Allergic rhinitis intranasal corticosteroids

Antihistamines and intranasal corticosteroids are considered first-line therapy for allergic rhinitis, whereas decongestants, mast cell stabilizers, leukotriene modifiers, and systemic corticosteroids are secondary treatment options. 

The anti-inflammatory actions of intranasal corticosteroids make them highly effective agents for allergic rhinitis treatment, especially as first-line treatment for patients presenting with persistent or moderate to severe allergic rhinitis. 

Intranasal corticosteroids are the most effective anti-inflammatory agents used in pediatric patients with allergic rhinitis. Although fewer studies have been conducted in children, results demonstrate that intranasal corticosteroids are effective and well tolerated, with an adverse-effect profile similar to placebo. Mometasone is indicated for children as young as 2 years of age, fluticasone is indicated for children 4 years of age and older, and beclomethasone, budesonide, flunisolide, and triamcinolone are indicated for children 6 years and older.15 Because concerns regarding effect of intranasal steroids on growth exist, the growth of pediatric patients prescribed intranasal steroids should be monitored routinely via stadiometry. 

Transgrund AJ, Whitaker AL, Small RE. Intranasal corticosteroids for allergic rhinitis. Pharmacotherapy 2002 22 1458-1467. van Cauwenberge P, Bachert C, Passalacqua G, et al. Consensus statement on the treatment of allergic rhinitis. Allergy 2000 55 116-134. 

Intranasal corticosteroids are the most effective treatment for allergic rhinitis during pregnancy. Beclomethasone and budesonide have been used most. Nasal cromolyn and first-generation antihistamines (chlorpheniramine, tripelennamine, and hydroxyzine) are also considered first-line therapy. Loratadine and cetirizine have not been as extensively studied. 

Salib RJ, Howarth PH. Safety and tolerability profiles of intranasal antihistamines and intranasal corticosteroids in the treatment of allergic rhinitis. Drug Saf 2003 26 863-93. 

Bennett ML, Fountain JM, McCarty MA, Sherertz EF. Contact allergy to corticosteroids in patients using inhaled or intranasal corticosteroids for allergic rhinitis or asthma. Am J Contact Dermat 2001 12(4) 193-6. 

Antihistamines and intranasal corticosteroids are the first-line treatments for allergic rhinitis. Sodium cromoglicate, ipratropium bromide and decongestants, are alternative or add-on treatments. Drug treatment should be selected according to the severity, frequency and duration of symptoms ... 

Quintiliani R. Hypersensitivity and adverse reactions associated with the use of newer intranasal corticosteroids for allergic rhinitis. Curr Ther Res Clin Exp 1996 57 478-88. 

The reasons for not including or only briefly mentioning this subject may include (1) a misconception that symptoms of allergic rhinitis are trivial and can be easily alleviated with the use of oral antihistamines and/or intranasal corticosteroids (2) an underestimation of the effect of allergic rhinitis on the quality of life, and (3) a lack of controlled trials of education in allergic rhinitis. 

Budesonide is a corticosteroid/flucocorticoid/intranasal steroid. It exhibits a wide range of inhibitory activities against multiple cell types and mediators involved in aller-gic-mediated inflammation. Its indications are Intranasal management of seasonal and perennial allergic rhinitis symptoms in adults and children oral inhalation for the maintenance treatment of asthma as prophylactic therapy in adults and children and for patients requiring oral corticosteroid therapy for asthma inhalation suspension maintenance treatment of asthma and prophylactic therapy in children 12 months to 8 years of age oral capsule Crohn s disease. 

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