Intranasal corticosteroids for allergic rhinitis

• Allergic rhinitis is defined as intermittent (or seasonal) or persistent (or perennial), according to symptom duration and frequency. • Intranasal corticosteroids are the most effective treatment option for moderate-severe symptoms and reduce sneezing, rhinorrhea, itching, post-nasal drip and nasal blockage, and total nasal symptom scores better than antihistamines. • There are currently six intranasal corticosteroids sprays available in the UK: beclometasone, budesonide, flunisolide, fluticasone, mometasone and triamcinolone. Administration is either once or twice a day, depending on the preparation used. • Although the six have not been directly compared in a single trial, there have been a number of comparison studies. Results show that they are all equally effective in controlling the symptoms of allergic rhinitis, both intermittent and persistent. • Corticosteroids are known to be potent inhibitors of nearly every component of the growth axis. There are no long-term comparative studies of once-daily intranasal corticosteroids on growth rate in children and the data from shortand intermittent-term studies is very limited. From one-year studies it appears that twice daily beclometasone can slow growth velocity in prepubertal children, whilst once daily mometasone, triamcinolone, fluticasone and budesonide do not affect growth velocity. It is possible that detectable growth suppression may only be seen with twice daily administration. • The effects of inhaled corticosteroids on growth velocity cannot be extrapolated to intranasal corticosteroids. It is questionable whether the effects on childhood growth seen in intermediate-term studies of intranasal corticosteroids for allergic rhinitis result in reduced adult height. • When agents in a given treatment class have similar efficacy and safety profiles, other product attributes can play a pivotal role in choosing a product. Sensory perception questionnaires have evaluated patient’s preferences and acceptability of the intranasal corticosteroids with respect to factors such as overall comfort during administration, medication run-off, odour and taste. • There has not been a direct comparison of all six intranasal corticosteroids with regard to patient preference. • Triamcinolone was preferred by patients when compared with beclometasone, fluticasone and mometasone in two studies. • Other studies showed that mometasone was preferred over budesonide, fluticasone and beclometasone (in that order), whilst budesonide was preferred over fluticasone.