Intranasal corticosteroids (INCS) play a significant role in the management of allergic rhinitis, particularly for moderate to severe symptoms NICE CKS. They are considered a first-line treatment option NICE CKS. All intranasal corticosteroids available in the UK are considered equally effective clinically, although their bioavailability varies NICE CKS.
For optimal effect, INCS should ideally be started two weeks prior to a known allergen season, as their maximal effect may not be seen until two weeks after initiating treatment NICE CKS. They are available as drops and sprays, with drops carrying a higher risk of systemic adverse effects due to potential incorrect administration and greater systemic bioavailability NICE CKS.
When choosing an INCS, factors such as systemic drug bioavailability, safety, cost, and ease of device use should be considered NICE CKS. Mometasone furoate and fluticasone furoate have negligible systemic absorption and are favoured for use in children NICE CKS,NICE CKS. For children, it is recommended to consider preparations other than twice-daily beclometasone, as it may suppress growth more than other INCS like fluticasone, mometasone, or triamcinolone NICE CKS. Prolonged treatment with any corticosteroid preparation has the potential to suppress growth in children, so their use in children is generally restricted to those with more severe or persisting symptoms NICE CKS,NICE CKS. Growth monitoring, specifically height, is advised for children receiving prolonged INCS treatment, and referral to a paediatrician should be considered if growth suppression is suspected NICE CKS,NICE CKS. The lowest effective dose should always be used in children NICE CKS.
INCS are also an initial treatment option for allergic rhinitis in people with Obstructive Sleep Apnoea/Hypopnoea Syndrome (OSAHS) who present with nasal congestion NICE NG202. If local adverse effects occur, treatment should be stopped and restarted once the effects settle NICE CKS.