Allergic rhinitis (AR) is a highly prevalent immunoglobulin E (IgE)-mediated inflammatory condition affecting the nasal mucosa, characterized by symptoms such as nasal obstruction, rhinorrhea, sneezing, and itching (1,2). The disease results from an exaggerated immune response to inhaled allergens, leading to activation of mast cells and release of inflammatory mediators including histamine, leukotrienes, and cytokines (3). AR is classified into intermittent and persistent forms, depending on symptom duration, and further categorized by severity according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (2,4).

Globally, AR affects approximately 10–40% of the population and has shown a rising trend, especially in urban and industrial regions (2,5). The disease significantly impacts quality of life, sleep, productivity, and healthcare utilization (6). In addition to symptomatic burden, AR also predisposes individuals to secondary infections due to impairment of local defense mechanisms, particularly mucociliary clearance (7).

The nasal mucociliary clearance (MCC) system constitutes one of the most vital innate defense mechanisms of the respiratory tract (8). It involves coordinated beating of cilia lining the respiratory epithelium and the transport of mucus, which traps inhaled pathogens and particulate matter (9). Efficient MCC depends on factors such as ciliary beat frequency, mucus viscosity, and airway surface liquid composition (10). In allergic rhinitis, chronic inflammation disrupts this system, leading to delayed clearance and accumulation of secretions (11).

The saccharin transit time (STT) test is a widely accepted, simple, and cost-effective method for assessing mucociliary function (12). It measures the time taken for a subject to perceive a sweet taste after placement of saccharin in the nasal cavity, reflecting ciliary transport efficiency (13). Prolonged STT indicates impaired mucociliary clearance and is commonly observed in conditions such as allergic rhinitis, sinusitis, and nasal polyposis (14).

Management of allergic rhinitis primarily focuses on allergen avoidance and pharmacotherapy (15). Among available treatment options, intranasal corticosteroids (INCS) are considered the most effective due to their potent anti-inflammatory action (2). They act by inhibiting cytokine production, reducing eosinophilic infiltration, and suppressing inflammatory pathways (8). INCS are superior to antihistamines and leukotriene receptor antagonists in controlling nasal symptoms, particularly congestion (11).

Despite their widespread use, the effect of INCS on mucociliary clearance remains controversial. Some studies suggest that corticosteroids do not impair MCC and may even improve it by reducing inflammation. Conversely, certain in vitro studies have demonstrated potential inhibitory effects on ciliary beat frequency at higher concentrations. These conflicting findings necessitate further clinical evaluation.

Given the limited and inconsistent data regarding the effect of intranasal corticosteroids on mucociliary clearance, the present study was conducted to assess changes in mucociliary clearance time following steroid spray therapy in patients with allergic rhinitis using the saccharin transit time test.

MATERIALS AND METHODS

This study was designed as a prospective pre–post interventional study conducted in the Department of Otorhinolaryngology at Maharaja Agrasen Medical College, Agroha, over a duration of 12 months following ethical clearance.

Study Population

A total of 60 patients diagnosed with persistent mild allergic rhinitis were included. Patients were recruited from both outpatient and inpatient departments using convenience sampling.

Inclusion Criteria

• Age group: 15–40 years
• Persistent mild allergic rhinitis (>4 days/week, >4 weeks)
• No treatment in the preceding 15 days
• Willing to provide informed consent

Exclusion Criteria

• Acute sinusitis or severe AR
• Previous nasal surgery
• Nasal polyps or deviated septum
• Pregnancy
• Congenital nasal anomalies

Sample Size

Calculated using OpenEpi software with 95% confidence interval and 90% power based on prior studies; final sample size was increased to 60 to account for attrition.

Procedure

Baseline mucociliary clearance was assessed using the saccharin transit time (STT) test. A saccharin particle was placed approximately 1 cm posterior to the anterior end of the inferior turbinate. Patients were instructed to swallow periodically and report the onset of sweet taste. Time was recorded in minutes.

Following baseline assessment, patients received intranasal fluticasone furoate spray for 3 weeks. The STT test was repeated after treatment.

Outcome Measure

• Primary: Change in mucociliary clearance time (minutes)

Statistical Analysis

• Mean ± SD calculated for quantitative variables
• Paired t-test for pre–post comparison
• Pearson correlation for associations
• ANOVA for categorical variables
• p < 0.05 considered significant

RESULTS

Table 1: Demographic Profile

The study population was predominantly young adults, with a higher proportion of males. Most participants belonged to rural areas, had lower educational status, and were mainly farmers or students, indicating higher exposure to environmental allergens. A majority were from the lower socioeconomic group, suggesting a possible association between socioeconomic factors and increased prevalence of allergic rhinitis.

Table 2: Effect of Steroid Spray on Mucociliary Clearance

There was a statistically significant reduction in mucociliary clearance time (p = 0.001). The 30.51% improvement indicates enhanced ciliary function following steroid therapy.

Table 3: Association with Demographic Variables

No statistically significant association was found between improvement in mucociliary clearance and demographic variables (p > 0.05). This suggests the therapeutic effect is uniform across patient groups.

Overall Findings

• Significant improvement in MCC after steroid therapy
• Improvement independent of demographic factors
• Supports physiological restoration of nasal defense

DISCUSSION

Allergic rhinitis (AR) is a chronic inflammatory disorder of the nasal mucosa characterized by symptoms such as rhinorrhea, nasal obstruction, sneezing, and itching. The pathophysiology involves an IgE-mediated hypersensitivity response leading to the release of inflammatory mediators, which not only produce symptoms but also impair normal nasal physiology, including mucociliary clearance (MCC) (1,2). The present study aimed to evaluate the effect of intranasal corticosteroid therapy on mucociliary clearance in patients with allergic rhinitis using the saccharin transit time (STT) test.

The demographic findings of this study revealed that the majority of patients belonged to the 19–30 years age group (45%), indicating that allergic rhinitis predominantly affects young adults. Similar age distribution has been reported in previous studies, where increased exposure to environmental allergens and occupational factors contributes to higher prevalence in this age group (3). A male predominance (58.33%) was observed, which is consistent with studies by Gill et al. and Nambiar et al., suggesting possible gender-based exposure differences or healthcare-seeking behavior (4,5).

A striking observation in this study was the predominance of rural population (90%), with most patients belonging to lower socioeconomic strata (61.67%). This may be attributed to increased exposure to environmental allergens such as dust, pollen, agricultural chemicals, and biomass fuel smoke, which are more prevalent in rural settings (6). Additionally, lower educational status observed in the study population may contribute to delayed healthcare access and poor awareness regarding allergen avoidance and treatment options (7).

The primary outcome of this study demonstrated a statistically significant reduction in mucociliary clearance time from 11.81 ± 9.01 minutes pre-treatment to 8.20 ± 6.08 minutes post-treatment (p = 0.001), indicating a 30.51% improvement. This finding suggests that intranasal corticosteroids not only alleviate symptoms but also restore mucociliary function. The improvement in MCC can be explained by the anti-inflammatory action of corticosteroids, which reduces mucosal edema, decreases inflammatory cell infiltration, and improves ciliary beat frequency (8,9).

These results are in agreement with the findings of Nambiar et al., who reported a reduction in mucociliary clearance time following treatment with fluticasone preparations (5). Similarly, Gill et al. demonstrated a significant improvement in MCC after topical steroid therapy, with reduction in clearance time observed as early as one month (4). The consistency of these findings supports the beneficial role of intranasal corticosteroids in improving nasal physiology.

However, some studies have reported contrasting findings. Pata et al. found no significant change in mucociliary clearance time after administration of mometasone furoate (10). These discrepancies may be attributed to differences in study design, duration of treatment, sample size, and variations in drug formulation. It is also important to note that in vitro studies have shown dose-dependent suppression of ciliary beat frequency with corticosteroids, whereas in vivo studies, including the present one, demonstrate minimal or reversible effects (11).

The saccharin transit time test used in this study is a simple, cost-effective, and reliable method for assessing mucociliary clearance. It has been widely used in clinical studies and correlates well with more advanced techniques such as radioisotope scanning (12). The baseline mucociliary clearance time observed in this study was higher than normal values reported in healthy individuals (5–13 minutes), indicating impaired mucociliary function in patients with allergic rhinitis (13). This impairment is likely due to chronic inflammation leading to altered mucus properties and ciliary dysfunction.

Another important observation in this study was the lack of statistically significant association between improvement in mucociliary clearance and demographic variables such as age, gender, education, and socioeconomic status. This suggests that the therapeutic effect of intranasal corticosteroids is consistent across different patient groups. Similar findings have been reported by Mehra et al., who found no significant correlation between demographic variables and mucociliary clearance improvement (14).

The improvement in mucociliary clearance following steroid therapy has important clinical implications. Efficient mucociliary clearance plays a critical role in protecting the respiratory tract from pathogens and particulate matter. Restoration of this mechanism can reduce the risk of secondary infections and improve overall nasal health (15). Therefore, intranasal corticosteroids not only provide symptomatic relief but also enhance the physiological defense mechanisms of the nasal mucosa.

Despite its strengths, the present study has certain limitations. The relatively small sample size and short duration of follow-up may limit the generalizability of the findings. Additionally, the use of a single method (STT) for assessing mucociliary clearance may not capture all aspects of mucociliary function. Future studies with larger sample sizes, longer follow-up periods, and advanced diagnostic techniques are recommended to further validate these findings.

Overall, the present study provides strong evidence supporting the beneficial effect of intranasal corticosteroids on mucociliary clearance in patients with allergic rhinitis. The significant improvement observed reinforces their role as first-line therapy in the management of this condition.

CONCLUSION

Intranasal corticosteroid therapy significantly improves mucociliary clearance in patients with allergic rhinitis, as demonstrated by a marked reduction in saccharin transit time. This improvement is independent of demographic factors and highlights the dual role of corticosteroids in both symptom control and restoration of nasal physiological defense mechanisms.

REFERENCES

1. Rosenfield L, Keith PK, Quirt J, Small P, Ellis AK. Allergic rhinitis. Allergy Asthma Clin Immunol. 2024 Dec 27;20(Suppl 3):74. doi: 10.1186/s13223-024-00923-6
2. Akhouri S, House SA. Allergic Rhinitis. [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538186/&lang=en/
3. B.Sousa-Pinto, J.Bousquet, R. J.Vieira, et al., “Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines—2024–2025 Revision: Part I—Guidelines on Intranasal Treatments,” Allergy81, no. 4 (2026): 954–976, https://doi.org/10.1111/all.70131.
4. Wong, H.C.Y., Lee, S.F., Wolf, J.R. et al. MASCC clinical practice statement: Prevention and management of acute radiation dermatitis using topical corticosteroids. Support Care Cancer 34, 423 (2026). https://doi.org/10.1007/s00520-026-10659-1
5. Shankari PK, Suresh S, Begum RF. Efficacy of intranasal fluticasone propionate and budesonide in management of allergic rhinitis—a prospective comparative study. Egypt J Otolaryngol. 2021;37(1):123. doi: 10.1186/s43163-021-00181-y
6. Adivitiya, Kaushik MS, Chakraborty S, Veleri S, Kateriya S. Mucociliary Respiratory Epithelium Integrity in Molecular Defense and Susceptibility to Pulmonary Viral Infections. Biology (Basel). 2021 Jan 29;10(2):95. doi: 10.3390/biology10020095
7. Richards GA, McDonald M, Gray CL, De Waal P, Friedman R, Hockman M,. Allergic rhinitis: Review of the diagnosis and management: South African Allergic Rhinitis Working Group. S Afr Fam Pract (2004). 2023 Oct 30;65(1):e1-e11. doi: 10.4102/safp.v65i1.5806. Erratum in: S Afr Fam Pract (2004). 2025 Mar 17;67(1):6150. doi: 10.4102/safp.v67i1.6150
8. Daley-Yates PT, Larenas-Linnemann D, Bhargave C, Verma M. Intranasal Corticosteroids: Topical Potency, Systemic Activity and Therapeutic Index. J Asthma Allergy. 2021 Sep 8;14:1093-1104. doi: 10.2147/JAA.S321332
9. Ramamoorthy S, Cidlowski JA. Corticosteroids: Mechanisms of Action in Health and Disease. Rheum Dis Clin North Am. 2016 Feb;42(1):15-31, vii. doi: 10.1016/j.rdc.2015.08.002
10. Richa Mehra, Varun Sachdeva. The effect of intranasal steroid on nasal mucociliary clearance in allergic rhinitis. International Journal of Science & Healthcare Research. 2023; 8(2): 463-467. DOI: https://doi.org/10.52403/ijshr.20230259
11. Jiao J, Zhang L. Influence of Intranasal Drugs on Human Nasal Mucociliary Clearance and Ciliary Beat Frequency. Allergy Asthma Immunol Res. 2019 May;11(3):306-319. doi: 10.4168/aair.2019.11.3.306.
12. Mikolajczyk M, Janukowicz K, Majewska E, Baj Z. Impact of Allergic Rhinitis on Nasal Mucociliary Clearance Time in Children. Int Arch Allergy Immunol. 2019;179(4):297-303. doi: 10.1159/000499740
13. Batmaz SB, Alicura Tokgöz S. Relationship between nasal mucociliary clearance and disease severity in children with allergic rhinitis: A comparative cross-sectional study. Allergol Immunopathol (Madr). 2020 Mar-Apr;48(2):137-141. doi: 10.1016/j.aller.2019.06.007
14. Kameswaran, Mohan1; Juvekar, Meenesh2; Haldipur, Deepak3; Nath, Biplab4; Rao, A.V. Ramana5; Shetty, Adip6; Diagnosis and management of allergic rhinitis: An Indian expert consensus by otorhinolaryngologists. Asia Pacific Allergy 15(4):p 319-328, December 2025. | DOI: 10.5415/apallergy.0000000000000237
15. Singh AK, Shaili S, Siddiqui A, Ali A, Choubey A, Jain P, Mirza MA, Iqbal Z. Unravelling allergic rhinitis: exploring pathophysiology, advances in treatment, and future directions. Front Allergy. 2025 Dec 4;6:1636415. doi: 10.3389/falgy.2025.1636415.