Intranasal glucocorticosteroids in children
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Published:
Mar 12, 2012
Keywords:
allergic rhinitis, children, intranasal glucocorticosteroids, management, conjunctivitis, rhinitis, rhinosinusistis, safety, adenoid hypertrophy
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Abstract
Allergic rhinitis is the most frequent chronic inflammatory, noninfectious disease in children, with the prevalence increased in pediatric population. The impact of poorly controlled allergic rhinitis on quality of life, psychologic well-being and capacity to function in activities of daily living and school performance can be significant. As well as these psychosocial difficulties, if left untreated, allergic rhinitis appears to increase the risk of developing potentially problematic co-morbid conditions, including asthma, sinusitis, and otitis media. The introduction of modern local intranasal glucocorticosteroids in the beginning of seventies last century was the most important therapeutic progress in the management of inflammatory disorders of the nasal mucosa. A series of studies have shown their multiple effects on the immune inflammatory reaction. Intranasal glucocorticosteroids are highly effective therapeutic modality for long-term therapy of allergic rhinitis, perennial nonallergic rhinitis and nasal polyposis as well as concomitant treatment of chronic rhinosinusitis and acute rhinosinusitis becoming the first-line therapeutic option in most cases. Intranasal preparations eliminate the systemic side effects and equal or exceed the efficacy of their systemic counterparts. The major disadvantage of this treatment is rather slow onset of action. But on the other hand, the main signs and symptoms of rhinitis, such as rhinorrhea, sneezing, obstruction and congestion are very well controlled. This treatment was found not only to reduce nasal symptoms but also to diminished ocular symptoms and improve quality of life of rhinitis patients. The latest studies in children, which evaluated potential systemic effects of newer agents of intranasal glucocorticosteroids have generally found no adverse effects on hypothalamic-pituitary-adrenal axis function or growth. They have a high degree of glucocorticoid receptor affinity, potency and specificity; low systemic availability; high rate of hepatic first-pass clearance and rapid systemic elimination, and what is very important for the compliance – once-daily dosing.
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Arcimowicz , M. (2012). Intranasal glucocorticosteroids in children. Alergoprofil, 8(1), 5-17. Retrieved from https://journalsmededu.pl/index.php/alergoprofil/article/view/720
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Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
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3. Backhouse C.I.: Intra-nasal flunisolide in the treatment of allergic rhinitis in general practice. Curr. Med. Res. Opin. 1979, 6: 14-19.
4. Baena-Cagnani C.E., Patel P.: Efficacy and long-term safety of mometasone furoate nasal spray in children with perennial allergic rhinitis. Curr. Med. Res. Opin. 2010, 26: 2047-2055.
5. Baldwin C.M., Scott L.J.: Mometasone furoate. A review of its intranasal use in allergic rhinitis. Drugs 2008, 68: 1723-1739.
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7. Bielory L., Chun Y., Bielory B.P., Canonica G.W.: Impact of mometasone furoate nasal spray on individual ocular symptoms of allergic rhinitis: a meta-analysis. Allergy 2011, 66: 686-693.
8. Bjorksten B., Clayton T., Ellwood P., Stewart A., Strachan D., the ISAAC Phase III Study Group. Worldwide time trends for symptoms of rhinitis and conjunctivitis: phase III of the International Study of Asthma and Allergies in Childhood. Pediatr. Allergy Immunol. 2008, 19: 110-124.
9. Bloom F.L., Cohan R.H., Leifer K.N. et al.: Flunisolide aerosol in the treatment of perennial allergic rhinitis. Ann. Allergy 1977, 38: 408-412.
10. Boner A.L., Sette L.: Rhinitis in children: efficacy and safety of a new intranasal corticosteroid. Eur. Respir. Rev. 1994, 20: 271-273.
11. Bousquet J., Khaltaev N., Cruz A.A. et al.: Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008, 63(Suppl. 86): 8-160.
12. Bousquet J., van Cauwenberge P., Ait Khaled N. et al.: Pharmacologic and anti-IgE treatment of allergic rhinitis ARIA update (in collaboration with GA2LEN). Allergy 2006, 61: 1086-1096.
13. Bousquet J., van Cauwenberge P., Khaltaev N., ARIA Workshop Group, World Health Organization. Allergic Rhinitis and its Impact on Asthma (ARIA). J. Allergy Clin. Immunol. 2001, 108(5 Suppl.): S147-S336.
14. Brannan M.D., Herron J.M., Affrime M.B.: Safety and tolerability of once-daily mometasone furoate aqueous nasal spray in children. Clin. Therapeutics 1997, 19: 1330-1339.
15. Brozek J.L., Bousquet J., Baena-Cagnani C.E. et al.: Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J. Allergy Clin. Immunol. 2010, 3: 466-476.
16. Bruni F.M., De Luca G., Venturoli V., Boner A.L.: Intranasal corticosteroids and adrenal suppression. Neuroimmunomodulation 2009, 16: 353-362.
17. Canonica G.W., Bousquet J., Mullol J. et al.: A survey of the burden of allergic rhinitis in Europe. Allergy 2007, 62(Suppl. 85): 17-25.
18. Cengel S., Akyol M.U.: The role of topical nasal steroids in the treatment of children with otitis media with effusion and/ or adenoid hypertrophy. Int. J. Pediatr. Otorhinolaryngol. 2006, 70: 639-645.
19. Cruz Á.A.: The ‘united airways’ require an holistic approach to management. Allergy 2005, 60: 871-874.
20. Dahl R., Nielsen L.P., Kips J. et al.: Intranasal and inhaled fluticasone propionate for pollen-induced rhinitis and asthma. Allergy 2005, 60: 875-881.
21. Denburg J.A.: Cytokines and inflammatory cells. W: Nasal Polyposis. An inflammatory disease and its treatment. Mygind N., Lildholdt T., Munksgaard. (red.). Wyd. 1. Copenhagen 1997: 78-87.
22. Derendorf H., Meltzer E.O.: Molecular and clinical pharmacology of intranasal corticosteroid: clinical and therapeutic implications. Allergy 2008, 63: 1292-1300.
23. Emeryk A., Bartkowiak-Emeryk M.: Postępowanie w alergicznym nieżycie nosa u dzieci. Alergia 2008, 3: 33-36.
24. Emin O., Fatih M., Emre D., Nedim S.: Lack of bone metabolism side effects after 3 years of nasal topical steroids in children with allergic rhinitis. J. Bone Miner. Metab. 2011, 29: 582-587.
25. Fokkens W., Lund V.J., Mullol J., Bachert C. et al.: European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) 2007. Rhinology 2007(Supplement 20): 1-136.
26. Georgalas C., Terreehorst I., Fokkens W.: Current management of allergic rhinitis in children. Pediatr. Allergy Immunol. 2010, 21: e119-e126.
27. Hallén H., Enderal J., Graf P.: Fluticasone propionate nasal spray is more effective and has a faster onset of action than placebo in treatment of rhinitis medicamentosa. Clin. Exp. Allergy 1997, 27: 552-558.
28. Hamilos D.L., Thawley S.E., Kramper M.A. et al.: Effect of intranasal fluticasone on cellular infiltration, endothelial adhesion molecule expression, and proinflammatory cytokine mRNA in nasal polyp disease. J. Allergy Clin. Immunol. 1999, 103: 79-87.
29. Holm A.F., Fokkens W.J., Godthepl T. et al.: Effects of 3 months’ nasal steroid therapy on nasal T cells and Langerhans cells in patients suffering from allergic rhinitis. Allergy 1995, 50: 204-209.
30. Jáuregui I., Dávila I., Sastre J. et al.: Validation of ARIA (Allergic Rhinitis and its Impact on Asthma) classification in pediatric population: The PEDRIAL study. Pediatr. Allergy Immunol. 2011, 22: 388-392.
31. Juliusson S., Holmberg K., Karlsson G. et al.: Mast cells and mediators in the nasal mucosa after allergen challenge. Effects of four weeks’ treatment with topical glucocorticoid. Clin. Exp. Allergy 1993, 23: 591-599.
32. Jung Y.G., Kim H.Y., Min J-Y. et al.: Role of intranasal topical steroid in pediatric sleep disordered breathing and influence of allergy, sinusitis, and obesity on treatment outcome. Clin. Exp. Otorhinolaryngol. 2011, 4: 27-32.
33. Juniper E.F.: Rhinitis management: the patient’s perspective. Clin. Exp. Allergy 1998, 28(Suppl 6): 34-38.
34. Kanai N., Denburg J., Jordana M. et al.: Nasal polyp inflammation: effect of topical nasal steroid. Am. J. Respir. Crit. Care Med. 1994, 150: 1094-1100.
35. Kariyawasam H.H., Scadding G.K.: Seasonal allergic rhinitis: fluticasone propionate and fluticasone furoate therapy evaluated. J. Allergy Asthma 2010, 3: 17-26.
36. Klemi P.J., Virolainen E., Puhakka H.: The effect of intranasal beclomethasone dipropionate on the nasal mucosa. Rhinology 1980, 18: 19-24.
37. Lack G., Caulfield H., Penagos M.: The link between otitis media with effusion and allergy: a potential role for intranasal corticosteroids. Pediatr. Allergy Immunol. 2011, 22: 258-266.
38. Lildholdt T., Dahl R., Mygind N.: Effect of corticosteroids on polyps. Evidence from controlled trials. W: Nasal Polyposis. An inflammatory disease and its treatment. Mygind N., Lildholdt T. (red.). Wyd. 1. Munksgaard, Copenhagen 1997: 160-169.
39. Lund V.J., Black J.H., Szabó L.Z. et al.: Efficacy and tolerability of budesonide aqueous nasal spray in chronic rhinosinusitis patients. Rhinology 2004, 42: 57-62.
40. Mackay I.S.: Topical medical management of allergic conditions of the nose. Part 2: Intranasal steroids. W: Rhinitis. Mackay I.S. (red.). Royal Society of Medicine Services Limited, London 1989: 183-198.
41. Meltzer E.O., Bachert C., Staudinger H.: Treating acute rhinosinusitis: comparing efficacy and safety of mometasone furoate nasal spray, amoxicillin, and placebo. J. Allergy Clin. Immunol. 2005, 116: 1289-1295.
42. Meltzer E.O., Charous B.L., Busse W.W. et al., Nasonex Sinusitis Group. Added relief in the treatment of acute recurrent sinusitis with adjunctive mometasone furoate nasal spray. J. Allergy Clin. Immunol. 2000, 106: 630-637.
43. Meltzer E.O., Orgel H.A., Jalowayski A.: Cytology. W: Allergic and non-allergic rhinitis. Clinical aspects. Mygind N., Naclerio R.M. (red.). Wyd. 1. Munksgaard, Copenhagen 1993: 66-81.
44. Meltzer E.O.: Allergic rhinitis: Managing the pediatric spectrum. Allergy Asthma Proc. 2006, 27: 2-8.
45. Minshall E., Ghaffar O., Cameron L. et al.: Assessment by nasal biopsy of long-term use of mometasone furoate aqueous nasal spray (Nasonex) in the treatment of perennial rhinitis. Otolaryngol. Head Neck Surg. 1998, 118: 648-654.
46. Modrzyński M., Mierzwiński J., Zawisza E., Piziewicz A.: Acoustic rhinometry in the assessment of adenoid hypertrophy in children. Med. Sci. Monit. 2004, 10: CR341-348.
47. Mullol J., Fernandez-Morata J.C., Juan M. et al.: Cytokines and steroids modulate COX-2 gene expression in human nasal polyps and mucosas. XVII E.R.S. I.S.I.A.N., Vienna 1998, Abstract Book: 206.
48. Mygind N., Lund V.J.: Topical corticosteroid therapy of rhinitis. Clin. Immunother. 1996, 5: 122-136.
49. Mygind N., Sörensen H., Pedersen C.B.: The nasal mucosa during long-term treatment with beclomethasone dipropionate aerosol. A light- and scanning electron microscopic study of nasal polyps. Acta Otolaryngol. 1978, 85: 437-443.
50. Mygind N.: Effects of beclomethasone dipropionate aerosol on nasal mucosa. Br. J. Clin. Pharmacol. 1977, 4: 287-291.
51. Mygind N.: Rola glikokortykosteroidów podawanych donosowo w leczeniu nieżytów nosa. W: Nieżyty nosa. Samoliński B., Janczewski G. (red.). Wydawnictwo Naukowe Scholar, Warszawa 2000: 95-110.
52. Nayak A.S., Settipane G.A., Pedinoff A. et al., Nasonex Sinusitis Group. Effective dose range of mometasone furoate nasal spray in the treatment of acute rhinosinusitis. Ann. Allergy Asthma Immunol. 2002, 89: 271-278.
53. Passsalacqua G., Cananonica G.W., Baiardini I.: Rhinitis, rhinosinusitis and quality of life in children. Pediatr. Allergy Immunol. 2007, 18(Suppl. 18): 40-45.
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