What role do intranasal corticosteroids play in the management of allergic rhinitis?

Intranasal corticosteroids (INCS) play a significant role in the management of allergic rhinitis, particularly for moderate to severe symptoms ². They are considered a first-line treatment option ². All intranasal corticosteroids available in the UK are considered equally effective clinically, although their bioavailability varies ¹.

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 ². 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 ¹.

When choosing an INCS, factors such as systemic drug bioavailability, safety, cost, and ease of device use should be considered ¹. Mometasone furoate and fluticasone furoate have negligible systemic absorption and are favoured for use in children ¹,². 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 ¹. 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 ¹,². 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 ¹,². The lowest effective dose should always be used in children ².

INCS are also an initial treatment option for allergic rhinitis in people with Obstructive Sleep Apnoea/Hypopnoea Syndrome (OSAHS) who present with nasal congestion ³. If local adverse effects occur, treatment should be stopped and restarted once the effects settle ¹.