS) and rhinoconjunctivitis quality of life questionnaire (RQLQ) after 14 days and 28 days of treatment. The expression of inflammatory factors (interleukin-4 (IL-4), interleukin-17 (IL-17), and interleukin-33 (IL-33)) was determined using the enzyme-linked immuno-sorbent assay (ELISA) before treatment and after three months of treatment. Results: The total effective rate in Group A was clearly higher than that in Group B, and the incidence of adverse reactions in Group A was significantly lower than that in Group B. Group B showed inconspicu- ous changes in nasal pH value before and after treatment, while Group A showed a significantly decreased nasal pH value after treatment. Moreover, after treatment, the VAS score of Group A was significantly lower than that of Group B in terms of all indexes except for ocular conditions and daily activities, and the expression of IL-4, IL-17, and IL-33 of Group A was significantly lower than that of Group B. Conclusion: Glucocorticoids are more effective than common nasal decongestants in inhibiting inflammatory factors, and they can relieve allergic rhinitis in patients more effectively and safely and strongly improve the life quality of the patients. Keywords: Glucocorticoid, nasal decongestant, IL-4, IL-17, IL-33 Introduction duce turbinate volume, thus significantly allevi- ating nasal congestion. They take effect within Allergic rhinitis is a mucosa inflammation driv- 5-10 minutes and have a long-lasting effect, en by type 2 helper T (Th2) cells, which is but long-term use of them will bring about huge induced by a reaction between allergens such side effects [8-10]. Some corticosteroids such as pollen, mold, and dust mites, and immune as glucocorticoids are effective in treating dys- cells [1-3]. It is characterized by sneezing, rhi- osmia caused by allergic rhinitis [11]. These nocnesmus, airflow obstruction and some ocu- drugs can regulate the number of rhinitis cells lar symptoms [4]. The incidence of such diseas- (neutrophilic granulocytes and/or eosinophils) es is on the rise year by year, seriously com- and nasal goblet cells to treat rhinitis [12]. This promising the patients’ life quality and impos- ing heavy medical expense burdens [5, 6]. study aimed to investigate the effects of gluco- corticoids on nasal condition, life quality, and Nasal decongestants such as oxymetazoline inflammatory factors of patients with allergic are common drugs for allergic rhinitis [7]. These rhinitis by comparing common nasal deconges- drugs can shrink nasal blood vessels and re- tants with glucocorticoids. Efficacy of glucocorticoids on allergic rhinitis General data and methods Detection indexes General data Visual analog scale (VAS) score of nasal symp- toms in patients from the two groups: The nasal A total of 200 patients with allergic rhinitis symptoms of the two groups included nasal treated in our hospital from January 2015 to obstruction, rhinocnesmus, nasal discharge, April 2018 were enrolled and divided into Group and sneezing were analyzed using VAS after 14 A and Group B. Group A (n=90) was treated with days and 28 days of treatment [13]. VAS score glucocorticoids, while Group B (n=110) was ran between 0-10 points, with 0 points indicat- treated with common vasoconstrictor nasal sp- ing no symptoms and 10 points indicating ray. extremely severe symptoms. During subse- quent visits, the nasal symptoms of the patients The inclusion criteria of patients were as fol- were evaluated again, and their changes were lows: Patients diagnosed with allergic rhinitis analyzed. based on the allergen skin prick test, and those whose family members understood the study. Nasal pH value of the two groups: The nasal pH The exclusion criteria were as follows: Patients value of each patient from the two groups was with psychological diseases and those allergic determined before treatment and after 14 days to drugs. of treatment. The determination was carried out from 14:30 to 17:00 on the determination Methods day at room temperature when the patients Patients in Group A were treated as follows: A were in a stable and calm mood specifically as nasal care device (Beijing Borne Tech Co., Ltd., follows: A short range pH paper was cut into Beijing, China) was employed to clean the nasal thin strips, and placed on the mucosa of inferi- cavity of each patient, and then glucocorti- or turbinate. After about 20 s, the strips were coid budesonide spray (Shanghai Johnson & taken out, and immediately compared with the Johnson Ltd., State Food and Drug Admini- standard color plate, and the pH value was stration (SFDA) approval number: J20180024) recorded. The interval between each measure- was adopted to spray each side of the nasal ment was about 10 min, and three measured cavity at 64 μg/time, once in the morning and nasal pH values were averaged as the nasal pH once in the evening. The budesonide was value of the patient. sprayed in the patients for 14 continuous days, The expression of inflammatory factors (inter- and then it was sprayed at 128 μg/time, once leukin-4 (IL-4), interleukin-17 (IL-17), and inter- in the morning, for 2 courses. leukin-33 (IL-33) in the two groups: Fasting Based on the treatment for patients in Group A, venous blood (5 mL) was sampled from each patients in Group B were additionally treated patient before treatment and after three with common vasoconstrictor nasal spray. The months of treatment, and let to stand for 20 nasal decongestant oxymetazoline hydrochlo- min. Then the serum was separated from the ride spray (Changzhou Kinyond Pharmaceutical sample by centrifugation at 3000 r/min for 10 Manufacturing Co., Ltd., SFDA: H20058017) min using a centrifuge manufactured by Beijing was adopted to spray each side of the nasal BMH Instruments Co., Ltd. The separated se- cavity at 37 μg/time, once in the morning and rum was quickly frozen in liquid nitrogen and once in the evening. The spray was used on the stored at -180°C for later use. The expression patients for 14 continuous days, and then it of IL-4, IL-17, and IL-33 in the serum was deter- was used as per the above standard for 2 mined using an enzyme-linked immuno-sorbent courses after 7 days. assay (ELISA) kit (Suzhou ELSBIO Co., Ltd.), and their expression between the two groups was Patients with infection symptoms in both compared. groups were required to be treated with anti- bacterial drugs and the type, dosage and treat- Rhinoconjunctivitis quality of life questionnaire ment course of the drugs were determined (RQLQ) score of the two groups: RQLQ was according to the patients’ drug allergy history applied to score the two groups before treat- and disease condition. ment and after 14 days and 28 days of treat- 2155 Int J Clin Exp Med 2020;13(4):2154-2162 Efficacy of glucocorticoids on allergic rhinitis Table 1. General baseline data of Group A and Group B [n fort, nasal discharge accompanied (%)] (X ± S) with blood, weariness, headache, Group A Group B and gastrointestinal reaction. Group t/X2 P (n=90) (n=110) Statistical analysis Sex 0.117 0.733 Male 48 (53.33) 56 (50.91) The data were analyzed comprehen- Female 42 (46.67) 54 (49.09) sively and statistically using SPSS Average age (Y) 35.23±5.14 34.89±5.67 0.440 0.661 19.0 (Asia Analytics Formerly SPSS, Average weight (Kg) 65.54±11.03 63.95±10.57 0.104 0.301 China). The enumeration data were Like smoking or not? 0.003 0.955 analyzed using X2, including general Yes 47 (52.22) 57 (51.82) data about sex, personal hobbies No 43 (47.78) 53 (48.18) such as smoking and drinking, dia- Drinking or not? 0.147 0.701 betes, hypertension, and hyperlipid- Yes 45 (50.00) 52 (47.27) emia. The number of patients with No 45 (50.00) 58 (52.73) effective treatment and the number of patients with adverse reactions Hyperlipidemia 0.175 0.676 were also analyzed using X2. Me- Yes 24 (26.67) 26 (56.00) asurement data were expressed by No 66 (73.33) 82 (44.00) the (X ± S) and analyzed by t test. Hypertension 0.241 0.624 The measurement data included Yes 23 (25.56) 21 (19.09) the general data about average age, No 67 (74.44) 89 (80.91) weight, VAS score, RQLQ score, Diabetes mellitus 0.003 0.960 nasal pH, and expression of IL-4, Yes 21 (23.33) 26 (23.64) IL-17, and IL-33 before and after sur- No 69 (76.67) 84 (76.36) gery for three months.
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