Corticosteroids rhinitis

Rhinitis is characterized by nasal stuffiness with partial or full obstmction, and itching of the nose, eyes, palate, or pharynx, sneezing, and rhinorrhoea. If left untreated it can lead to more serious respiratory diseases such as sinusitis or asthma. Although several types of dmgs are available for treatment, nasal spray topical corticosteroids are widely regarded as the reference standard in rhinitis therapy (250). 

The corticosteroids are used in the management and prophylactic treatment of the inflammation associated with chronic asthma or allergic rhinitis. 

Up to 80% of asthmatics have symptoms of rhinitis, and inflammation of the upper airways may increase AHR.1,3 Treatment of rhinitis with intranasal corticosteroids may improve asthma symptoms and is recommended for asthma patients with rhinitis. 

Budesonide (Rhinocort) 32 meg spray, 1-4 sprays in each nostril daily Preferred corticosteroid for allergic rhinitis. 

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. 

Topical intranasal decongestants (e.g., oxymetolazine, xylome-tolazine, phenylephrine, and naphazoline) are OTC options that provide prompt relief of nasal congestion. Nasal decongestants are dosed multiple times daily.15 Tachyphylaxis, rebound congestion, and rhinitis medicamentosa may occur with chronic use therefore, use should be limited to 3 to 5 days.8,12 These may be used 5 to 10 minutes before administration of intranasal corticosteroids in patients with blocked nasal passages.15... 

Systemic corticosteroids, administered orally or by depot injection, are considered last-resort options when all other treatments for SAR are inadequate. Systemic steroids may be used to control rhinitis symptoms in patients with severe PAR or nasal polyposis. Data comparing oral and parenteral steroid therapy are lacking however, oral therapy is preferred due to its low cost... 

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. 

Azelastine nasal spray is indicated for children 5 years of age and older and is considered an alternative to intranasal corticosteroids in patients with persistent severe symptoms. Intranasal cromolyn, another commonly used agent in children, is indicated in patients 2 years of age and older and has an acceptable safety profile. However, limited efficacy and multiple daily administrations limit its use to mild and early rhinitis or for prophylaxis of a known imminent exposure. 

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. 

Both budesonide and fluticasone are corticosteroids but fluticasone is more potent than budesonide and has a higher first-pass effect, hence more of the drug is metabolised leading to fewer adverse effects. A dose of 100 pg of budesonide is equivalent to 50 pg of fluticasone. Both budesonide and fluticasone are indicated for the prophylaxis of allergic rhinitis (hay fever). 

Fluticasone is a potent corticosteroid that is available as a nasal spray indicated in allergic rhinitis (hay fever) and as an inhaler used in asthma. 

There are a number of corticosteroids that are used in pulmonology as inhalation medications. For rhinitis sprays may be used which also contain corticosteroids. Coricosteroids in these topical medications include beclometasone, fluticasone, mometa-sone and also budesonide. 

Nasal corticosteroids are effective in vasomotor rhinitis, but because of the duration of the disorder, certain caution is advised to avoid systemic effects and local adverse reactions after long-term use. Ipratropium bromide spray works well if the dominating problem is runny nose. 

Fluorination of corticosteroids at C-9 or/and C-6 increases glucocorticoid activity, while mineralocorticoid activity, responsible for sodium retention (the main adverse effect of corticoids), is decreased (cf. Chapter 4). Fluorocorticoster-oids were the first fluorinated compounds to be used clinically. They are still major drugs against many inflammatory disorders rheumatoid polyarthritis, ORL (asthma, rhinitis), brain edema, dermatological, allergies, anaphylactic shock, Quincke s edema). 

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. 

Isaksson M, Bruze M, Hornblad Y, Svenonius E, Wihl JA. Contact allergy to corticosteroids in asthma/rhinitis patients. Contact Dermatitis 1999 40(6) 327-8. 

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. 

Clavel R, Andre C, Bousquet J Reduction of corticosteroid therapy by sublingual immunotherapy. Double blind study against placebo of standardised 5 grass pollen extract in rhinitis. Allergy 1995 50/26 279. 

Studies of omalizumab in asthmatic volunteers showed that its administration over 10 weeks lowered plasma IgE to undetectable levels and significantly reduced the magnitude of both the early and the late bronchospastic responses to antigen challenge. Clinical trials have shown repeated intravenous or subcutaneous injection of anti-IgE MAb to lessen asthma severity and reduce the corticosteroid requirement in patients with moderate to severe disease, especially those with a clear environmental antigen precipitating factor, and to improve nasal and conjunctival symptoms in patients with perennial or seasonal allergic rhinitis. 

Corticosteroids—a group of anti-inflammatory drugs similar to the natural corticosteroid hormones produced by the cortex of the adrenal glands. The disorders that often improve upon corticosteroid treatment include asthma, allergic rhinitis, eczema, and rheumatoid arthritis. 

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 ... 

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