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Open Access 
F u l l  L e n g t h  A r t i c l e  

 Effect of Beclomethasone Dipropionate Versus Mast Cell Stabilizer 

on Mucociliary Clearance in Patients of Allergic Rhinitis  
 

Muhammad Ramzan 1, Nasir Iqbal 2, Arslan Karim 3 
1 Ex House officer Nishtar Hospital Multan 

2 Ex House officer, Medical officer BHU Wandher Multan 
3 Ex House officer, Medical officer BHU Qadir Pur Multan 

A B S T R A C T  

Objective: The study was conducted to compare the effect of Beclomethasone dipropionate with mast cell stabilizer on 

mucociliary clearance in patients of allergic rhinitis. 

Patients and Methods: A randomized trial was carried out in ENT department of Nishtar Hospital Multan from 

December 2016 to February 2017. Patients of allergic rhinitis from both genders were included in the study after written 

consent. Mucociliary transport velocity was measured by saccharine dye test. The collected data was processed and 

analyzed by SPSS software 23 version and presented in tabulation form. Qualitative variables were analyzed in 

percentage and frequency form. The main outcome variable, mucociliary transport velocity, age and weight of patients 

were presented as mean and stranded deviation. Students’ test was applied to calculate p value. P value <0.05 was 

taken as significant. 

Results: A total number of 140 patients were included in the study and were divided in two main groups. There were 70 

volunteers in each group.  One group was provided Beclomethasone and other group was given mast cell stabilizer for 

one week.  After careful analysis and calculation, it was observed that the mean of mucociliary transport velocity after 

one week of Beclomethasone dipropionate treatment was 7.33±1.27 mm/minute with p value 0.558 and mean of velocity 

after mast cell stabilizer (Nedocromil sodium) was 7.82±1.2 mm/minute with p-values 0.304. 

Conclusion: No statistical significance was found with both treatment regimens. 

Key words: Allergy, Beclomethasone Dipropionate, Mucociliary clearance, Nedocromil sodium, Rhinitis, Saccharine dye 

test. 

Author`s Contribution 
1 Conception, synthesis, planning of research 
and manuscript writing Interpretation and 
discussion 
2 Data analysis, interpretation and 
manuscript writing, 3 Active participation in 
data collection. 

Address of Correspondence 

Arslan Karim 
Email: ziali43@hotmail.com 

Article info. 

Received:  September 20, 2017 
Accepted:  December 19, 2017 

Cite this article. Ramzan M, Iqbal N, Karim A. To compare effect of Beclomethasone 
dipropionate with mast cell stabilizer on mucociliary clearance in patients of allergic rhinitis. 
JIMDC.2018; 7(2):92-96 

Funding Source: Nil 
Conflict of Interest: Nil 

I n t r o d u c t i o n  
 

In upper respiratory disorders, allergic rhinitis has 

important correlation with asthmatic complications.1 Its 

prevalence in United States ranges between 5 to 22 

percent. Major symptoms of allergic rhinitis are pruritus of 

nose and eyes, rhinorrhea, nasal congestion and 

sneezing. Less common symptoms include popping of 

ears, coughing and throat clearing.2 Chronic breathing 

disease and the consequences of allergic rhinitis 

complications like sinusitis, Eustachian tube dysfunction 

and sleep disturbances are major complications which 

result in morbidity.3 Parental history of atopic disease 

increases the chance of disease occurrence in next 

generation by 30 percent and even more risk when both 

parents have such disease.4 Allergic rhinitis as itself 

O R I G I N A L  A R T I C L E  



 

                           93 J I M D C   2 0 1 8  93 

explains is the hypersensitivity response to the external 

allergens mediated by IgE antibodies. Its outcomes are 

nasal symptoms or upper respiratory tract disturbances 

presenting as its main hallmarks. There is a list of 

allergens, which are the cause of this hypersensitivity. 

These include trees and small plants pollens, house dust, 

insects and some foods.5 

In allergic rhinitis, mast cells and basophils are first line of 

defense, which has high affinity receptors for IgE 

antibodies and second line of defense are Eosinophils, 

Monocytes and Platelets with low affinity receptors.6 It is 

not necessary that all the subjects having IgE serum level 

show clinical significance. It is also understood that there 

is no probability of any specific organ to be effected by 

increase in IgE serum level. Although in allergic rhinitis 

patients mast cells degranulate, causing release of 

inflammatory mediators, which ultimately lead to 

stimulation of nasal end organs, producing different 

symptoms like sneezing, itching, nasal congestion and 

rhinorrhea.7 Among the persons with raised IgE serum 

level and positive skin sensitivity test, about 90 percent 

population show immediate hypersensitivity response 

followed by the symptoms stated above.  

Mediators released by first and second line defenders 

show collective symptomatic response with less 

information about individual exact response, although 

some individual response has been discussed on the 

base of nasal provocation tests. Histamine causes acute 

antigen antibody response, serotonin causes sneezing 

and rhinorrhea without congestion while leukotrienes and 

prostaglandins cause rhinorrhea and congestion both.8 To 

cope with this nasal disease there are different ways of 

therapy. Before treatment, avoidance from the causative 

factors are more important as care is the best health 

remedy. All the sources of pollens, dust and other 

hypersensitive allergens must be avoided to cope with 

this disease. Otherwise frequently used medicines for the 

treatment of allergic rhinitis are antihistamines, 

decongestants, nedocromil sodium (NDS) and 

glucocorticoids.9 Immunotherapy is also preferred to lower 

the threshold for development of clinical symptoms by 

injecting a series of injections with allergens.   

Antihistamines provocation includes rapid onset and 

reducing sneezing, rhinorrhea and pruritus but not 

congestion. Decongestants like pseudoephedrine 

hydrochloride with alpha-adrenergic agonist properties 

constrict the nasal vascular bed, which results in 

decreased blood supply, and thus lowering of mucosal 

edema. Nedocromil sodium (NDS), a frequently used 

mast cell stabilizer is also the same in effectiveness as 

antihistamines.10 Glucocorticoids that include Flunisolide, 

Beclomethasone Dipropionate and Dexamethasone are 

very potent and preferred drugs for the treatment of 

allergic rhinitis. There mode of action is the same as that 

of antihistamines with rapid onset reducing 

hypersensitivity symptoms. 

To evaluate the efficacy and to find out the significant 

difference in treatment effects, different drugs have been 

compared in different studies. In this study, two drug 

groups discussed above have been focused to evaluate 

their therapeutic efficiency by certain tests. The two drugs 

are Beclomethasone dipropionate (BDP) a 

glucocorticosteroid and Nedocromil sodium (NDS) a mast 

cell stabilizer, both provocation results effect on 

mucociliary clearance.11 There are many tests used to 

evaluate the mucociliary clearance like saccharine test, 

dye method and radiographic method. Saccharine test is 

inexpensive and reliable technique frequently preferred 

for the mucociliary clearance measurement.12 The study 

was conducted to evaluate the difference between the 

efficacies of two drugs on allergic rhinitis. 

P a t i e n t s  a n d  M e t h o d s  

This prospective study was conducted in ENT department 

of Nishtar Medical College and Hospital Multan from 

December 2016 to February 2017 on patients of allergic 

rhinitis. After proper approval from institutional ethical 

committee, a total 140 patients, of both gender were 

included in this study. Sample size was calculated by 

using online software raosoft by using reference study of 

Svendsen and colleagues with confidence interval 95%.13 

A written consent was taken from the participants with 

verbal briefing about procedure, purpose and protocol of 

study. Patients were divided into two main groups 

randomly by lottery method and allocated to drugs 

Beclomethasone dipropionate and Nedocromil sodium 

(NDS) in equal ratio.14 Inclusion criteria was nonsmokers, 

no history of asthma, no previous chronic upper and lower 

respiratory disease, no nasal structural abnormality. Only  



 

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patients with acute allergic rhinitis were included in the 

study.15 Patients already treated with Beclomethasone 

dipropionate and Nedocromil sodium (NDS) were 

excluded from the study. 

All selected patients were gone through mucociliary 

function test to measure mucociliary transport velocity at 

baseline and after treatment with Beclomethasone 

dipropionate and Nedocromil sodium (NDS). To measure 

mucociliary transport velocity (mm/min), saccharine dye 

test was applied.16 The test was preferred as it was 

inexpensive, readily available, easy to perform and 

reproducible. A particle of saccharine with special blue 

dye was placed on the anteriomedial portion of the inferior 

turbinate at the point 4 cm apart from the nasal tip. The 

transport time was measured from the time of application 

of saccharine with dye up to the sweet taste in mouth. It 

was further confirmed by blue dye in the pharynx. The 

length of nasal cavity was measure with the help of cotton 

swab from the nasal tip to the pharyngeal wall.17 With the 

help of measured transport time and length of nasal cavity 

mucociliary transport velocity (mm/min) was calculated. 

The same procedure was repeated on the same nostrils 

after one-week treatment of both medicine groups i.e. 1st 

group treated with Beclomethasone dipropionate and 2nd  

 

group treated with NDS. Mucociliary transport velocity 

was calculated according to same method as before 

treatment. The daily dose during treatment was, 4 mg 

Nedocromil sodium (2 mg per puff) and 0.1 mg 

Beclomethasone dipropionate (0.05 mg per puff) two time 

each medicine daily. Treatment was continued for one 

week on each group.18 

All the data were collected and saved in excel 

spreadsheets and SPSS version 23. Main outcome 

variable of current study was mucociliary transport 

velocity, which was calculated by transport time, and 

nasal length expressed as mm/min. Qualitative data like 

gender were analyzed in percentage and frequency. The 

main outcome variable mucociliary transport velocity, age 

and weight of patients were presented as mean and 

standard deviation. Paired sample t-test was applied to 

calculate p value and p-value ≤ 0.05 was taken as 

statistically significant.  

R e s u l t s  

Total 140 patients of both genders were included in this 

study. Gender distribution showed that there were more 

males (69.3%) than females (30.7%). Mean age and 

weight of the patients was 32.65±4.93 years and 

62.22±4.93 kg respectively. Majority of the patients 

(65.7%) were in age group 31-45 years. Weight 

distribution showed that large number of patients (61.4%) 

had weight between 61-70 kg (Table 1). Mean age and 

weight of the patients treated with Beclomethasone was 

29.81±3.25years and 60.64±3.40 kg respectively. While 

the mean age and weight of the patients treated with NDS 

was 35.48±4.69 years and 63.8±5.68 kg respectively 

(Table 2). Mean mucociliary transport velocity of the 

patients in two groups at baseline and after one week of  

Table 1: Demographic characteristics of study 

participants (n=140) 

Characteristics Frequency  Percentage  

Gender 

Male 97 69.3 

Female 43 30.7 

Stratified Age (years) 

20-30  48 34.3 

31-45  92 65.7 

Stratified Weight (kg) 

50-60  54 38.6 

61-71  86 61.4 

Descriptive Statistics 

Age (years) Mean±SD  
32.65±4.93 

Weight (kg) 62.22±4.93 

Table 2: Group wise demographic characteristics of 

participants 

Groups Variable Mean±SD 

Beclomethasone 

(n=70) 

Age (years)  29.81±3.25  

Weight (kg) 60.64±3.40  

Nedocromil sodium 

(n=70) 

Age (years) 35.48±4.69  

Weight (kg) 63.80±5.68  



 

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treatment was statistically insignificant with p-values 

0.558 and 0.304 respectively (Table 3).  

D i s c u s s i o n  

Allergic rhinitis is directly correlated with different upper 

respiratory complications leading to acute or chronic 

respiratory diseases. Therefore, different treatment 

strategies are implemented to overcome this disease. 

Antihistamines, decongestants, Nedocromil sodium 

(NDS), glucocorticoids and immunotherapy are the 

preferred modes of treatment. Above all self-care and 

health consciousness are also very important factors to 

avoid these kinds of diseases. In current study, the two 

groups of drugs used in the treatment of this disease 

have been compared in their efficacy. Many studies have 

been presented by different researches on the effects of 

drugs discussed above, over different aspects of 

treatment outcome. Ratner et al in 2002 had conducted a 

research on the effect of Cromolyn sodium on allergic 

rhinitis, which showed positive results of drug relieving the 

major symptoms caused by allergic rhinitis.19 We focused 

on the comparison of treatment efficacy of glucocorticoids 

(Beclomethasone dipropionate) and mast cell stabilizer 

(Nedocromil sodium (NDS). The treatment efficacy was 

evaluated on the basis of mucociliary transport velocity in 

nasal cavity by saccharine dye test. Pelucchi et al in 1995 

described the effectiveness of intranasal Azelastine and 

Beclomethasone dipropionate on seasonal nasal 

symptoms which showed that the later drug had better 

treatment outcome.20 A study presented by Watson et al 

in 1993 showed the effects of Beclomethasone on 

treatment of allergic rhinitis with asthmatic complications 

compared with placebo.  The results concluded the direct 

effect on upper respiratory symptoms due to allergic 

rhinitis and indirect positive effect on lower respiratory 

complications like asthma.21 Svendsen et al in 1989 

proposed in their research there was no significant 

difference in efficacy of Nedocromil sodium and 

Beclomethasone dipropionate in the treatment of allergic 

rhinitis accompanied by asthmatic respiratory disorders.21 

Another study by stafanger et al in 1987 showed effect of 

Beclomethasone dipropionate and Flunisolide on the 

movement of nasal cilia obtained from healthy volunteers 

by gentle scraping. The results showed a minor but 

irreversible decrease in Ciliary Beating Frequency (CBF) 

of the cilia by both drugs.22 

Rudd et al in 1983 described the effect of orally taken 

mast cell stabilizers on exercise-induced asthma. The 

results showed that M&B 22,948 (Z-0-propoxyphenyl-

8azapurin-6-one) a mast cell stabilizer had no significant 

effect on histamine hypersensitivity but significant effect 

on exercise induced asthmatic complications.23 In another 

study, Holmberg et al in 1986 demonstrated the effects of 

Beclomethasone on mucociliary activity in comparison 

with placebo which revealed no significance in the 

results.24 The current study is in comparison with that 

study, especially focusing on outcome variable. The 

results showed that mucociliary transport velocity after 

one week of Bechlomethasone treatment was 7.33±1.27 

mm/minute and of mast cell stabilizer (Nedocromil 

sodium) treatment was 7.82±1.2 mm/minute with p-values 

0.558 and 0.304 showing no significant difference. 

C o n c l u s i o n  

There was no significant difference between the 

mucociliary transport velocity after treatment of 

Beclomethasone and mast cell stabilizer. This shows the 

same effectiveness of both drugs in treatment of allergic 

rhinitis. 

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1. Marogna M, Braidi C, Colombo C, Colombo F, Palumbo L. 
A randomized controlled trial of a phytotherapic compound 
containing Boswellia serrata and bromeline for seasonal 
allergic rhinitis complicated by upper airways recurrent 

Table 3: Comparison of two groups before and after 
treatment 

Groups Time Mucociliary 
transport 
velocity(mm/
minute)  
Mean±S.D 

p-

value 

Bechlomethasone Before 
treatment 

7.46±1.43 0.558 

After 1 
week of 
treatment 

7.33±1.27 

Nedocromil sodium Before 
treatment 

8.01±0.93 0.304 

After 1 
week of 
treatment 

7.82±1.2 



 

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