Which medications in the drug class Nasal corticosteroids are used in the treatment of Allergic Rhinitis?

Answer

Nasal corticosteroids

The intranasal steroids are divided into three generations based on their bioavailability. First generation corticosteroids, such as, beclomethasone, are more bioavailable and tend to produce more systemic adverse effects than newer intranasal corticosteroids. The second- and third-generation categories are less bioavailable and have limited systemic adverse effects.

Nasal steroid sprays are highly efficacious in treating allergic rhinitis.^{[97, 98, 99, 100, 101]}They control the 4 major symptoms of rhinitis (ie, sneezing, itching, rhinorrhea, congestion). They are effective as monotherapy, although they do not significantly affect ocular symptoms. Studies have shown nasal steroids to be more effective than monotherapy with nasal cromolyn or antihistamines.^{[98, 99]}Greater benefit may occur when nasal steroids are used with other classes of medication. They are safe to use and not associated with significant systemic adverse effects in adults (this may also be true for children, but the data are less clear).

In October 2013, the FDA approved once-daily triamcinolone acetonide (Nasacort Allergy 24HR) nasal spray as an over-the-counter treatment for nasal allergy symptoms in children aged 2 years or older, adolescents, and adults. It is the first over-the-counter glucocorticoid approved for the treatment of nasal allergy symptoms.Flonase was approved by FDA to be available over the counter on July 24, 2014, and Rhinocort was recently approved last year March 23, 2015.^[102]

Local adverse effects of nasal steroid sprays are limited to minor irritation or nasal bleeding, which resolve with temporary discontinuation of the medication. Nasal septal perforations are rarely reported and are less common with the newer corticosteroids and delivery systems. Safety during pregnancy has not been established; however, clinical experience suggests nasal corticosteroids (particularly beclomethasone, which has most experience in use) are not associated with adverse fetal effects.

The nasal steroids can be used prn, but seem to be maximally effective when used on a daily basis as maintenance therapy. They may also be helpful for vasomotor rhinitis or mixed rhinitis (a combination of vasomotor and allergic rhinitis) and can help to control nasal polyps.

Beclomethasone, intranasal (Beconase AQ, QNASL)

Corticosteroid with potent anti-inflammatory properties. Elicits effects on various cells, including mast cells and eosinophils. It also elicits effects on inflammatory mediators (eg, histamine, eicosanoids, leukotrienes, cytokines). Available in solution or suspension forms and delivered as a metered-dose nasal sprays.

Budesonide, intranasal (Rhinocort Aqua, Rhinocort Allergy)

Corticosteroid considered efficacious and safe for allergic rhinitis. May decrease number and activity of inflammatory cells, resulting in decreased nasal inflammation.

Fluticasone (Flonase Allergy Relief, GoodSense Nasoflow, Ticaspray, Veramyst)

Intranasal corticosteroid. Indicated for seasonal and perennial allergic rhinitis. Relieves nasal symptoms associated with allergic rhinitis. Has also demonstrated improvement in allergic eye symptoms. May decrease number and activity of inflammatory cells, resulting in decreased nasal inflammation.

Ciclesonide (Omnaris, Zetonna)

Newer corticosteroid nasal spray indicated for allergic rhinitis. Prodrug that is enzymatically hydrolyzed to pharmacologic active metabolite C21-desisobutyryl-ciclesonide following intranasal application. Corticosteroids have a wide range of effects on multiple cell types (eg, mast cells, eosinophils, neutrophils, macrophages, lymphocytes) and mediators (eg, histamines, eicosanoids, leukotrienes, cytokines) involved in allergic inflammation. Each spray delivers 50 mcg.

Triamcinolone (Nasacort Allergy 24 HR, Nasal Allergy 24 HR)

Intranasal corticosteroid efficacious and safe for allergic rhinitis. May decrease number and activity of inflammatory cells, resulting in decreased nasal inflammation.

Mometasone, intranasal (Nasonex, Propel Mini)

Nasal spray; may decrease number and activity of inflammatory cells, resulting in decreased nasal inflammation. Demonstrated no mineralocorticoid, androgenic, antiandrogenic, or estrogenic activity in preclinical trials. Decreases rhinovirus-induced up-regulation in respiratory epithelial cells and modulate pretranscriptional mechanisms. Reduces intraepithelial eosinophilia and inflammatory cell infiltration (eg, eosinophils, lymphocytes, monocytes, neutrophils, plasma cells).

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Javed Sheikh, MD Assistant Professor of Medicine, Harvard Medical School; Clinical Director, Division of Allergy and Inflammation, Clinical Director, Center for Eosinophilic Disorders, Beth Israel Deaconess Medical Center

Javed Sheikh, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology

Disclosure: Received grant/research funds from Genentech for other.

Coauthor(s)

Tiffany Jean, MD Fellow, Department of Allergy and Immunology, Kaiser Permanente Los Angeles Medical Center

Tiffany Jean, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Stephen C Dreskin, MD, PhD Professor of Medicine, Departments of Internal Medicine, Director of Allergy, Asthma, and Immunology Practice, University of Colorado Health Sciences Center

Stephen C Dreskin, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association for the Advancement of Science, American College of Allergy, Asthma and Immunology, Clinical Immunology Society, Joint Council of Allergy, Asthma and Immunology, American Association of Immunologists

Disclosure: Received consulting fee from Genentech for consulting; Received grant support from NIH for research; Received consulting fee from Clinical Immunization and Safety Assessment (CISA) Network (administered by Vanderbilt University) for consulting; Received consulting fee from o Member, Medical Expert Panel, Division of Vaccine Injury Compensation (DVIC), Department of Health and Human Services. for med legal reviews; Received consulting fee from o Member, Medical Expert Panel, Vaccine Review, Pfize.

Chief Editor

Michael A Kaliner, MD Clinical Professor of Medicine, George Washington University School of Medicine; Medical Director, Institute for Asthma and Allergy

Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, Association of American Physicians

Disclosure: Nothing to disclose.

Additional Contributors

William F Schoenwetter, MD Consultant in Allergic Diseases, Brainerd Medical Center, Brainerd, Minnesota

William F Schoenwetter, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Physicians, American Medical Association, Joint Council of Allergy, Asthma and Immunology, Minnesota Medical Association

Disclosure: Nothing to disclose.

Umer Najib, MD Clinical Research Fellow, Department of Medicine, Division of Allergy and Inflammation, Beth Israel Deaconess Medical Center

Disclosure: Nothing to disclose.

Which medications in the drug class Nasal corticosteroids are used in the treatment of Allergic Rhinitis?

Nasal corticosteroids

Beclomethasone, intranasal (Beconase AQ, QNASL)

Budesonide, intranasal (Rhinocort Aqua, Rhinocort Allergy)

Fluticasone (Flonase Allergy Relief, GoodSense Nasoflow, Ticaspray, Veramyst)

Ciclesonide (Omnaris, Zetonna)

Triamcinolone (Nasacort Allergy 24 HR, Nasal Allergy 24 HR)

Mometasone, intranasal (Nasonex, Propel Mini)

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Which medications in the drug class Nasal corticosteroids are used in the treatment of Allergic Rhinitis?

Nasal corticosteroids

Beclomethasone, intranasal (Beconase AQ, QNASL)

Budesonide, intranasal (Rhinocort Aqua, Rhinocort Allergy)

Fluticasone (Flonase Allergy Relief, GoodSense Nasoflow, Ticaspray, Veramyst)

Ciclesonide (Omnaris, Zetonna)

Triamcinolone (Nasacort Allergy 24 HR, Nasal Allergy 24 HR)

Mometasone, intranasal (Nasonex, Propel Mini)

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