Allergic Rhinitis Treatment Guidelines

Introduction to Fluticasone Propionate

The American Academy of Otolaryngology-Head and Neck Surgery recommends a dose of 2 sprays per nostril once daily (total 200 mcg/day) of Flonase (fluticasone propionate) for adults with allergic rhinitis, and 1 spray per nostril once daily (100 mcg/day) for children aged 4-11 years, and 2 sprays per nostril once daily (200 mcg/day) for children aged 12-17 years 1

Common side effects of fluticasone propionate include headache, pharyngitis, epistaxis, nasal burning/irritation, nausea/vomiting, asthma symptoms, and cough, with a favorable safety profile when used as directed, and minimal systemic activity due to low absorption from the gut 1

The American Academy of Otolaryngology-Head and Neck Surgery recommends the following dosing guidelines for nasal medications in children:

Age	Medication	Dosage
2-5 years	Triamcinolone acetonide	1 spray per nostril daily
2-5 years	Mometasone furoate	1 spray per nostril daily
2-5 years	Fluticasone furoate	1-2 sprays per nostril daily
6-11 years	Triamcinolone acetonide	2 sprays per nostril daily
6-11 years	Flunisolide	1 spray per nostril 3 times daily or 2 sprays twice daily
6-11 years	Budesonide	2 sprays per nostril twice daily
12+ years	Most medications	Follow adult dosing patterns

For pediatric nasal medication administration, use age-appropriate dosing and proper technique with the child's head in the correct position, keeping the head upright and directing the spray away from the nasal septum to prevent irritation, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery and the Rhinology society 1, 2
The American Academy of Otolaryngology-Head and Neck Surgery and the Rhinology society also recommend inserting the tip gently into the nostril, having the child breathe in slowly while spraying, avoiding spraying toward the nasal septum, using the right hand to spray the left nostril and vice versa, and having the child lie down with their head tilted back for optimal delivery 1, 2
To prevent infection spread, the Rhinology society recommends avoiding medication sharing between children 2
The Journal of Allergy and Clinical Immunology recommends examining the nasal septum periodically when using corticosteroid sprays to check for mucosal erosions, limiting decongestant use to 3 days maximum to prevent rhinitis medicamentosa (rebound congestion), and notes that irregular use of medications like corticosteroids reduces their effectiveness, and overuse of decongestants can lead to rebound congestion within 3-30 days 3