Allergic rhinitis (AR) is currently the most common chronic disease in children in the United States, affecting as many as 40% of the children in the population. AR can substantially decrease a child’s quality of life and can contribute to school absenteeism. Intranasal corticosteroids (INS) are thought to be the most effective treatment choice for controlling the symptoms of AR. However, parent and physician concerns over INS safety in children have often led to INS being used as a second-line treatment option. More recently, safety studies have shown that the newer INS agents have improved safety profiles compared with older INS agents. The newer INS drugs have been found to have minimal adverse effects on growth and hypothalamic-pituitary-adrenal-axis function in children, which is a concern when prescribing corticosteroids. This review will discuss the pathophysiology, diagnosis, and classification of AR. The mechanism of action, efficacy, and safety of INS will also be discussed by focusing on clinical evidence. Furthermore, other considerations, such as parent or caregiver education and patient compliance, will be reviewed.
Get full access to this article
View all access options for this article.
References
1.
U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. Management of Allergic and Nonallergic Rhinitis. AHRQ publication 02:E023, Boston, MA. Summary, Evidence Report/Technology Assessment: Number 54. http://www.ahrq.gov/clinic/epcsums/rhinsum.htm. May 2002.
2.
Blaiss M, Group ARiSC.Allergic rhinitis and impairment issues in school-children: a consensus report. Curr Med Res Opin.2004; 20(12): 1937-1952.
3.
Kay G.The effects of antihistamines on cognition and performance. J Allergy Clin Immunol.2000; 105(6 Pt 2): S622-S627.
4.
Dykewicz MS, Fineman S, Skoner DP, et al.Diagnosis and Management of Rhinitis: Complete Guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol.1998; 81(5 Pt 2): 478-518.
5.
Bousquet J, Cauwenberge PV, Khaltaev N, Aria Workshop Group, World Health Organization. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol.2001; 108(5 Suppl): S147-S334.
Sibbald B, Barnes G, Durham SR.Skin prick testing in general practice: a pilot study. J Adv Nurs.1997; 26(3): 537-542.
10.
Barnes PJ.Molecular mechanisms of glucocorticoid action in asthma. Pulm Pharmacol Ther.1997; 10(1): 3-19.
11.
Holm A, Fokkens W, Godthelp T, et al.Effect of 3 months' nasal steroid therapy on nasal T cells and Langerhans cells in patients suffering from allergic rhinitis. Allergy.1995; 50(3): 204-209.
12.
Mullol J, Xaubet A, Lopez E, et al.Comparative study of the effects of different glucocorticosteroids on eosinophil survival primed by cultured epithelial cell supernatants obtained from nasal mucosa and nasal polyps. Thorax.1995; 50(3): 270-274.
13.
Mullol J, Lopez E, Roca-Ferrer J, et al.Effects of topical anti-inflammatory drugs on eosinophil survival primed by epithelial cells. Additive effect of glucocorticoids and nedocromil sodium. Clin Exp Allergy.1997; 27(12): 1432-1441.
14.
Lumry WR.A review of the preclinical and clinical data of newer intranasal steroids used in the treatment of allergic rhinitis. J Allergy Clin Immunol.1999; 104(4 Pt 1): S150-S158.
15.
Mygind N, Nielsen L, Hoffmann H, et al.Mode of action of intranasal corticosteroids. J Allergy Clin Immunol.2001; 108(1 Suppl): S16-S25.
16.
Meltzer E.The pharmacological basis for the treatment of perennial allergic rhinitis and non-allergic rhinitis with topical corticosteroids. Allergy.1997; 52(36 Suppl): 33-40.
17.
Foresi A.A comparison of the clinical efficacy and safety of intranasal fluticasone propionate and antihistamines in the treatment of rhinitis. Allergy.2000; 55(Suppl 62): 12-14.
18.
Weiner JM, Abramson MJ, Puy RM.Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ. 1998; 317 (7173): 1624-1629.
19.
Berger W, Kaiser H, Gawchik S, et al.Triamcinolone acetonide aqueous nasal spray and fluticasone propionate are equally effective for relief of nasal symptoms in patients with seasonal allergic rhinitis. Otolaryngol Head Neck Surg.2003; 129(1): 16-23.
20.
Mandl M, Nolop K, Lutsky BN.Comparison of once daily mometasone furoate (Nasonex) and fluticasone propionate aqueous nasal sprays for the treatment of perennial rhinitis. The 194-079 Study Group. Ann Allergy Asthma Immunol. 1997; 79(3): 237-245.
21.
Gross G, Garcia J, Faruqi R, et al.Therapeutic equivalence of triamcinolone acetonide HFA and CFC nasal aerosols. Ann Allergy Asthma Immunol.2005; 94(1): 200-200:267-268.
22.
Skoner DP, Rachelefsky GS, Meltzer EO, et al.Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate. Pediatrics.2000; 105(2): E23-E29.
23.
Schenkel EJ, Skoner DP, Bronsky EA, et al.Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics. 2000; 105(2): E22-E28.
24.
Skoner D, Gentile D, Angelini B, et al.The effects of intranasal triamcinolone acetonide and intranasal fluticasone propionate on short-term bone growth and HPA axis in children with allergic rhinitis. Ann Allergy Asthma Immunol.2003; 90(1): 56-62.
25.
Ober S, Gentile D, Kairis E, et al.Growth velocity and HPA axis function during 1-year treatment with triamcinolone acetonide aqueous (TAA) nasal spray in children with allergic rhinitis (AR). J Allergy Clin Immunol. 2005; 115(2): S267-S267.
26.
Wilson AM, Sims EJ, McFarlane LC, Lipworth BJ.Effects of intranasal corticosteroids on adrenal, bone, and blood markers of systemic activity in allergic rhinitis. J Allergy Clin Immunol.1998; 102(4 Pt 1): 598-604.
27.
Boner A.Effects of intranasal corticosteroids on the hypothalamic-pituitary-adrenal axis in children. J Allergy Clin Immunol.2001; 108(1 Suppl): S32-S39.
28.
Allen D.Systemic effects of intranasal steroids: an endocrinologist's perspective. J Allergy Clin Immunol.2000; 106(4 Suppl): S179-S190.
29.
Cervin A, Andersson M.Intranasal steroids and septum perforation—an overlooked complication? A description of the course of events and a discussion of the causes. Rhinology.1998; 36(3): 128-132.
30.
Onrust S, Lamb H.Mometasone furoate. A review of its intranasal use in allergic rhinitis. Drugs.1998; 56(4): 725-745.
31.
Day J, Buckeridge D, Clark R, et al.A randomized, double-blind, placebo-controlled, controlled antigen delivery study of the onset of action of aerosolized triamcinolone acetonide nasal spray in subjects with ragweed-induced allergic rhinitis. J Allergy Clin Immunol.1996; 97(5): 1050-1057.
32.
Selner J, Weber R, Richmond G, et al.Onset of action of aqueous beclomethasone dipropionate nasal spray in seasonal allergic rhinitis. Clin Ther. 1995; 17(6): 1099-1109.
33.
Bachert C, El-Akkad T.Patient preferences and sensory comparison of three intranasal corticosteroids for the treatment of allergic rhinitis. Ann Allergy Asthma Immunol.2002; 89: 292-297.
34.
Gerson I, Green L, Fishken D.Patient preference and sensory comparisons of nasal spray allergy medications. J Sen Stud.1999; 14: 491-496.
35.
Shah SR, Miller C, Pethick N, et al.Two multicenter, randomized, single-blind, single-dose, crossover studies of specific sensory attributes of budesonide aqueous nasal spray and fluticasone propionate nasal spray. Clin Ther. 2003; 25(8): 2198-2214.
36.
Weber R, Garcia J, Faruqi R, et al, The Study 405 Investigator Group. Longterm safety and efficacy of a triamcinolone acetonide hydrofluroalkane-134A (HFA)-nasal aerosol in patients with persistent allergic rhinitis. Ann Allergy Asthma Immunol.2005; 94 (1): 199-199:264-265.
37.
Bachert C, Cauwenberge Pv, Khaltaev N, World Health Organization. Allergic Rhinitis and Its Impact on Asthma. In Collaboration with the World Health Organization. Executive Summary of the Workshop Report. 7-10 December 1999, Geneva, Switzerland. Allergy. 2002; 57(9): 841-855.
