Effects of Nasal Corticosteroids on Boosts of Systemic Allergen-Specific IgE Production Induced by Nasal Allergen Exposure

BackgroundAllergen exposure via the respiratory tract and in particular via the nasal mucosa boosts systemic allergen-specific IgE production. Intranasal corticosteroids (INCS) represent a first line treatment of allergic rhinitis but their effects on this boost of allergen-specific IgE production are unclear.AimHere we aimed to determine in a double-blind, placebo-controlled study whether therapeutic doses of an INCS preparation, i.e., nasal fluticasone propionate, have effects on boosts of allergen-specific IgE following nasal allergen exposure.MethodsSubjects (n = 48) suffering from grass and birch pollen allergy were treated with daily fluticasone propionate or placebo nasal spray for four weeks. After two weeks of treatment, subjects underwent nasal provocation with either birch pollen allergen Bet v 1 or grass pollen allergen Phl p 5. Bet v 1 and Phl p 5-specific IgE, IgG1–4, IgM and IgA levels were measured in serum samples obtained at the time of provocation and one, two, four, six and eight weeks thereafter.ResultsNasal allergen provocation induced a median increase to 141.1% of serum IgE levels to allergens used for provocation but not to control allergens 4 weeks after provocation. There were no significant differences regarding the boosts of allergen-specific IgE between INCS- and placebo-treated subjects.ConclusionIn conclusion, the application of fluticasone propionate had no significant effects on the boosts of systemic allergen-specific IgE production following nasal allergen exposure.Trial Registrationhttp://clinicaltrials.gov/ NCT00755066研究背景：经呼吸道，尤其是鼻黏膜接触变应原，可增强全身变应原特异性IgE的产生。鼻内糖皮质激素（Intranasal Corticosteroids, INCS）是变应性鼻炎的一线治疗药物，但它们对这种变应原特异性IgE产生增强效应的影响尚不明确。 研究目的：本研究借助一项双盲安慰剂对照试验，旨在明确治疗剂量的鼻内糖皮质激素制剂——丙酸氟替卡松鼻喷剂——对鼻内变应原暴露后变应原特异性IgE水平升高的影响。 研究方法：本研究纳入48名患有草花粉与桦树花粉过敏的受试者，每日予丙酸氟替卡松鼻喷剂或安慰剂鼻喷剂治疗，疗程共4周。治疗2周后，受试者分别接受桦树花粉变应原Bet v 1或草花粉变应原Phl p 5的鼻黏膜激发试验。分别于激发试验当日，以及激发后1、2、4、6、8周采集血清样本，检测Bet v 1与Phl p 5特异性IgE、IgG1-4、IgM及IgA水平。 研究结果：鼻内变应原激发试验后4周，受试者针对激发所用变应原的血清IgE水平较基线中位数升高至141.1%，但针对对照变应原的IgE水平未出现此类升高。鼻内糖皮质激素治疗组与安慰剂治疗组受试者的变应原特异性IgE升高幅度无显著统计学差异。 研究结论：综上，丙酸氟替卡松的使用对鼻内变应原暴露后全身变应原特异性IgE产生的增强效应无显著影响。 临床试验注册：http://clinicaltrials.gov/ NCT00755066