The Efficacy of Budesonide, Levocabastine, and Their Combination in Treatment of Vasomotor Rhinitis.

INTRODUCTION: Relevant studies have demonstrated that glucocorticoids and antihistamines, such as budesonide and azelastine, are effective in the treatment of vasomotor rhinitis, with their combined use being more effective than that of a single drug. The aim of this study was to assess the improvement in the symptoms of patients following the combined administration of these drugs. METHODS: We conducted a single-center randomized study on 42 patients. Participants were randomly treated with budesonide, levocabastine hydrochloride, or their combination for 2 weeks. The visual analog scale (VAS) score and levels of eosinophil cationic protein (ECP), histamine (HA), leukotriene B4 (LTB4), and vasoactive intestinal peptide (VIP) in nasal secretions were evaluated before and after treatment. RESULTS: The symptoms of patients were improved in all 3 treatment groups compared with those before treatment. Following combined treatment, the improvement in symptoms of nasal obstruction, runny nose, nasal itching, and sneezing was much greater than those in the groups treated with budesonide or levocabastine hydrochloride alone (p = 0.04, 0.004, 0.005, 0.004, respectively). The decreased levels of these inflammatory mediators were significantly different between the different treatment groups. CONCLUSIONS: Budesonide or levocabastine hydrochloride alone improved the nasal symptoms of patients with vasomotor rhinitis and reduced the levels of ECP, HA, LTB4, and VIP in nasal secretions. However, their combination improved the symptoms of patients more significantly than each drug alone.

[COMPARATIVE EVALUATION OF THE TREATMENT OF VASOMOTOR RHINITIS IN PATIENTS WITH AND WITHOUT COVID-19 INFECTION].

The aim of our study was to evaluate the effectiveness of treatment with the local antihistamine medicine Palada NS in patients with vasomotor rhinitis who have had COVID-19 infection (6 months after transfer) and have not. The diagnosis of vasomotor rhinitis was made on the basis of subjective (sneezing frequency, degree of difficulty in nasal breathing, nature, consistency, color of nasal discharge, as well as color of swelling of the nasal mucosa and turbinates, impaired olfactory function, general condition of the patient) and objective (anterior and posterior rhinoscopy, endoscopy, rhinomanometry) examination.Patients in both groups were treated with Palladium NS for 10 days (2 sprays, 2 times a day for 10 days). All studies were performed in patients before, 3-5 days after, and at the end of the treatment. The effectiveness of treatment was assessed according to patients' subjective complaints and objective indicators of instrumental examination. Symptoms before and after treatment were assessed on a 3-point scale. A positive result of treatment was revealed in the majority of patients. Which manifested itself in a decrease in the number of subjective and objective complaints. In patients who did not undergo COVID-19 infection, the subjective and objective indicators' improvement was revealed as early as on the 5th day of treatment, in patients with vasomotor rhinitis who underwent COVID-19 at least 6 months ago, the improvement was recorded only by the end of treatment. Based on the results of our studies, the proposed treatment regimen for vasomotor rhinitis with the local antihistamine medicine Palada NS can be recommended for patients with vasomotor rhinitis, both with and without COVID-19 infection.

[Treatment of allergic and vasomotor rhinitis: the role of beclomethasone dipropionate and hyaluronic acid (with high molecular weight).] / Trattamento delle riniti allergiche e vasomotorie: il ruolo del beclometasone dipropionato e dell'acido ialuronico (ad alto peso molecolare).

Inflammatory rhinitis is a very common disorder. It includes allergic rhinitis (AR) and non-allergic rhinitis (NAR). Nasal inflammation is shared by both disorders. So, anti-inflammatory treatment is indicated for both. Beclomethasone dipropionate (BDP) is a corticosteroid that is long time available both as intranasal spray and aerosol solution. BDP is a corticosteroid with proved efficacy in the treatment of rhinitis, both as spray and aerosol. Safety issue has been satisfactory explored, thus BDP is usually safe and well tolerated. Hyaluronic acid (HA) with high molecular weight has anti-inflammatory activity associated with wetting-lubricating effect. BDP may be usefully employed in acute forms, HA may be also used in chronic ones.

A Pilot Study Investigating Clinical Responses and Biological Pathways of Azelastine/Fluticasone in Nonallergic Vasomotor Rhinitis before and after Cold Dry Air Provocation.

BACKGROUND: Nonallergic vasomotor rhinitis (NAVMR) has been considered a diagnosis by exclusion due to unknown mechanisms or lack of diagnostic biomarkers. METHODS: To determine clinical responses and biological pathways in NAVMR subjects challenged to cold dry air (CDA) in an environmental exposure chamber (EEC) pre- and posttreatment with azelastine/fluticasone (AzeFlu), 30 NAVMR subjects, prescreened for CDA-induced symptoms (approx. 14°C, <15% relative humidity, ×1 h) were randomized to treatment with AzeFlu (n = 20) or placebo (n = 10) for 2 weeks. Total nasal symptoms scores, minimum cross-sectional area, cough, and conjunctival redness were recorded at visit 1 (pretreatment) and visit 2 (posttreatment) before, during, and after CDA challenge. At both visits, nasal lavage fluid (NLF) and nasal scrapings (NS) were collected pre- and post-CDA challenge. Substance P, neurokinin-A, and calcitonin gene-related peptide concentrations in NLF were analyzed pre- and postchallenge at each visit. Their relationship with CDA-induced symptoms was determined by statistical analysis. MicroRNA sequencing from NS determined differentially expressed miRNA between the treatment groups post-CDA challenge at each visit. RESULTS: The minimum cross-sectional area (p < 0.05), cough count (p < 0.05), and substance P (p < 0.01) improved posttreatment with AzeFlu versus placebo. Gene targets for differentially expressed miRNAs at visit 1 were enriched for biological pathways regulating epithelial ciliogenesis and cell integrity that were modified in the AzeFlu-treated group versus placebo posttreatment. CONCLUSIONS: This study demonstrated the feasibility of an EEC model to investigate CDA-induced clinical responses and pathobiology in NAVMR subjects pre- and posttreatment with AzeFlu. NAVMR disease mechanisms for other nonallergic triggers can be investigated similarly.

[The topical treatment of allergic and vasomotor rhinitis: the role of beclomethasone dipropionate]. / Il trattamento topico delle riniti allergiche e vasomotorie: il ruolo del beclometasone dipropionato.

Allergic rhinitis is the most frequent allergic disorder, as its prevalence is more than 20% in the general population. Non-allergic rhinitis has similar symptoms, but pathogenic mechanisms are non-IgE-mediated. Anyway, both diseases share a common inflammatory pathway, thus anti-inflammatory drugs represent the optimal therapeutical option. Beclomethasone dipropionate (BDP) is a corticosteroid that is long time available both as intranasal spray and aerosol solution. The present review aims at analysing the most relevant and recent studies concerning the BDP use in allergic and non-allergic rhinitis. The research was performed using Medline and Scopus database, key words were: allergic and non-allergic rhinitis, beclomethasone (last access 31st July 2014). BDP is a corticosteroid with proved efficacy in the treatment of rhinitis, both as spray and aerosol. Safety issue has been satisfactory explored, thus BDP is usually safe and well tolerated.

Determination of oxidative stress and effect of erdosteine on rhinitis medicamentosa in a rat model.

We aimed to determine the presence of oxidative stress in rhinitis medicamentosa (RM) and to evaluate the effect of erdosteine (ED) on mucosal changes in a rat model. Twenty-four male rats were used in this experimental study. Three groups were created. Group 1 (n=8) was the control group. Two puffs of 0.05% oxymetazolin were sprayed into the nasal cavities of the remaining rats (n=16) three times daily for eight weeks. One of these 16 rats was scarified at the end of the eight weeks and examined to confirm the presence of RM. Seven of the remaining 16 rats were killed, and venous blood samples were taken (Group 2). Group 3 (n=8) received 10mg/kg of an ED suspension orally for seven days. All rats were put on formalin for light microscopy. The total antioxidant status (TAS) was similar in all groups (p=0.073). The total oxidative status (TOS) of the RM group was significantly higher than that of the control group and RM+ED group (Group 3) (p=0.003 and p=0.011, respectively). The pathological recovery of the nasal mucosa of the rats was similar in the RM+ED and control groups. The TOS was high in this RM rat model, and oxidative stress was associated with RM. ED significantly ameliorated nasal mucosal changes induced by RM, suggesting that oxidative stress may play an important role in the pathophysiology of this condition.

Intranasal capsaicin in management of nonallergic (vasomotor) rhinitis.

Capsaicin is a selective transient receptor potential vanilloid 1 (TRPV1) ion channel agonist and has been demonstrated to reduce nerve conduction of nociceptive C fibers in the trigeminal nerve without affecting conduction in Adelta fibers. This chapter reviews the classification of chronic rhinitis subtypes, the prevalence and epidemiology of nonallergic rhinitis (NAR), postulated pathophysiology and mechanisms of NAR including the role of transient receptor potential (TRP) ion channels and discusses the potential therapeutic benefits of capsaicin in the treatment of chronic rhinitis subtypes, specifically NAR. Evidence supports that hypersensitivity of TRP ion channels on sensory afferent neurons innervating nasal mucosa is responsible for inducing NAR symptoms. These symptoms, characterized as excessive nasal glandular secretion, nasal congestion, and headache, are mediated through neuropeptide release during axonal and parasympathetic reflexes which are initiated by a spectrum of nonspecific irritants that activate TRP channels. Rational approaches to treat the pathophysiology of NAR would be to develop therapies with selective TRPV1 agonist activity like capsaicin that target desensitization of TRP ion channels on sensory afferent nerves.

Pharmacological evaluation of selective α2c-adrenergic agonists in experimental animal models of nasal congestion.

Nasal congestion is one of the most troublesome symptoms of many upper airways diseases. We characterized the effect of selective α2c-adrenergic agonists in animal models of nasal congestion. In porcine mucosa tissue, compound A and compound B contracted nasal veins with only modest effects on arteries. In in vivo experiments, we examined the nasal decongestant dose-response characteristics, pharmacokinetic/pharmacodynamic relationship, duration of action, potential development of tolerance, and topical efficacy of α2c-adrenergic agonists. Acoustic rhinometry was used to determine nasal cavity dimensions following intranasal compound 48/80 (1%, 75 µl). In feline experiments, compound 48/80 decreased nasal cavity volume and minimum cross-sectional areas by 77% and 40%, respectively. Oral administration of compound A (0.1-3.0 mg/kg), compound B (0.3-5.0 mg/kg), and d-pseudoephedrine (0.3 and 1.0 mg/kg) produced dose-dependent decongestion. Unlike d-pseudoephedrine, compounds A and B did not alter systolic blood pressure. The plasma exposure of compound A to produce a robust decongestion (EC(80)) was 500 nM, which related well to the duration of action of approximately 4.0 hours. No tolerance to the decongestant effect of compound A (1.0 mg/kg p.o.) was observed. To study the topical efficacies of compounds A and B, the drugs were given topically 30 minutes after compound 48/80 (a therapeutic paradigm) where both agents reversed nasal congestion. Finally, nasal-decongestive activity was confirmed in the dog. We demonstrate that α2c-adrenergic agonists behave as nasal decongestants without cardiovascular actions in animal models of upper airway congestion.

Allergic rhinitis and non-allergic rhinitis in children in the tropics: prevalence and risk associations.

BACKGROUND: The age-related comparative prevalence of allergic rhinitis (AR) and non-allergic rhinitis (NAR) in children is poorly defined. We aimed to characterize AR and NAR in children. METHODS: This study enrolled children with chronic rhinitis who presented to a tertiary paediatric center for a diagnostic skin prick test (SPT). Parents completed a medical history questionnaire for their child, including disease activity for asthma and rhinitis. Sociodemographic data was obtained and all participants underwent a common inhalant SPT panel. A positive SPT indicated AR. RESULTS: From March 2001 to March 2009, 6,660 children (64% male) were enrolled (aged 6 months to 19 years, mean 7.82 years). Only 3.7% (249) of the children were <2 years old, and almost 30% of these had AR. Most children with AR (73%) presented after age 6. Males were more likely to have AR (vs. NAR) (OR 1.5; CI 1.39-1.77). Antihistamine and salbutamol use did not differ between children with AR and NAR. Children with AR were more likely to require adjunct therapy with inhaled corticosteroids (51.2% vs. 43.2%, P < 0.001), have drug hypersensitivity (especially antipyretic drugs) (2.5% vs. 1.3%, P = 0.384) or an asthma admission (9.1% vs. 6.0%, P < 0.001). CONCLUSIONS: AR is more common in male children, is relatively rare below the age of 2 years, and accounts for two-thirds of all childhood chronic rhinitis and 73.3% of all chronic rhinitis in school-aged children (≥6 years old). Children with AR have more severe rhinitis symptoms and more often suffer from asthma-related events and admissions.

Traumatic unilateral vasomotor rhinitis.

Vasomotor rhinitis (VMR) is a commonly encountered entity that may be difficult to diagnose. The classic symptoms are clear rhinorrhea and nasal congestion, commonly brought on by exercise, stress, heat, cold, and environmental irritants. The diagnosis is one of exclusion, and management usually involves avoidance of inciting agents and treatment with an anticholinergic nasal spray. We describe a case of VMR in a 22-year-old woman who presented with symptoms of clear, left-sided rhinorrhea and epiphora that had begun shortly after a motor vehicle accident approximately 1.5 years earlier, but which she had not reported at that time. The patient's left carotid canal had been fractured and the surrounding sympathetic plexus injured in the accident, resulting in an overactive parasympathetic system. Both exercise and heat exacerbated her symptoms. Allergy was excluded by negative allergy testing, and the patient did not respond to fluticasone nasal spray. Given the mechanism of injury, the unilaterality of symptoms, and the patient's lack of response to nasal steroids, it was thought that the VMR was due to the earlier traumatic injury, which had resulted in imbalance of the autonomic neural input. A trial of ipratropium was given to directly treat the parasympathetic overactivity. This treatment resulted in immediate improvement in both the nasal and lacrimal secretions.

Olopatadine 0.6% nasal spray protects from vasomotor challenge in patients with severe vasomotor rhinitis.

BACKGROUND: Vasomotor rhinitis (VMR) is a hypersensitivity syndrome with heightened reactivity to environmental triggers. METHODS: Twenty-two patients with severe VMR were treated nasally with either normal saline or 0.6% olopatadine and challenged nasally with a hyperosmolar mannitol solution. RESULTS: Treatment with 0.6% olopatadine resulted in an improvement in instantaneous nasal symptom scores at 5 and 30 minutes (p < 0.01) compared with baseline and at 30 minutes after hyperosmolar challenge compared with saline-pretreated individuals (p < 0.01). There was also an improvement in nasal peak inspiratory flow rate at 30 minutes after hyperosmolar challenge compared with saline-pretreated individuals (p < 0.01). CONCLUSION: In this patient population 0.6% olopatadine appears to be efficacious in symptom reduction in VMR and protects from hyperosmolar challenge.

Two-week comparison study of olopatadine hydrochloride nasal spray 0.6% versus azelastine hydrochloride nasal spray 0.1% in patients with vasomotor rhinitis.

Olopatadine hydrochloride nasal spray 0.6% (OLO) and azelastine nasal spray 137 micrograms (AZE) are effective in treating allergic rhinitis and AZE is indicated for nonallergic vasomotor rhinitis (VMR). This study evaluates the relative safety and efficacy of OLO and AZE in patients with VMR. This randomized, double-blind, parallel-group, multicenter study compared OLO (an investigational use) with AZE over 14 days in patients (n = 129) ≥12 years of age with chronic VMR. Efficacy included the severity of nasal symptom scores. Safety included adverse events (AEs) and nasal examinations. Patient perceptions of treatment satisfaction and changes in allergy condition were determined using the Treatment Satisfaction Questionnaire for Medication and Patient Global Assessment scores. In the OLO and AZE groups, reflective scores for individual nasal symptoms (nasal congestion, rhinorrhea, postnasal drip, and sneezing) and total nasal VMR symptom scores decreased significantly from baseline to day 14 (p < 0.05). No significant between-group differences were observed (p > 0.05). No serious AEs were reported in either group. Overall, 22 and 20 AEs were reported in the OLO and AZE groups, respectively. The most common AE was taste disturbance, reported by three (5.3%) and six (10.3%) patients in the OLO and AZE groups, respectively. Patients in both groups reported similar treatment satisfaction scores and a majority of patients in both groups perceived an overall improvement in their rhinitis condition. OLO has a similar efficacy and safety profile to AZE for the management of VMR in patients ≥12 years of age.

Overview of the treatment of allergic rhinitis and nonallergic rhinopathy.

Allergic rhinitis (AR) and nonallergic rhinopathy (NAR) represent common nasal conditions affecting millions of individuals across the world. Although patients present with similar symptomatology, those with NAR are frequently affected only after childhood and present with a lack of other comorbid atopic disorders such as asthma, atopic dermatitis, and food allergies. Patients with pure NAR usually have no identifiable specific allergen sensitivity, whereas those with mixed (allergic and nonallergic) rhinitis are sensitized to aeroallergens in a manner that does not fully explain the duration or extent of their symptoms. This review presents the diverse options of currently available pharmacologic agents for the treatment of AR and NAR, including intranasal corticosteroids, H(1)-antihistamines, decongestants, cromolyn sodium, antileukotrienes, anticholinergics, capsaicin, anti-IgE, and intranasal saline, in addition to subcutaneous immunotherapy. Furthermore, treatment algorithms for AR and NAR are presented with a stepped-up, stepped-down scheme to aid the clinician in choosing appropriate therapy.

A comparative analysis of the decongestive effect of oxymetazoline and xylometazoline in healthy subjects.

BACKGROUND: Oxymetazoline and xylometazoline are locally effective and direct acting drugs that relieve nasal congestion. The aim of this study was to objectively determine and compare the decongestive effects of oxymetazoline and xylometazoline in healthy subjects. METHODS: The study population comprised thirty healthy adults. All subjects underwent active anterior rhinomanometry (AARhm) and acoustic rhinometry (AR) tests following the application of oxymetazoline, xylometazoline, or placebo (physiological saline). The change in nasal resistance, nasal airflow, and different cross-sectional areas (CSAs) of the nasal cavity in the subjects were examined for each solution separately. The measurements were obtained over a 1-h period (baseline and 1, 15, 30, and 60 min post-dosing). All results were analyzed using the Kruskal-Wallis test and the Mann-Whitney U test. RESULTS: A total of 6,300 measurements of AARhm and AR were obtained. The application of placebo did not cause a statistically significant change in nasal resistance, nasal airflow, and CSAs (CSA1, 2, and 3, respectively) of the nasal cavity. In contrast, statistically significant changes in nasal resistance (inspiration p = 0.000 and p = 0.004; expiration p = 0.000 and p = 0.000), nasal airflow (inspiration p = 0.000 and p = 0.004; expiration p = 0.000 and p = 0.000), and CSAs of the nasal cavity (CSA2 p = 0.000 and p = 0.000, CSA3 p = 0.000 and p = 0.00), with the exception of CSA1 (p = 0.982 and p = 0.994), were obtained after the application of oxymetazoline and xylometazoline. A comparison of oxymetazoline and xylometazoline based on nasal resistance, nasal airflow, and CSAs of the nasal cavity demonstrated no statistically significant difference, except for CSA3. CONCLUSION: Oxymetazoline and xylometazoline are fast-acting and potent topical decongestants that have similar decongestive effects.

Vasomotor rhinitis.

Vasomotor rhinitis is a common disorder that is seen routinely in allergy practice. It affects millions of Americans and results in significant morbidity. The pathophysiology of this complex heterogeneous disorder is unknown, but we are making advances in this regard. Symptoms and signs can closely resemble those of allergic rhinitis and can be difficult to differentiate from those resulting from allergy. A careful history, physical examination, and diagnostic testing help clinicians arrive at a definitive diagnosis, but treatment can be challenging. Therapy should be based on the presenting symptoms of vasomotor rhinitis. Combination therapy with topical corticosteroids and azelastine is useful. However, in patients whose predominant symptom is rhinorrhea, use of atopical anticholinergic agents can be quite useful. Up-to-date pathogenesis, epidemiology, diagnosis, and treatment approaches are discussed in this review.

Weather/temperature-sensitive vasomotor rhinitis may be refractory to intranasal corticosteroid treatment.

Vasomotor rhinitis (VMR) is a common but poorly understood disorder of which there are two major subgroups: VMR(w/t), triggered by weather/temperature and VMR(ir), triggered by airborne irritants. No specific biological pathways or specific treatments for VMR(w/t) or VMR(ir) have been identified. However, intranasal corticosteroids (INSs) are effective in treating many forms of nonallergic rhinitis that include these conditions. A recently introduced INS with established efficacy in allergic rhinitis and enhanced affinity, fluticasone furoate, may possess the potency and safety profile required to treat chronic VMR(w/t). Two replicate studies (FFR30006 and FFR30007) were conducted in six countries to evaluate the efficacy and safety of fluticasone furoate nasal spray in subjects with VMR(w/t). After a 7- to 14-day screening period, subjects (n = 699) with symptomatic VMR(w/t) received fluticasone furoate, 110 mug q.d. or placebo for 4 weeks in these two randomized, double-blind, parallel-group studies. Subjects rated their nasal symptoms (congestion, rhinorrhea, and postnasal drip) twice daily on a 4-point categorical scale and evaluated their overall response to treatment at study end. Fluticasone furoate did not significantly improve daily reflective total nasal symptom scores, the primary end point, versus placebo (p = 0.259) and there was no improvement in any other measure of efficacy. The active treatment was well tolerated. Fluticasone furoate was not effective in treating subjects with a newly defined condition, weather-sensitive VMR. These unexpected results suggest that VMR(w/t) is a distinct subgroup of VMR that is refractory to treatment with INSs. Additional study of other treatments for VMR(w/t) (including INSs) is warranted.

Pharmacokinetic characteristics and safety and tolerability of a reformulated azelastine hydrochloride nasal spray in patients with chronic rhinitis.

BACKGROUND: Intranasal azelastine hydrochloride (Astelin, Meda Pharmaceuticals, Somerset, NJ, USA) is a first-line treatment for allergic and non-allergic vasomotor rhinitis with well-established therapeutic efficacy and safety. A new formulation of azelastine nasal spray (Astepro, Meda Pharmaceuticals, Somerset, NJ, USA), with a sorbitol-based vehicle and sucralose as a taste-masking agent, was developed to reduce the bitter taste of azelastine experienced by some patients. OBJECTIVE: Two studies were conducted to evaluate the safety, tolerability and pharmacokinetic parameters of this new formulation compared with the original azelastine nasal spray. METHODS: In a pharmacokinetic study, 18 healthy volunteers received either a single dose of the new formulation or the original formulation and pharmacokinetic parameters were determined. In a 1-year safety study, patients with chronic rhinitis were randomized to the new formulation (n = 430) or the original formulation (n = 432) to assess tolerability and the potential for adverse effects on the nasal mucosa. RESULTS/CONCLUSIONS: The new formulation was safe and well tolerated with long-term use and had a comparable pharmacokinetic profile to the original formulation. The overall incidence of treatment-emergent adverse events with the new formulation (48.4%) and the original formulation (49.1%) was similar, with no evidence of increased nasal irritation, nasal septal perforation, severe epistaxis or ulceration with either formulation during the 1-year study.

Botulinum toxin for treatment of glandular hypersecretory disorders.

SUMMARY: The use of botulinum toxin to treat disorders of the salivary glands is increasing in popularity in recent years. Recent reports of the use of botulinum toxin in glandular hypersecretion suggest overall favourable results with minimal side-effects. However, few randomised clinical trials means that data are limited with respect to candidate suitability, treatment dosages, frequency and duration of treatment. We report a selection of such cases from our own department managed with botulinum toxin and review the current data on use of the toxin to treat salivary gland disorders such as Frey's syndrome, excessive salivation (sialorrhoea), focal and general hyperhidrosis, excessive lacrimation and chronic rhinitis.

[Efficacy evaluation of polysaccharide nucleic acid-fraction of BCG on vasomotor rhinitis].

OBJECTIVE: To investigate the efficacy and safety of polysaccharide nucleic acid-fraction (BCG-PSN) in the treatment of vasomotor rhinitis. METHOD: Sixty patients were randomly divided into BCG-PSN group (n = 30) and control group (n = 30). The patients in BCG-PSN group were administered with BCG-PSN 1.0 mg twice a week for two months, and intranasal azelastine was used if needed. The patients in control group were administered with intranasal azelastine solely twice a day, which could be decreased with the symptom relief. Follow-up was 6 months. Symptom and medication scores were recorded. Side effects were registered. RESULT: The symptom and medication scores of BCG-PSN group were significantly lower than that of control group (P < 0.01) after BCG-PSN treatment. There was no significant difference in symptom score between the two groups at 6 months after BCG-PSN treatment (P > 0.05), while the medication score of BCG-PSN group was still much lower than that of control group (P < 0.01). No serious adverse events were reported in BCG-PSN group except for local pain on the injection place in one patient. CONCLUSION: BCG-PSN is effective and safe in the treatment of vasomotor rhinitis.