Intranasal Corticosteroids for Allergic Rhinitis and Nasal Polyps

Introduction to Intranasal Corticosteroids

The American Academy of Allergy, Asthma, and Immunology recommends intranasal corticosteroids as first-line treatment for allergic rhinitis due to their superior efficacy and safety profiles 1, 2

Fluticasone propionate and mometasone furoate are the most widely recommended first-line agents due to their superior efficacy, once-daily dosing convenience, and excellent safety profiles 1, 2
The American College of Allergy, Asthma, and Immunology suggests that intranasal corticosteroids are more effective than oral antihistamines for all nasal symptoms, with high-quality evidence supporting their use as first-line monotherapy 4, 1

For children 2-5 years, triamcinolone acetonide or mometasone furoate are recommended, while for children 4-11 years, fluticasone propionate is an option 2
The American Academy of Pediatrics recommends that children ≥6 years can use budesonide, and adolescents and adults ≥12 years can use any intranasal corticosteroid, typically starting with 2 sprays per nostril once daily 2

The American Academy of Allergy, Asthma, and Immunology states that intranasal corticosteroids have no clinically significant effects on hypothalamic-pituitary-adrenal axis function at recommended doses in adults or children, with a strength of evidence rated as high 4, 3, 5
Fluticasone propionate, mometasone furoate, and budesonide show no growth suppression in children at recommended doses, according to the American College of Allergy, Asthma, and Immunology 3, 2, 5

The American Academy of Allergy, Asthma, and Immunology recommends directing the spray away from the nasal septum to reduce epistaxis risk, and keeping the head tilted downward during administration to prevent medication from draining into the throat 2
The American College of Allergy, Asthma, and Immunology advises against prescribing beclomethasone dipropionate as first-line in children due to documented growth suppression, and against discontinuing therapy when symptoms improve, as continuous daily use is required for maintenance of symptom control 3, 2, 5