Side Effects of Intranasal Steroids for Allergic Rhinitis

Introduction to Side Effects

Intranasal corticosteroids, when given in recommended doses, are not generally associated with clinically significant systemic side effects, according to the American Academy of Allergy, Asthma, and Immunology 1, 2, 3

Nasal irritation and bleeding are the most common local side effects but are relatively rare and can be minimized with proper administration technique, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 4
Burning or stinging sensations, especially with propylene glycol-containing solutions, may occur in some patients 4
Nasal septal perforations are extremely rare but have been reported with long-term use, as noted by the American Academy of Allergy, Asthma, and Immunology 1, 4
Preparations containing propylene glycol and benzalkonium chloride may result in local irritation or ciliary dysfunction, according to the American College of Allergy, Asthma, and Immunology 1, 4

Studies in both children and adults have failed to demonstrate any consistent, clinically relevant systemic effects from intranasal corticosteroids when used at recommended doses, as reported by the American Academy of Allergy, Asthma, and Immunology 1, 2
No significant effects on the hypothalamic-pituitary-adrenal (HPA) axis have been found, according to the American College of Allergy, Asthma, and Immunology 1, 2
No significant effects on ocular pressure or cataract formation have been reported, as noted by the American Academy of Ophthalmology 1, 2, 4
No significant effects on bone density in adults have been found, according to the American College of Rheumatology 1, 2

Growth effects are a potential concern in children, but studies with intranasal fluticasone propionate, mometasone furoate, and budesonide have shown no effect on growth at recommended doses compared with placebo, as reported by the American Academy of Pediatrics 1, 2
Growth suppression has been reported only with long-term use of beclomethasone dipropionate that exceeded recommended doses, or administration to toddlers, according to the American Academy of Pediatrics 1, 2

Direct sprays away from the nasal septum to prevent repetitive direct application, as recommended by the American Academy of Allergy, Asthma, and Immunology 4, 5
The nasal septum should be periodically examined to ensure there are no mucosal erosions, according to the American Academy of Otolaryngology-Head and Neck Surgery 4, 5

Unlike oral decongestants, intranasal corticosteroids do not cause insomnia, loss of appetite, irritability, or palpitations, as noted by the American College of Allergy, Asthma, and Immunology 7
Unlike topical decongestants, they can be used long-term without risk of rhinitis medicamentosa, according to the American Academy of Allergy, Asthma, and Immunology 6, 7