Corticosteroids for allergic rhinitis

Examples

Nasal sprays (topical corticosteroid aerosols)

Generic Name	Brand Name
budesonide	Rhinocort
flunisolide	Rhinalar
fluticasone propionate	Flonase
mometasone furoate monohydrate	Nasonex
triamcinolone acetonide	Nasacort AQ

Pill (oral-systemic) corticosteroids

Generic Name
prednisone

Injected (systemic) corticosteroids

Generic Name	Brand Name
methylprednisolone acetate	Depo-Medrol
triamcinolone acetonide	Kenalog

How It Works

In allergic rhinitis, corticosteroids reduce swelling and inflammation in the nose, resulting in fewer symptoms.

When you take pill or injected (systemic) corticosteroids, the medicine travels throughout your body. This can result in serious side effects.

When you use nasal corticosteroids, most of the medicine stays in the nose and does not travel throughout the body. This results in fewer and less serious side effects than pill or injected corticosteroids.

Why It Is Used

You may use nasal corticosteroid sprays if your allergy symptoms are mostly in your nose. Your doctor may suggest them:

• When nasal congestion (obstruction) is a major symptom.
• When other medicines have not helped your symptoms.
• When the side effects of other medicines have become a problem.
• Before the beginning of the pollen season in people who are allergic to pollen. This may reduce their symptoms during the season.

Pill or injected corticosteroids are not used as often as nasal corticosteroids because of the possible side effects. Your doctor may suggest them when:

• You have severe symptoms that other medicines have not helped.
• You need short-term treatment of severe allergic rhinitis, and you cannot use nasal sprays (such as if the nose is completely blocked by congestion or you have nasal polyps).
• You need quick control of symptoms.

How Well It Works

Corticosteroids are the most effective medicine currently available for allergic rhinitis.

• Corticosteroids reduce all symptoms of allergic rhinitis, such as sneezing, itching, runny nose, and stuffy nose.
• Nasal corticosteroid sprays are more effective at reducing allergy symptoms, such as nasal blockage, discharge, and itching, than pill antihistamines.
• Corticosteroids start working quickly, but it may be several weeks before you feel the full effect.

Side Effects

Side effects of nasal spray corticosteroids are rare and minimal, even after long periods of continuous use.

• The most common complaint is a burning sensation in the nose right after you use the spray. Some people have an unpleasant aftertaste. Others may have some dryness in the nasal mucous membranes. You can often avoid these side effects by trying another brand.
• Nosebleeds occur in some people who use the nasal spray.

Rare side effects of nasal corticosteroids include:

• Sores in the nose.
• A hole (perforation) that forms in the wall between the nostrils (septum).

Pill or injected corticosteroids are rarely used to treat allergic rhinitis for more than a few days, because they can have serious side effects. Side effects may include:

• Skin breakdown or muscle loss (atrophy).
• Increased bruising.
• Increased blood pressure.
• Weight gain or fluid retention.
• Increased bone loss, contributing to osteoporosis.
• Damage to the blood supply of the bones, which can kill bone cells (avascular osteonecrosis).
• Slowing a child's growth.
• Making diabetes worse.
• Eye complications, such as glaucoma or cataracts.
• Increased risk of a sore or infection.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Because of their side effects, you should use pill or injected corticosteroids only when you have severe symptoms. One shot can be used, or the pills are used for no longer than 3 to 10 days.

Nasal corticosteroid sprays work best when you take them regularly on a daily basis. They do not cause rebound congestion.

Corticosteroids are not the kind of steroids used for muscle building. People do not "bulk up" when they use corticosteroids.

Health professionals disagree on whether nasal corticosteroids should be your first or second treatment option. Some doctors use nasal corticosteroids to treat allergic rhinitis only when other treatment, such as antihistamines, does not work, while others use nasal corticosteroids right away.

There has been some concern that nasal corticosteroids may cause side effects in children, such as growth delay and behavioural disturbances. At the recommended doses, nasal corticosteroid sprays have not been shown to produce serious side effects. However, because of possible side effects, talk with your doctor about whether corticosteroids are right for your child, and if so, which ones to use.

Women who are pregnant or breast-feeding should take corticosteroids only after discussing the risks with their doctors.

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Author:	Debby Golonka, MPH Ralph Poore	Last Updated: September 27, 2007
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Harold S. Nelson, MD - Allergy and Immunology Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
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