Allergic Rhinitis Treatment with Budesonide and Fluticasone Nasal Sprays

Dosage and Administration

The American Academy of Otolaryngology-Head and Neck Surgery recommends budesonide nasal spray at 2 sprays per nostril twice daily (or 4 sprays per nostril in the morning) for allergic rhinitis in patients 6 years and older, with a total daily dose of 128 μg 1, 2
The American Academy of Otolaryngology-Head and Neck Surgery recommends fluticasone propionate nasal spray at 2 sprays per nostril once daily for adults with allergic rhinitis, with a total daily dose of 200 μg 1, 2
Budesonide is not approved for children under 6 years of age 1
Common side effects of budesonide include epistaxis, pharyngitis, bronchospasm, coughing, and nasal irritation 2
Common side effects of fluticasone propionate include headache, pharyngitis, epistaxis, nasal burning/irritation, nausea, vomiting, asthma symptoms, and cough 1, 2

Intranasal corticosteroids, such as budesonide and fluticasone propionate, are considered the most effective medications for treating allergic rhinitis 3
Regular use of intranasal corticosteroids, rather than as-needed use, is recommended to maintain optimal symptom control 3

The onset of action of intranasal corticosteroids may be delayed, with maximal efficacy reached in days to weeks 3
Local side effects, such as nasal irritation, bleeding, and nasal septal perforation, are rare and can be avoided with proper administration technique 3
Studies have shown no effect on growth at recommended doses of intranasal fluticasone propionate and budesonide compared with placebo 3

At low‑to‑medium daily doses (≈200 µg/day) in patients ≥ 12 years, intranasal fluticasone propionate exhibits a wide safety margin with minimal systemic adverse effects. 4

When administered at higher daily doses, fluticasone propionate may decrease bone mineral density and increase the risk of cataract formation; patients with pre‑existing risk factors for osteoporosis or ocular disease should be monitored accordingly. 4