Safety of Intranasal Steroids: an Updated Perspective
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RHINITIS, CONJUNCTIVITIS, AND SINUSITIS (JJ OPPENHEIMER AND J CORREN, SECTION EDITORS)
Safety of Intranasal Steroids: an Updated Perspective John McDonnell 1 & Katherine Weller 1 & Lily C. Pien 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Intranasal corticosteroid sprays have been available as over-the-counter (OTC) medications since 2013. As such, clinicians need to be up-to-date with the risks and the safety of INS, as patients may have concerns and detailed questions. The following is a review of the recent medical literature regarding the safety profile, adverse reactions, and special populations using INS. Recent Findings The latest research on intranasal steroid sprays (INS) continue to confirm that INS rarely have significant local side effects, such as severe and persistent epistaxis. Recent studies looking at systemic side effects such as hypothalamic pituitary axis suppression, growth effects, and ocular effects do not indicate any new concerns nor have found significant differences from the past literature. The use of combination INS and topical antihistamine medications did not reveal any new safety issues. Use of INS with topical decongestants found some limited effects of tachyphylaxis and rebound congestion. Studies continue to support the use of newer INS for children and continued monitoring of growth in this population. The HIV population should avoid use of INS with the prescription of ritonavir, given demonstration of adrenal suppression. Summary This updated perspective has found that newer generation INS should be used at the lowest effective dose for the selected population, that clinicians can inform patients using the OTC INS preparations that there are very few safety concerns, and that regular follow-up visits can provide further reassurance with physical examinations and address patient’s questions. Future research regarding the safety of INS should study newer preparations when developed and if used in combination with other topical agents. Keywords Allergic rhinitis . Rhinitis . Intranasal steroid spray . Side effects . Safety . Special populations
Introduction Allergic rhinitis is a common disease, with a worldwide prevalence of up to 25% [1] and an associated economic burden of billions of dollars [2, 3].The mainstay of treatment is allergen avoidance and pharmacotherapy. For the latter, intranasal steroid sprays (INS) are essential [3, 4•, 5–7, 8•, 9] medications This article is part of the Topical Collection on Rhinitis, Conjunctivitis, and Sinusitis Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11882-020-00960-2) contains supplementary material, which is available to authorized users. * Lily C. Pien [email protected] 1
Department of Allergy and Clinical Immunology, Cleveland Clinic, Desk A90, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
which have been used for management of this condition since 1973 [10]. Non-allergic rhinitis, without infections, is a large group of nasal di
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