Clinical Studies Of Perennial Allergic Rhinitis Treated With Long-term Low-dose Roxithromycin

Objective: Lately, the study of roxithromycin (RXM) and other 14-membered macrolide antibiotics' anti-inflammatory and immunoregulatory activity has made much progress. Although the precise mechanisms remain unclear, some mechanism verified were correlated with allergy diseases, inculding perennial allergic rhinitis(PAR). Long-term low-dose macrolide antibiotics had been successfully used to treat asthma patients, while nothing had been reported about using it to treat PAR. To determine whether RXM is effective in the management of patients with PAR, the changs of symptoms and rhinoscopic findings were observed; To investigate the possible mechanisms, the amount of eosinophils (EOS) in nasal secrection and concentration of serum cytokine were measured.Materials and methods: 111 outpatients with PAR wererandomly divided into 3 groups: immunotherapy control group,RXM group and RXM/immunotherapy group. Except somepatients failed to follow-up, the immunotherapy group wasconsisted of 21 patients, the RXM group comprised 22 patients,the RXM/immunotherapy group was composed of 30 patients.The patients in RXM group were treated with 150mg (childrenwith 2.5~5mg/kg) of RXM once a day orally for 12 weeks. Themethod of immunotherapy: 20 sorts of allergen used for patientscame from Beijing Xiehe Hospital. The allergen was verified bymedical history, skin test and special IgE test in vitro.The initialconcentration was chose according to the result of skin test: "+" ---- 1:106,"++" ---- 1:108,"+++" ---- 1:1012, hypodermic injection,twice a week. Injection began with 0.1ml, added 0.1ml in thenext time until 1.0ml. The concentration was added up to 10times for the next course, follow-up was not terminated until 12weeks, then the patients continued to receive the subsequentimmunotherapy. When patients in the third group received immunotherapy, they were administered with 150mg (childrenwith 2.5~5mg/kg) of RXM once a day orally at the same time.All the patients in the three groups were told to come to hospitalonce a month. All the patients were given symptom and rhinoscopic findings scores before and after therapy,respectively.The efficacy of therapy was assessed as the formula: (total score pretreatment — total score post-treatment) /total score pretreatment × 100%the result ≥ 51% indicated significant effect, 50% ~21% indicated effect, ≤20% indicated no effect, The amount ofEOS in the nasal secretion was counted under microscope(×400) after Wright's staining, and the concentration of serumIL-5 and IL-8 were detected by ELISA. All the data wereanalyzed by THE SAS SYSTEM FOR WINDOWSTM RELEASE 6.12 Result: Most patients in the two experimental groups feltsymptoms decrease after treating for 25~35 days. 12 weeks later,improvement of symptoms and signs was noted in most patients.No significant side effects were noted. 1. The effective rate of immunotherapy group, RXM group, and RXM/immunotherapy group was 19.05%, 72.73%, 80%, respectively. The efficacy of the two experimental groups was more significant (P<0.01); Thescores of symptoms and rhinoscopic findings were significantlylower than that before treatment (all P<0.01). 2. After treatment,the amount of EOS in the two experimental groups wassignificantly lower than that in immunotherapy group(P<0.05); The amount of EOS in RXM group andRXM/immunotherapy group was significantly lower thanthat before treatment(P<0.01, P<0.01, respectively ). 3. Aftertreatment, the levels of serum IL-5 in the two experimentalgroups were significantly lower than that in immunotherapygroup (P<0.05); The levels of serum IL-5 in RXM group andRXM/immunotherapy group significantly decreased comparedwith pretreatment ( P<0.01, P<0.01, respectively ). 4. Aftertreatment, the concentration of serum IL-8...