Effect of steroids on nasal inflammatory cells and cytokine profile

Objectives: To assess the cellular and humoral effects of unilateral topical steroid application on the nasal mucosa of chronic sinusitis patients. Study Design: Cohort study with randomized grouping. Methods: Chronic sinusitis patients awaiting endonasal sinus surgery were randomly divided into a study group and a control group. All patients underwent allergy studies and categorized as allergic or nonallergic, Patients in the study group were exposed unilaterally to fluticasone propionate nasal spray, 100 mu g/day for 4 to 6 weeks before the planned surgery. The control group was not exposed to steroids, At the time of surgery, anterior ethmoid mucosa specimens were obtained, The samples were immunostained for CD3, MEP, CD68, elastase, and tryptase, In situ hybridization was used for the detection of interleukin (IL)-4, IL-5, and interferon gamma (IFN-gamma) mRNA, The results were compared between the treated and untreated sides of exposed patients, as well as with nontreated controls. Results: Twenty-one patients consented to participate in the study. The number of CD3-, MBP-, and tryptase-positive cells was significantly less in the treated and untreated sides of exposed patients, compared with unexposed controls. IL-4 and IL-5 mRNA were significantly downregulated in the treated side of allergic patients, as compared with nontreated patients. This effect could not be shown for IL-4 in nonallergic patients. Conclusions: Topical steroid therapy had an anti-inflammatory effect on both allergic and nonallergic chronic sinusitis patients. The unilateral application of the steroid spray affected the contralateral side as well.