A Study On Effects Of Topical Antihistamines As An Add On Drug To The Standard Regimen That Includes Normal Saline Douching And Topical Corticosteroids In Patients With Chronic Rhinosinusitis With Nasal Polyp

Abstract

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a newlinechronic inflammatory condition associated with significant newlinemorbidity (1). It is estimated to affect 1 4% of the general newlinepopulation and 25 30% of patients with chronic rhinosinusitis newline(CRS) (2). Rhinosinusitis is traditionally classified in to three types newlinebased on the duration as acute - 4 weeks, subacute -4 12 weeks newlineand chronic - 12 weeks, with or without exacerbations (3). CRSwNP newlinecharacterised grossly by grape-like projections of inflammatory newlinepolyps within the nasal cavity. Diagnosis is made based on newlinechronology of symptoms, endoscopy or computed tomography newlineimaging (4). CRSwNP can cause long-term symptoms such as newlineprominent nasal obstruction (81 95%), facial congestion/ newlinepressure/fullness (70 85%) post-nasal drip, loss of smell (61 69%) newlineand discharge (51 83%), all of which negatively affect patients newlinehealth related quality of life (5). The exact pathophysiology behind newlineCRSwNP has not yet been elucidated. However the possible reason newlinebehind this could be the role of inflammatory mediators. Cytokines newlineIL-4, IL-5, and IL-13, and the chemokines CCL24 and CCL263 newlinecould be the possible cause behind the development of nasal polyps newlineTopical newlineintranasal corticosteroids are recommended for the efficacy, newlinetolerability and ease of use. It has been shown as an effective newlineadjuvant treatment and can effectively decrease nasal polyp size, newlinereduce sinonasal symptoms, and improve patient s quality of life newline(13, 14). Along with intranasal corticosteroids, intranasal newlineantihistamines are also proposed as first line therapy in patients newlinewith allergic rhinitis. It has more rapid onset of action ranging from newline15 to 30 minutes. Newer antihistamines have fewer adverse effects newlineand cause much less drying than their predecessors (16). Nasal newlinemucociliary clearance is an important intrinsic defense mechanism newlineof the respiratory tract. Mucociliary clearance is of great newlineimportance to assess the effects of nasal drugs and additives on newlinenasal ciliary function