Introduction

Allergic rhinitis (AR) is a common chronic condition, with intranasal corticosteroids recommended as a key treatment due to their effectiveness and minimal systemic side effects. These drugs act on multiple immune pathways and are preferred for their targeted action, rapid onset, safety in pregnancy, and cost-effectiveness. Mucosal immunity, particularly secretory immunoglobulin A (sIgA), plays a crucial role in preventing antigen penetration and infection. Reduced sIgA levels are linked to increased susceptibility to allergies and asthma. However, despite growing interest, there is limited and conflicting evidence regarding how intranasal corticosteroids affect nasal sIgA levels in AR patients.

Aim

To analyse the levels of sIgA in the nasal secretions of healthy adults and AR patients who received treatment with intranasal beclomethasone dipropionate (BD) and triamcinolone acetonide (TA).

Method

Study Design

Treatment Strategy 

• The study enrolled 58 adults: 29 newly diagnosed AR patients and 29 healthy controls
• AR was diagnosed using AR and its impact on asthma (ARIA) criteria, clinical history, skin prick tests, and immunoglobulin E levels
• Patients were randomized to receive BD or TA nasal sprays for one month
• Nasal secretions were collected to measure sIgA via enzyme-linked immunosorbent assay (ELISA) before and after treatment
• Statistical analyses compared groups, with significance set at p < 0.05

Endpoints

Results

• Group comprised 13 AR patients who received BD and group 2 included 16 AR patients who received TA and control group included 29 healthy adults
• The baseline demographics were similar among the groups with no significant differences in age or gender
• The mean nasal fluid sIgA levels were 573.7+192.2 µg/ml and 564.8+270.8 µg/ml in groups 1 and 2 respectively, vs 559.7+241.9 µg/ml in control group
• Differences were observed in weed and cereal pollen allergies between treatment groups, while other allergens showed no variation
• Higher proportion of patients in group 1 had weed pollen (100% vs 62.5%; p=0.20) and cereal pollen allergies (46.2% vs 0%; p=0.004) than in group 2
• Serum IgE and sIgA levels did not differ significantly between BD and TA groups
• However, both treatments significantly increased sIgA levels after one month, with no significant difference in the magnitude of increase between the two therapies as seen in Table 1.

Table 1. Secretory IgA values at baseline and after first month  

Conclusion

ENT Updates. 2024;14(1):5-10. Doi: 10.5152/entupdates.2024.23346.