K. Haggart

Effects of mediator antagonism on mannitol and adenosine monophosphate challenges

Background Airway hyper‐responsiveness (AHR) to indirect stimuli is a useful non‐invasive surrogate inflammatory marker in the evaluation of asthma, while histamine and cysteinyl leukotrienes are important inflammatory mediators.

Comparative effects of desloratadine, fexofenadine, and levocetirizine on nasal adenosine monophosphate challenge in patients with perennial allergic rhinitis

Background There are no data directly comparing the relative efficacy of modern H1‐antihistamines in allergic rhinitis using nasal provocation challenge.

Butterbur, a herbal remedy, attenuates adenosine monophosphate induced nasal responsiveness in seasonal allergic rhinitis.

Background Butterbur (BB) or Petasites hybridus, a herbal remedy, exhibits in vitro inhibition of cysteinyl leukotriene biosynthesis. However, no placebo‐controlled studies have been performed to evaluate the effectiveness of BB on objective outcomes such as nasal provocation testing in seasonal allergic rhinitis (SAR).

Effects of butterbur treatment in intermittent allergic rhinitis: a placebo-controlled evaluation

BACKGROUND Butterbur (Petasites hybridus) contains the active ingredient petasin, which exhibits antileukotriene and antihistamine activity. Previous studies of intermittent allergic rhinitis (IAR) have demonstrated a comparable response to butterbur compared with a histamine H1-receptor antagonist on the 36-Item Short-Form Health Survey quality-of-life score. However, there has been no placebo-controlled study of the effects of butterbur use on objective and subjective outcomes in IAR. OBJECTIVE To evaluate the effects of treatment with butterbur vs placebo on objective and subjective outcomes in IAR. METHODS A double-blind, placebo-controlled, crossover study was carried out during the grass pollen season in Tayside, Scotland. Thirty-five patients (14 men and 21 women) with IAR received butterbur, 50 mg twice daily, or placebo for 2 weeks. Domiciliary measurements were taken in the morning and evening for peak nasal inspiratory flow (PNIF) (the primary outcome variable), nasal and eye symptoms, and rhinoconjunctivitis-specific quality-of-life score. RESULTS Butterbur treatment had no significant effect on PNIF, total nasal symptom score, eye symptom score, or quality of life compared with placebo use. Mean (SEM) morning and evening PNIF values were 107 (6) and 114 (6) L/min, respectively, for butterbur vs 105 (6) and 117 (6) L/min for placebo. Mean (SEM) morning and evening total nasal symptom scores (maximum total score, 12) were 3.4 (0.4) and 3.5 (0.4), respectively, for butterbur vs 3.7 (0.3) and 3.8 (0.4) for placebo. CONCLUSIONS There was no significant clinical efficacy of butterbur use vs placebo use on objective and subjective outcomes in IAR. Further studies are now indicated to investigate the use of butterbur in persistent allergic rhinitis.

Relationship between airway hyperresponsiveness to mannitol and adenosine monophosphate.

Background: Assessment of airway hyperresponsiveness (AHR) to indirect bronchoconstrictor stimuli is a useful noninvasive tool in the evaluation of asthma and its treatment. We investigated the putative relationship in AHR between inhaled adenosine monophosphate and mannitol.

Butterbur, a herbal remedy, confers complementary anti‐inflammatory activity in asthmatic patients receiving inhaled corticosteroids

Background The effects of butterbur (BB), a herbal remedy, as add‐on therapy to inhaled corticosteroids in patients with atopic asthma is currently unknown.

Reproducibility of response to nasal lysine-aspirin challenge in patients with aspirin-induced asthma

BACKGROUND Peak nasal inspiratory flow (PNIF) and acoustic rhinometry objectively measure the effects of nasal provocation testing. Although the latter is conventionally used in nasal lysine-aspirin challenge, use of the former in aspirin-induced asthma (AIA) has never been evaluated. OBJECTIVE To evaluate the reproducibility of PNIF and acoustic rhinometry following nasal lysine-aspirin challenge in AIA. METHODS Fourteen patients with a clear-cut history of AIA underwent nasal lysine-aspirin challenge at 2 separate visits 1 week apart. Both PNIF and minimum cross-sectional area (MCA) were measured using acoustic rhinometry for 120 minutes following standard nasal lysine-aspirin challenge (25 mg). RESULTS Prechallenge values were not significantly different at visit 1 vs visit 2 for mean [SEM] PNIF (128 [13] vs 127 [9] L/min) and MCA (6.89 [0.51] vs 6.94 [0.57] cm2). The mean (SEM) maximum percent PNIF change from baseline for visit 1 and visit 2 was -42 (5) and -42 (6), respectively, and the mean (SEM) average percent PNIF change from baseline was -25 (4) and -25 (6), respectively. The mean (SEM) maximum percent MCA change from baseline for visit 1 and visit 2 was -49 (4) and -48 (3), respectively, and the mean (SEM) average percent MCA change from baseline was -25 (8) and -24 (4), respectively. Coefficients of variation for maximum and average responses were 2.3% and 6.5%, respectively, for PNIF and 7.4% and 16.1% for MCA. CONCLUSIONS Measurement of PNIF following nasal lysine-aspirin challenge is a simple and reproducible alternative to acoustic rhinometry, with maximum response being a more reproducible outcome measure than average response.

Butterbur, a herbal remedy, protects against allergen-sensitized mast cell priming in seasonal allergic rhinitis

2 Butterbur, a Herbal Remedy, Protects Against Allergen-Sensitized Mast Cell Priming in Seasonal Allergic Rhinitis I. J. Carstairs 1, D. K. C. Lee 2, K. Haggart 2, C. M. Jackson 2, G. E Currie 2, B. J. Lipworth2; IAsthma and Allergy Research Group, Dundee, UNITED KINGDOM, 2Asthma and Allergy Research Group, Ninewells Hospital and Medical School, UNITED KINGDOM. BACKGROUND: Butterbur (BB) or Petasites hybridus, an herbal remedy, exhibits in vitro inhibition of cysteinyl leukotrienes biosynthesis and has been shown to be as effective as Hi-antihistamines on symptomatic control in seasonal allergic rhinitis (SAR). However, no placebo controlled studies have been performed to evaluate the effectiveness of BB on objective outcomes in SAR. METHODS: 20 patients with grass pollen sensitized SAR were randomized in double blind, cross over fashion to receive for 2 weeks either BB 50 mg twice daily or placebo (PL) twice daily during the grass pollen season. Nasal adenosine monophosphate (AMP) challenge (the primary outcome) was administered as a single 400 mg/ml dose after each randomized treatment, in order to evaluate in vivo allergen sensitized mast cell priming. RESULTS: Spontaneous recovery following AMP challenge (area under the response time profile curve as % 9 min) was significantly attenuated (p=0.028) with BB (584 __ 289) compared to PL (1438 _+ 240); mean difference: 854 (95% CI 95-1614), and lhe maximum % PNIF fall from baseline following AMP challenge was significantly blunted (p=0.036) with BB (30 _+ 4) compared to PL (43 + 5); mean difference: 13 (95% CI 1-25). SUMMARY: BB exhibited protection against allergen sensitized mast cell priming which may explain its clinical efficacy in patients with SAR. Funding: Universi~ of Dundee 3 Large Particle Nebulized Saline Therapy for Chronic Nasal Obstruction: A Prospective Evaluation