Using radiofrequency turbinate reduction (RFTR) prior to drug therapy for moderate to severe allergic rhinitis hastens initial clinical improvement but does not alter the disease course. However, initial RFTR was found to reduce the ratio of matrix metalloproteinase-9 (MMP-9) to tissue inhibitor matrix metalloproteinase-1 (TIMP-1), thus reducing symptoms, according to a recent study published in the Brazilian Journal of Otorhinolaryngology.

Intranasal corticosteroids and oral antihistamines have been utilized in allergic rhinitis  for some time. No previous studies have researched RFTR as an adjuvant therapy prior to drug treatment, however. The study authors theorized that RFTR followed by pharmacologic treatment would result in even more positive outcomes.

Investigators based in Jakarta, Indonesia, oversaw a randomized controlled trial that took place between July 2018 and February 2020 involving 32 patients (N=32) ranging in age from 26 to 47 years with persistent allergic rhinitis. Participants were divided into 2 groups. One cohort underwent RFTR followed by an intranasal corticosteroid and antihistamine H-1. The control group received the medications alone. In all, the control group lost 3 patients due to dropout, loss to follow up, or refusal of biopsy evaluation after treatment.


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In week 4, the researchers assessed inflammatory mediators through enzyme-linked immunosorbent assay (ELISA) testing for levels of eosinophil cationic protein (ECP), interleukin (IL)-5, and the 70 kilodalton heat shock proteins (HSP-70s) and evaluated for markers of physiological mucosal remodeling via biopsy and immunohistochemistry examination.

The week 4 results demonstrated that patients in the RFTR cohort had a significantly better clinical response than those in the control group (Chi-Square Test; P <.05). The RFTR group also showed a decrease in IL-5 levels but no significant difference in levels of ECP when compared with controls (Mann Whitney test; P >.05). Additional week-4 findings showed that patient in the RFTR group had a greater reduction in the MMP-9/TIMP-1 ratio than patients in the control group (unpaired t-test, P <.05) and a lower increase in HSP-70s, but the difference in the latter case did not reach statistical significance (Mann Whitney test, P >.05). In week 8, however, the investigators found no significant difference in clinical improvement between the intervention and control groups.

The researchers also found no statistically significant differences in the levels of inflammatory and remodeling biomarkers between groups.

Study limitations included a small sample size and a brief follow-up period.

The investigators concluded that although initial RFTR brought about faster symptom relief during the first 4 weeks of treatment for moderate to severe persistent allergic rhinitis, it “did not alter the course of this chronic inflammatory disease. Therefore, maintenance therapy by pharmacotherapy should still be given to control inflammation,” they recommended.

Reference

Irawati N, Bashiruddin J, Rengganis I, et al. The effect of early radiofrequency turbinate reduction, intranasal steroid, and antihistamine H-1 on persistent allergic rhinitis: a randomized clinical trial. Braz J Otorhinolaryngol. Published online May 20, 2022. doi:10.1016/j.bjorl.2022.04.001