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Weather/temperature-sensitive vasomotor rhinitis may be refractory to intranasal corticosteroid treatment

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Abstract:

Vasomotor rhinitis (VMR) is a common but poorly understood disorder of which there are two major subgroups: VMRw/t, triggered by weather/temperature and VMRir, triggered by airborne irritants. No specific biological pathways or specific treatments for VMRw/t or VMRir have been identified. However, intranasal corticosteroids (INSs) are effective in treating many forms of nonallergic rhinitis that include these conditions. A recently introduced INS with established efficacy in allergic rhinitis and enhanced affinity, fluticasone furoate, may possess the potency and safety profile required to treat chronic VMRw/t. Two replicate studies (FFR30006 and FFR30007) were conducted in six countries to evaluate the efficacy and safety of fluticasone furoate nasal spray in subjects with VMRw/t. After a 7- to 14-day screening period, subjects (n = 699) with symptomatic VMRw/t received fluticasone furoate, 110 g q.d. or placebo for 4 weeks in these two randomized, double-blind, parallel-group studies. Subjects rated their nasal symptoms (congestion, rhinorrhea, and postnasal drip) twice daily on a 4-point categorical scale and evaluated their overall response to treatment at study end. Fluticasone furoate did not significantly improve daily reflective total nasal symptom scores, the primary end point, versus placebo (p = 0.259) and there was no improvement in any other measure of efficacy. The active treatment was well tolerated. Fluticasone furoate was not effective in treating subjects with a newly defined condition, weather-sensitive VMR. These unexpected results suggest that VMRw/t is a distinct subgroup of VMR that is refractory to treatment with INSs. Additional study of other treatments for VMRw/t (including INSs) is warranted.

Keywords: Congestion; fluticasone furoate; intranasal corticosteroids; perennial nonallergic rhinitis; placebo; postnasal drip; randomized controlled trial; rhinorrhea; vasomotor rhinitis; weather/temperature triggers

Document Type: Research Article

DOI: http://dx.doi.org/10.2500/aap.2009.30.3206

Affiliations: Biogenics Research Institute, San Antonio, Texas

Publication date: March 1, 2009

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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