Absence of nasal mucosal atrophy with fluticasone aqueous nasal spray

Objective: To evaluate whether 1 year of continuous treatment with intranasal fluticasone propionate would lead to atrophy in the nasal mucosa compared with an active control, oral terfenadine. Design: Prospective, randomized, multicenter, open-label, parallel-group study. Setting: Two tertiary care academic institutions. Patients: Seventy-five subjects older than 18 years with perennial allergic rhinitis. Interventions: Patients received either fluticasone propionate aqueous nasal spray, 200 mug once daily, or terfenadine, 60 mg twice daily, for I year. Nasal biopsy specimens were obtained before and after 1 year of treatment and were evaluated for evidence of atrophy. Main Outcome Measures: Epithelial and collagen layer thickness of the nasal mucosa as assessed by light microscopy and the presence and degree of edema, and regularity of collagen fibrils as assessed by electron microscopy. Analyses were performed without knowledge of subject identity or treatment assignment. Results: Neither fluticasone nor terfenadine treatment led to atrophy in the nasal mucosa by clinical or histologic observation. No significant changes from baseline were observed for any assessment of atrophy. In contrast to what would have been expected if atrophy were to occur, mean epithelial layer thickness in the fluticasone group significantly increased compared with terfenadine treatment (P=.03). Conclusions: Treatment with intranasal fluticasone for 1 year increases the thickness of the nasal epithelium as compared with a year's treatment with terfenadine and does not lead to atrophy in the nasal mucosa. The increased thickness in the fluticasone treatment may represent repair from epithelial damage caused by chronic allergic inflammation.