Nasal glucocorticoids

Levocabastine (Livostin) and olopatadine (Patanol) are ophthalmic antihistamines that can be used for allergic conjunctivitis that is often associated with allergic rhinitis. However, systemic antihistamines are usually effective for allergic conjunctivitis, making an ocular product unnecessary. They may be a logical addition to nasal glucocorticoids when ocular symptoms occur. 

Topical administration to the nose The safety of nasal glucocorticoids in the treatment of allergic rhinitis has been reviewed (434,435). The local application of glucocorticoids for seasonal or perennial rhinitis often results in systemic adverse effects. The use of nasal sprays containing a glucocorticoid that has specific topical activity (such as beclomethasone dipropionate or flunisolide) seems to reduce the systemic adverse effects, but they can nevertheless occur, even to the extent of suppression of basal adrenal function in children (436). Local adverse effects include Candida infection, nasal stinging, epistaxis, throat irritation (437), and, exceptionally, anosmia (438). 

Benign intracranial hypertension with nasal glucocorticoids has been reported (439). 

Garbe E, LeLorier J, Boivin JF, Suissa S. Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma. JAMA 1997 277(9) 722-7. 

The male client taking a nasal glucocorticoid spray calls the clinic nurse and reports that the medication is not helping his condition. Which question should the nurse ask the client first ... 

Glaucoma and ocular hypertension have been reported after dermal application of glucocorticoids for facial atopic eczema (SEDA-19,376) (64), and after treatment with beclomethasone by nasal spray and inhalation (SEDA-20, 373 65). 

Toxic optic neuropathy can occur and may underlie various reports of sudden blindness in patients taking glucocorticoids. In one case, transient visual loss occurred on several occasions, each time after administration of a glucocorticoid (SEDA-17, 447). In another case, blindness occurred suddenly and paradoxically after glucocorticoid injections into the nasal turbinates (78). Although glucocorticoids are sometimes used successfully to relieve... 

Osteonecrosis of the femoral head after the use of a glucocorticoid nasal spray has been reported (445). 

Luengo M, Pons F, Martinez de Osaba MJ, Picado C. Prevention of further bone mass loss by nasal calcitonin in patients on long term glucocorticoid therapy for asthma a two year follow up study. Thorax 1994 49(11) 1099-102. 

In case of an obstruction of the nasal airways, the swelling should first be reduced and then the patient should apply the anti-inflammatory medication to ensure its necessary distribution over the complete mucosa. Antihistamines in addition to oral therapy may also be applied locally, intranasally or conjunctivally. The combination of all three substance groups (H, antihistamines, topic glucocorticoids and antileukotrienes) as a pretreatment as well as a symptomatic treatment during immunotherapy increases the chances of success of hyposensitization in our experience [unpubl. data]. 

Excessive lacrimation and other ocular disturbances have been reported secondary to intravenous fluorouracil (64-66). In a review of this subject, blurred vision, excessive lacrimation, excessive nasal discharge, and conjunctivitis were the most commonly reported ocular effects of fluorouracil (67). The symptoms, eye irritation and excessive tear production, can be aggravated by cold weather. The onset of symptoms varies from 15 minutes to 14 months after the start of treatment (64). The symptoms usually resolve 2-3 weeks after withdrawal of therapy, with or without the use of topical antibiotic-glucocorticoid combinations (64,67). 

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