Corticosteroids in the management of upper respiratory allergy: The emerging role of steroid nasal sprays

Abstract

Corticosteroids are undoubtedly the pharmacotherapeutic agents with the broadest application for the treatment of many types of rhinitis, not just those of atopic origin. However, this potent class of drugs also has the greatest potential for adverse effects and complications. Proper use requires that they be used only after failure of more conservative measures, at the smallest effective dose, for the shortest possible time, and preferably should be administered by the topical intranasal route. Topical corticosteroids, concentrated at the area involved, offer significant relief to patients with allergic rhinitis, and although only a relatively small amount of drug is taken up systemically, cautions for proper use are important. Topical steroids should be used only after accurate diagnosis. They must adequately contact the nasal mucosa, and patients should be properly instructed in their use and monitored for local and systemic side effects. Currently available topical preparations--dexamethasone, beclomethasone, flunisolide, and triamcinolone--have differing characteristics. The use of a preparation with a high margin of safety reduces the risk of undesirable systemic effects.