Continuous Use of Intranasal Corticosteroids for Allergic and Non-Allergic Rhinitis

Safety of Long-Term Use

Intranasal corticosteroids are the most effective medication class for controlling symptoms of allergic rhinitis, including sneezing, itching, rhinorrhea, and nasal congestion, according to the American Academy of Allergy, Asthma, and Immunology 1, 2
Unlike topical decongestants, intranasal corticosteroids do not cause rebound congestion and can be used for extended periods, as recommended by the American College of Allergy, Asthma, and Immunology 3
When used at recommended doses, intranasal corticosteroids are not generally associated with clinically significant systemic side effects, as stated by the American Academy of Allergy, Asthma, and Immunology 1, 4

Continuous daily use of intranasal corticosteroids is more effective than as-needed use for seasonal allergic rhinitis, with significant relief provided, according to the American College of Allergy, Asthma, and Immunology 1
The onset of therapeutic effect occurs between 3-12 hours, but several days of continuous use are needed to build up to full effectiveness, as recommended by the American Academy of Allergy, Asthma, and Immunology 1

Patients should be instructed to direct sprays away from the nasal septum to minimize local side effects, such as nasal irritation and bleeding, as advised by the American Rhinologic Society 3, 5
The nasal septum should be periodically examined to ensure there are no mucosal erosions, which may suggest increased risk for subsequent septal perforation, according to the American Rhinologic Society 3, 5

In patients with chronic rhinosinusitis, intranasal corticosteroids should be continued even after endoscopic sinus surgery, as recommended by the European Rhinologic Society 6, 5
Different intranasal corticosteroid formulations have similar clinical efficacy despite differences in potency, lipid solubility, and binding affinity, according to the American College of Allergy, Asthma, and Immunology 2