Intranasal Corticosteroids for Allergic Rhinitis

Amanda J. Trangsrud, PharmD, Amy L. Whitaker, PharmD, Ralph E. Small, PharmD

Disclosures

Pharmacotherapy. 2002;22(11) 

In This Article

Abstract and Introduction

Abstract

Intranasal corticosteroids are accepted as safe and effective first-line therapy for allergic rhinitis. Several intranasal corticosteroids are available: beclomethasone dipropionate, budesonide, flunisolide, fluticasone propionate, mometasone furoate, and triamcinolone acetonide. All are efficacious in treating seasonal allergic rhinitis and as prophylaxis for perennial allergic rhinitis. In general, they relieve nasal congestion and itching, rhinorrhea, and sneezing that occur in the early and late phases of allergic response, with studies showing almost complete prevention of late-phase symptoms. The rationale for topical intranasal corticosteroids in the treatment of allergic rhinitis is that adequate drug concentrations can be achieved at receptor sites in the nasal mucosa. This leads to symptom control and reduces the risk of systemic adverse effects. Adverse reactions usually are limited to the nasal mucosa, such as dryness, burning and stinging, and sneezing, together with headache and epistaxis in 5-10% of patients regardless of formulation or compound. Differences among agents are limited to potency, patient preference, dosing regimens, and delivery device and vehicle.

Introduction

Allergic rhinitis affects approximately 40 million people each year in the United States -- 10-30% of adults and up to 40% of children.[1,2] Total direct costs are estimated to be $4.5 billion/year, with many as 3.8 million missed days of work and school/year increasing indirect costs associated with the condition.[2] It is a significant health problem with economic burdens, and it impairs patients' quality of life. Allergic rhinitis can cause serious complications to eustachian tubes, nose, and sinuses, and is considered a risk factor for development of asthma.[3,4] In several studies intranasal corticosteroids played a significant role in improving health-related quality of life through their ability to control symptoms.[5] The drugs have proved to be safe and effective for treatment of allergic rhinitis, and they now are accepted as first-line therapy.[6,7,8,9,10] Those that are available are beclomethasone dipropionate, budesonide, flunisolide, fluticasone propionate, mometasone furoate, and triamcinolone acetonide. All are efficacious in treatment of seasonal allergic rhinitis and prophylaxis of perennial allergic rhinitis. With several agents to choose from, it is important to consider their differences.[6,10]

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