Nasal Steroid Dosing for Allergic Rhinitis and Adenoid Hypertrophy in Children

Dosing Recommendations

For children 2-5 years with allergic rhinitis, the American Academy of Pediatrics recommends 1 spray per nostril once daily of triamcinolone acetonide 1
For children ≥12 years with allergic rhinitis, the American College of Allergy, Asthma, and Immunology recommends 2 sprays per nostril once daily of fluticasone furoate, with a total daily dose of 110 μg 2
For adenoid hypertrophy, the same dosing as allergic rhinitis is typically used, with an emphasis on continuous rather than as-needed use, as recommended by the American Academy of Otolaryngology 3, 4

Intranasal corticosteroids demonstrate superior efficacy compared to antihistamines and leukotriene antagonists for both allergic rhinitis and adenoid hypertrophy, with a strength of evidence rated as high by the Journal of Allergy and Clinical Immunology 4, 5
The onset of therapeutic effect occurs between 3-12 hours, with maximum efficacy reached in days to weeks, according to the American College of Allergy, Asthma, and Immunology 6, 2

Studies with fluticasone propionate, mometasone furoate, and budesonide at recommended doses have shown no effect on growth compared to placebo, with a strength of evidence rated as moderate by the Journal of Allergy and Clinical Immunology 7, 1
No clinically significant effect on the hypothalamic-pituitary-adrenal axis has been demonstrated in children at recommended doses, as reported by the American Academy of Pediatrics 4

The American College of Allergy, Asthma, and Immunology recommends priming the bottle before first use, having the child blow their nose prior to using the spray, and keeping the head in an upright position during administration 1, 2
The contralateral technique, where the spray is held in the opposite hand in relation to the nostril being treated, reduces the risk of epistaxis, according to the Journal of Allergy and Clinical Immunology 1

Local side effects such as nasal irritation, epistaxis, and nasal septal perforation are rare, with a strength of evidence rated as low by the Journal of Allergy and Clinical Immunology 7
Proper administration technique can minimize side effects, as recommended by the American Academy of Otolaryngology 7, 1