Changes in nasal leukocytes and epithelial cells associated with topical beclomethasone treatment

Effects of topical application of methotrexate on nasal mucosa in rats: a preclinical assessment study

OBJECTIVE

The aim of this study is to investigate dose-dependent effect of the topical application of methotrexate (MTX) in rats on the normal nasal mucosa, liver tissue, liver enzymes, and hemoglobin levels.

STUDY DESIGN

Preclinical animal study.

SETTING

Twenty male adult wistar albino rats were randomly divided into 4 groups (n=5). A single puff of MTX (2.5 microg) was applied to both nasal cavities 2 times a day. The animals were given MTX 1 day a week in group 1, 3 days a week in group 2, and 5 days a week in group 3. Control group animals were given 1 puff of physiologic saline to both nasal cavities 5 days a week and 2 times a day. After 28 days, liver biopsies, blood samples, and 5 nasal mucosal biopsies were taken. Histological examination was made with respect to certain parameters semiquantitatively (grade 0-3). The aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels and hemoglobin counts were studied from blood samples.

RESULTS

There are no statistically significant differences with respect to histopathological parameters between the control group and the groups 1-3 (P>0.05). Histopathological examination of liver tissue did not reveal any evident difference between the control and study groups. Mean AST and ALT as liver function tests and hemoglobin counts were within normal limits. Topical application of MTX at these doses has no toxic effect on the nasal mucosa, the liver tissue, AST and ALT levels, and hemoglobin level.

CONCLUSIONS

These results have been encouraging to investigate use of the topical application of MTX in nasal manifestation of autoimmune disease or addition of the topical application of MTX to the steroid treatment in cases with massive nasal polyposis resistant to steroids and prone to recurrence.

Techniques of intranasal steroid use

OBJECTIVE

The effectiveness of topical intranasal steroids (INS) sprays for the treatment of allergic and nonallergic rhinitis may be limited by lack of instruction in the optimal spray technique. To determine whether the technique used affects the efficacy and safety of the product, this review of evidence had the goal of identifying and establishing a preferred method of applying INS sprays.

STUDY DESIGN

A MEDLINE search of pertinent literature on 7 INS and 1 intranasal antihistamine spray preparations conducted with the use of appropriate search terms, yielded an initial 121 articles, 29 of which were identified as appropriate for review and grading for quality of evidence.

RESULTS

The analysis provided no definitive evidence regarding how best to instruct patients to use INS or antihistamine spray devices.

CONCLUSIONS

On the basis of a lack of clear evidence regarding instructions to maximize efficacy and safety of these drugs, the panel recommended a 7-step standard technique.

Cytologic distinctions between clinical groups using curette-probe compared to cytology brush

BACKGROUND

We had previously used curette-probe (Rhinoprobe; Arlington Scientific, Springville, UT) to study nasal cytology in various types of patients. Because of the potential sampling ease of using a brush, we sought to compare cytological results obtained with a curette-probe with those obtained using a cytology brush (Cytobrush Plus; Medscand, Malmö, Sweden).

OBJECTIVE

To compare the ability of samples of nasal leukocytes obtained with a curette-probe versus a cytology brush to distinguish clinical categories of patients attending an allergy clinic.

METHODS

Adult allergy clinic patients were studied by both curette-probe and cytology brush sampling. Quantitation of eosinophils and total leukocytes was performed on samples. Comparisons of cell quantities for each sampling method were made in patients classified into clinical groups. Patients with rhinitis complaints and abnormalities of nasal mucosal appearance with or without aeroallergy were compared with other patients. The adjustment of leukocyte quantities for the numbers of epithelial cells observed was also analyzed. Sampling methods were also compared for receiver operating characteristics.

RESULTS

Curette-probe sample leukocyte quantities distinguished patients with symptoms of rhinitis (SR) with abnormal nasal appearance from other patients. This between-group distinction was more significant for leukocyte numbers normalized for the number of epithelial cells. SR patients with both abnormal nasal appearance and aeroallergy had significantly more eosinophils and less goblet cells than other patients. Greater than five curette-probe eosinophils were only observed in patients with SR. Brush samples did not show differences between patients stratified in these ways, and eosinophils were observed in patients without SR. Receiver operating characteristics favored curette-probe samples in terms of leukocyte or eosinophil increases characterizing their respective symptomatic patient subgroups.

CONCLUSIONS

Curette-probe-obtained nasal samples allow for leukocyte and eosinophil quantitations which characterize rhinitis patients better than brush-obtained samples. Total leukocyte quantitations obtained by curette-probe may represent a marker of inflammatory nasal disease in adults undergoing allergy evaluation and treatment for rhinitis.