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Published on: December 20, 2024
Nasal budesonide mitigates air pollution effects in adults with allergic rhinitis: A randomized trial
Eashan Halbe1, Christopher F Rider1, Agnes C Y Yuen1
1Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
Background:
Allergic rhinitis (AR) involves nasal inflammation from aeroallergens that is treatable with nasal corticosteroids. However, the efficacy of nasal corticosteroids after diesel exhaust (DE) exposure and effects on nasal epigenetic age acceleration (EAA) are unknown.
Objective:
To investigate the effects of nasal budesonide on AR-related nasal inflammation and nasal EAA after DE exposure.
Methods:
In this double-blinded randomized crossover trial, 20 healthy nonsmokers with AR used once-daily 256 µg budesonide and placebo nasal spray for at least 4 weeks each, with an intervening washout of at least 4 weeks. Initial exposure and re-exposure to allergen and DE were completed over consecutive days in separate periods, preceded by at least 2 weeks of pretreatment/washout. Nasal lavage fluid, nasal brushings, peak nasal inspiratory flow (PNIF), and Total Nasal Symptom Score (TNSS) were collected at treatment baselines, and before and 24 hours after each exposure. PNIF and TNSS were also collected 0.5 hours after exposure. Nasal cytokines and EAA were quantified using multiplex assays and Illumina EPIC arrays, respectively.
Results:
Reductions in nasal interleukin-5 from budesonide pretreatment persisted 24 hours after initial exposure and re-exposure to allergen and DE, despite their proinflammatory effects. Reductions in interleukin-17A persisted 24 hours after initial DE exposure. Budesonide increased PNIF 24 hours after initial exposure and re-exposure to allergen, and at 0.5 hours after initial exposure and 24 hours after re-exposure to DE. Allergen-induced TNSS was suppressed by budesonide at 0.5 and 24 hours after re-exposure. Budesonide and allergen/DE exposures modulated nasal EAA across different clocks.
Conclusion:
In AR, prophylactic nasal budesonide spray attenuated nasal inflammation and modulated nasal EAA and PNIF before and after repeated acute exposures to allergen and DE.
Trial Registration:
ClinicalTrials.gov Identifier: NCT04342039 (URL: https://clinicaltrials.gov/study/NCT04342039).
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