Which medications in the drug class Corticosteroids, Intranasal are used in the treatment of Pediatric Allergic Rhinitis?

Updated: Jun 04, 2021
  • Author: Jack M Becker, MD; Chief Editor: Harumi Jyonouchi, MD  more...
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Answer

Corticosteroids, Intranasal

This class of medications is most effective. Intranasal corticosteroids are potent anti-inflammatory agents shown to decrease allergic rhinitis symptoms in more than 90% of patients. Presently, 9 medications are available in this class, and all are essentially equivalent in efficacy, although few head-to-head studies have been performed. Mometasone (Nasonex) and fluticasone furoate (Veramyst) have been demonstrated to have a somewhat faster onset of action; however, after one week, no difference is found between medications. Most can be used on a once-daily basis, and all have a similar safety profile. Nasonex is the only medication that did not show an effect on growth at one year. Veramyst did not show a growth effect in a 2-week study that is designed to evaluate for growth affects.

There are 2 nasal inhalers, Qnasl and Zetonna. They are a spray form and allow for better nasal deposition for some patients who like a spray-type inhaler. They have shown to help decrease ocular symptoms. In the spring of 2014, Nasacort (triamcinolone) . Only Qnasl, Zetonna and Nasonex are presently available by prescription. The other are over the counter

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. Beconase AQ is approved for children aged 6 y or older. QNASL is indicated for children aged 4 y or older.

Budesonide intranasal (Rhinocort Aqua)

May decrease number and activity of inflammatory cells, resulting in decreased nasal inflammation.

Ciclesonide intranasal (Omnaris, Zetonna)

Corticosteroid nasal spray indicated for AR. 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.

Flunisolide intranasal (Nasarel)

May decrease number and activity of inflammatory cells, resulting in decreased nasal inflammation.

Fluticasone intranasal (Flonase, Veramyst)

May decrease number and activity of inflammatory cells, resulting in decreased nasal inflammation.  Veramyst is now available as OTC (Brand name: Flonase sensimist)

Mometasone, intranasal (Nasonex)

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).

Triamcinolone, intranasal (Nasacort AQ)

May decrease number and activity of inflammatory cells, resulting in decreased nasal inflammation.


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