Effect of Topical Nasal Corticosteroids on Patients With Chronic Fatigue Syndrome and Rhinitis

Kakumanu et alOriginal Contribution Background: Chronic fatigue syndrome (CFS) is a dis- abling illness of persistent fatigue. Recent studies have shown that patients with CFS have an increased preva- lence of nonallergic rhinitis. Inflammation of the nasal passages due to allergic rhinitis can cause nasal congestion resulting in an increased number of sleep disturbances and daytime fatigue. While topical nasal corticosteroids have been shown to alleviate nasal obstruction effectively in patients with rhinitis who do not have CFS, it is unknown whether topical nasal corticosteroids will reduce CFS symptoms. Study Objective: The purpose of this study is to determine whether topical nasal corticosteroids will reduce daytime sleepiness in patients with CFS and rhinitis. Methods: Twenty-eight of 31 subjects with rhinitis and a diagnosis of CFS completed the double-blind, random- ized, placebo-controlled trial. Two subjects failed screening, and 3 subjects withdrew from the study prior to its com- pletion. Subjects were randomized according to Balaam's crossover design, and one of the following interventions was used for each group in the study: 8-week treatment with a topical nasal corticosteroid, 8-week treatment with a placebo saline spray, 4-week treatment with a topical nasal corticosteroid followed by a 4-week treatment with a placebo saline spray, or a 4-week treatment with a placebo saline spray followed by a 4-week treatment with a topical nasal corticosteroid. Data focusing on rhinitis symptoms, severity of chronic fatigue symptoms, and quality of life were gathered at biweekly office visits and with daily diaries. Results: The results indicated that daytime sleepiness was reduced when patients with rhinitis and CFS were treated with topical nasal corticosteroids. The severity of associated CFS symptoms, specifically fatigue, muscle pain, post- exertional fatigue, and daily activity, did not improve with treatment.