Intranasal Steroids for Children With Allergic Rhinitis

Marcia L. Buck, Pharm.D., FCCP

Pediatr Pharm. 2001;7(5)

Introduction

Intranasal steroids have traditionally been reserved for patients with severe allergic symptoms not controlled by antihistamines alone. Recently, the use of these agents as a first-line therapy has become more common, especially after the release of newer formulations requiring only once or twice daily dosing. In a recent consensus paper, the American College of Allergy, Asthma, and Immunology listed intranasal steroids as the most effective therapy in controlling the symptoms of allergic rhinitis.^[1] There are currently six corticosteroids available in an intranasal dosage form: beclomethasone dipropionate, budesonide, flunisolide, fluticasone propionate, mometasone furoate, and triamcinolone acetate.^[2,3,4,5,6]

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Cite this: Intranasal Steroids for Children With Allergic Rhinitis - Medscape - May 01, 2001.

Introduction
Mechanisms of Action
Potency
Lipophilicity
Onset of Effect and Time to Maximum Effect
Systemic absorption
Clinical efficacy
Adverse effects
Effect on growth
Dosing
Cost
Summary
References
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Antiepileptic hypersensitivity syndrome.

This retrospective review describes 14 children from a single institution with antiepileptic hypersensitivity reactions. Eight of the patients had received phenytoin, six were taking carbamazepine, and the remaining children were taking phenobarbital, alone or in combination with other agents. The average time from initiation of therapy to symptoms was 23.0±14.8 days. All patients had rash and fever, with 71.4% exhibiting an elevated white cell count and over half having an elevated sedimentation rate, elevated aminotransferases, and lymphadenopathy. Bessmertny O, Hatton RC, Gonzalez-Peralta RP. Antiepileptic hypersensitivity syndrome in children.

Ann Pharmacother 2001;35:533-8.

Compatibility of spacers and MDIs. This brief technical report focuses on the utility of spacer devices for improving the function of metered-dose inhalers (MDIs). Spacer-MDI combinations that fail to provide a good fit or are difficult to use, as well as reviews of spacer size, special features, cost, and cleaning instructions are included in tables. Lakamp RE, Berry TM, Prosser TR, et al. Compatibility of spacers with metered-dose inhalers. Am J Health-Syst Pharm 2001;58:585-91.

Naratriptan pharmacokinetics. In this study, the authors evaluated the pharmacokinetic profile of naratriptan in 8 patients between 12 and 16 years of age. Serial blood samples were obtained after a single 2.5 mg oral naratriptan dose. Median time to peak serum concentration was 4 hours, with a range of 1.5-4 hours. Average maximum concentration was 8.0 ng/ml, elimination half-life was 4.9 hrs, and apparent clearance was 558.8 ml/min. Blood pressure, pulse, and electrocardiogram parameters did not change significantly from baseline. From these data, the authors concluded that naratriptan pharmacokinetics in adolescents were similar to values in adults and that no dosing change was necessary. Christensen ML, Eades SK, Fuseau E, et al. Pharmacokinetics of naratriptan in adolescent subjects with a history of migraine. J Clin Pharmacol 2001;41:170-5.

Phenytoin in children with traumatic brain injury. The authors of this study evaluated the metabolism of phenytoin in 10 children after head injury. The patients received a 15-20 mg/kg phenytoin loading dose followed by 7 mg/kg/day. The unbound fraction of phenytoin increased over the 9 day study period from 0.14±0.04 to 0.17±0.04 (p<0.05). A time variant model provided a superior fit of the data in most patients, revealing a low baseline Vmax of 2.82±2.35 mg/kg/day rising to an induced Vmax of 20.79±13.71 mg/kg/day, approximately twice that of most noninjured children, suggesting a more rapid removal of drug. Stowe CD, Lee KR, Storgion SA, et al. Altered phenytoin pharmacokinetics in children with severe, acute traumatic brain injury. J Clin Pharmacol 2001;40:1452-61.

The following actions were taken by the Pharmacy and Therapeutics Committee at their meeting on 4/27/01:

Esomeprazole (Nexium^®), the s-isomer of omeprazole, was added to the Formulary for the treatment of gastrointestinal reflux, erosive esophagitis, and duodenal ulcers. Omeprazole (Prilosec^®) was removed from the Formulary. Pediatric studies have not been conducted with esomeprazole, but dosing of esomeprazole in adults is the same as for omeprazole.
Indocyanine green (IC Green^®) was added to the Formulary for ophthalmic angiography.
Caspofungin (Cancidas^®), a echinocandin antifungal, was added for the treatment of invasive aspergillosis in patients refractory or intolerant of other therapies.
Liposomal amphotericin B (Ambisome^®) was also added to the Formulary. Amphotericin B lipid complex (Abelcet^®) was removed.
The restrictions for eptifibatide (Integrilin^®) were amended to include use as an adjunct to angioplasty with or without stenting.

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Intranasal Steroids for Children With Allergic Rhinitis

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