S268 Abstracts
FEBRUARY 2005
Effect of Benzalkonium Chloride on Nasal Mucociliary
1067 Clearance in Normal Volunteers: A Double Blind, Cross-
Over, Randomized Study
J. A. Rizzo1, A. Rego Silva1, D. Medeiros2, M. F. Motta2, E. Sarinho2;
1Pediatrics dep., Universidade Federal de Pernambuco-Brazil, Recife-PE,
BRAZIL, 2Pediatrics, Universidade Federal de Pernambuco-Brazil,
Recife-PE, BRAZIL.
RATIONALE: Benzalkonium chloride (BK) is a preservative widely
used in topical nasal solutions to prevent contamination. Its effect on nasal
mucociliary clearance (NMC) has not been established clearly. We per-
formed an IRB approved study to evaluate the effect of BK 0,2% on
NMC.
METHODS: Ten adult normal volunteers with no airway infections in
previous 3 months were selected. After anterior rhinoscopy, 1 drop
(0,05ml) of 99mtechnetium sulphur colloid was placed on the floor of nasal
cavity 1,5cm behind the anterior border, another at the tip of the nose to
create a fix mark and the individual seated with the face in parallel and in
contact with the gamma camera collimator. Fifteen second frames were
acquired for 15 minutes (60 images) and the NMC velocity calculated
measuring time and distance between the starting point of drop movement
and its fall into the pharynx. Saline with or without BK 0,2% was sprayed
on each nostril 3 times a day for 2 weeks, followed by equal wash-out and
medication periods and NMC evaluations. Bottle weighting was done for
compliance check. Analysis were done on logs and in 10 volunteers for
BK and 9 for saline with no BK.
RESULTS: After BK solution NMC velocity decreased from
7,9+1,5mm/min. to 6,3+1,8mm/min. (p=0,05). After placebo from
8,5+1,2mm/min. to 7,3+1,8mm/min. (p=0,27). There was no carryover
(period) effect.
CONCLUSIONS: In this small group BK solution impaired NMC. We
are evaluating a n = 45 group.
Funding: Libbs Farmaceutica do Brasil
Montelukast and Desloratadine in the Treatment of Peren-
1068 nial Allergic Rhinitis: A Randomized, Double Blind, Place-
bo Controlled Study
M. Ciebiada1, M. Górska–Ciebiada1, L. M. DuBuske2, P. Górski1;
1Departament of Pneumonology and Allergology, Medical University of
Lodz, Lodz, POLAND, 2Immunology Research Institute of New England,
Gardner, MA.
RATIONALE: The aim of this study was to investigate effects treatment
for 6 weeks of perennial allergic rhinitis with desloratadine or mon-
telukast alone and in combination.
METHODS: A 32 week randomized, double blind, placebo controlled,
crossover study was done in 20 adult patients having more than a 2 year
history of perennial allergic rhinitis, dust mites allergy, and a total nasal
symptom score ≥6 (congestion ≥2). Patients with asthma, non-allergic
rhinitis, and seasonal allergy were excluded. There were four 6-week
treatment periods, each separated by a 2-week wash out. In each treatment
period patients received montelukast 10mg or desloratadine 5mg daily, or
a combination of montelukast 10mg and desloratadine 5mg or placebo.
Nasal lavage ECP was assessed.
RESULTS: Total nasal symptom score before the treatment was 9.7; after
placebo was 8.3; after desloratadine was 5.1; after montelukast was 4.56,
and after montelukast plus desloratadine was 4.04. Improvement in sub-
TUESDAY
jects treated with montelukast alone, desloratadine alone, and in combi-
nation was significant. The level of ECP in nasal lavage decreased after
treatment with both agents separately, greater effect being seen after the
combined medication.
CONCLUSIONS: The treatment of perennial allergic rhinitis with either
desloratadine or montelukast was effective, the combination perhaps
being even more effective.
Funding: Medical University of Lodz
J ALLERGY CLIN IMMUNOL
Simple Application of Allergen-Impermeable Bed Covers
1069 for Adult Patients With Allergic Rhinitis in Korea
C. Kim1, C. Hong2, S. Choi2, D. Kim3; 1Department of Internal Medicine,
Inha University College of Medicine, Incheon, REPUBLIC OF KOREA,
2Department of Internal Medicine, Yonsei University College of Medi-
cine, Seoul, REPUBLIC OF KOREA, 3Department of Applied Chemistry,
Dongyang Technical College, Seoul, REPUBLIC OF KOREA.
RATIONALE: Many allergen avoidance trials recommend multiple
interventions and strict management plans, but application of such avoid-
ance measure is often impractical. We performed this study to assess the
effect of simple employment of allergen-impermeable covers without any
other form of mite-reduction measures in Korea.
METHODS: Thirty-five patients with house dust mite (HDM)-sensitive
allergic rhinitis were assigned to receive impermeable (active group;
Allergy-X-Cover, Korea) or non-impermeable (placebo group) covers for
their beddings, and used for 1 year without any strict management method
for the covers. The concentration of HDM major allergen in dust from
patients’ bedding was measured at baseline and every 2-month interval.
Symptom score for previous week, visual-analogue scale for rhinitis were
assessed at baseline and every 2-month interval. Methacholine challenge
tests were performed at baseline and after 6 and 12 months.
RESULTS: Compared with placebo group, the amount of dust collected
from bedding was decreased in active group. Active group showed
decreased concentration of HDM Group 1 allergen in bedding dust during
the study period. In active group, symptom score for rhinorrhea and nasal
obstruction was significantly improved, but symptom for sneezing and
nasal itching was not changed. Compared with placebo, visual-analogue
scale was improved in active group. Airway hyperresponsiveness mea-
sured by methacholine challenge tests was not significantly different
between active and placebo group during study period.
CONCLUSIONS: These results suggest that simple application of
impermeable cover provide marginal but significant reduction to allergen
exposure and clinical benefits.
Funding: Allergy C&C Co
Exhaled Nitric Oxide (eNO) as a Tool for Asthma Screening
1070 in Military Recruits
R. Arora, C. E. Thornblade, P. Dauby, L. L. Hagan; Department of Aller-
gy/Immunology, Wilford Hall Medical Center, San Antonio, TX.
RATIONALE: As a marker of inflammation, eNO may be a useful
screening tool in the evaluation of asthma, especially in a military recruit
population.
METHODS: In basic military recruits referred for respiratory complaints
during training, eNO levels were determined prior to a full evaluation for
asthma, including history, physical, baseline spirometry and histamine
challenge.
RESULTS: Of 172 basic trainees who had symptoms suggestive of asth-
ma and underwent a histamine challenge, 80% had a positive histamine
challenge and were diagnosed with asthma. An eNO value of 10.5 parts
per billion (ppb) provided a sensitivity of 86% for positive histamine
challenge and diagnosis of asthma with only 26 false positives. Speci-
ficity at this level of eNO was 21%. An eNO value of 46 ppb provided
100% specificity and positive predictive value but only 17% sensitivity.
A conservative rough estimate of the cost to train a new Air Force recruit
is $10,000 per person. Approximately 1000 basic trainees a year are
referred for an asthma evaluation with about 80% subsequently diag-
nosed with asthma and separated from the Air Force. Using this data, if
an eNO level of 10.5 ppb or greater could identify 86% of Air Force
recruits who subsequently are diagnosed with asthma, definitive evalua-
tion of this population prior to starting basic training could save well over
$6.5 million a year.
CONCLUSIONS: Exhaled nitric oxide may provide a simple and cost-
effective means of screening for asthma, especially in a military setting.
Funding: Air Force Surgeon General