Effects of repeated once daily dosing of three intranasal corticosteroids on basal and dynamic measures of hypothalamic-pituitary-adrenal–axis activity☆,☆☆,★,★★
Section snippets
Patients
Sixteen healthy, nonallergic volunteers (nine women and seven men; mean age [SEM], 30.7 [2.7] years) completed the study. All subjects had normal full blood counts and biochemical profiles (including creatinine, urea, electrolytes, and liver function), normal urinalysis, and normal spirometry. In light of the case reports of anaphylaxis in atopic subjects after injection of Synacthen, all volunteers were screened for an atopic history or a positive skin prick test response. Any volunteer with a
RESULTS
There was no significant carryover effect between the nonrandomized placebo and the randomized placebo, respectively, with any of the parameters measured (as geometric means ± SEM) (overnight urinary cortisol, 17.1 ± 2.3 vs 20.8 ± 2.8 nmol; pre-ACTH serum cortisol, 547.5 ± 23.2 vs 574.0 ± 24.3 nmol/L; or post-ACTH, 781.2 ± 32.6 vs 761.0 ± 31.7 nmol/L). The randomized placebo was used for all comparisons with the three active treatments.
DISCUSSION
Suppression of overnight urinary cortisol occurred with FP (43%), TAA (23%), and BDP (21%), although this was only statistically significant for FP. The presence of detectable adrenal suppression does not necessarily imply that the observed effects are clinically relevant, although it is evident from the scatter plot that individuals differ in their susceptibility to the systemic adverse effects of intranasal corticosteroids. It is important to point out that this degree of suppression would
Acknowledgements
We thank Rhone-Poulenc Rorer Inc. (USA) for supplying the nasal sprays.
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2016, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :However, an effect of fluticasone propionate on the HPA axis has been found in 2 studies. In a 4-way crossover study of fluticasone propionate, beclomethasone propionate, and triamcinolone acetonide in 16 healthy adult volunteers, fluticasone propionate (200 μg/d) but not beclomethasone propionate (336 μg/d) or triamcinolone acetonide (220 μg/d) demonstrated statistically significant suppression of overnight UFC excretion.11 There was no effect of any of the 3 INCSs on serum cortisol before and after adrenocorticotropic hormone stimulation.
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2016, Immunology and Allergy Clinics of North AmericaImpact of study design on the evaluation of inhaled and intranasal corticosteroids' effect on hypothalamic-pituitary-adrenal axis function
2014, Journal of Pharmaceutical SciencesBurden of allergic rhinitis: Results from the Pediatric Allergies in America survey
2009, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Of particular note are reports of cortisol suppression and growth slowing during treatment with some INCSs.13-15 Cortisol suppression might be problematic in children because of the absence of weight-based dosing of INCSs to effectively relieve symptoms.13,15,16 Currently available INCSs and other prescription nasal sprays appear to also vary in speed of relief and duration of action and might not provide complete or long-lasting relief of nasal allergy symptoms.63
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From the Department of Clinical Pharmacology, Ninewells Hospital and Medical School, University of Dundee, Dundee.
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Supported by Rhone-Poulenc Rorer, Inc.
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Reprint requests: Brian J. Lipworth, MD, Department of Clinical Pharmacology and Therapeutics, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, Scotland, U.K.
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