Comparing Inhaled Nasal Corticosteroids

Dean L.

Sneezing, watery runny nose, and itchy palate are all common symptoms of allergic rhinitis. There are two main types of allergic rhinitis: seasonal (also called hay fever, usually triggered by pollens) and perennial (occurs all year around and has many triggers, including pollen, animal dander, and dust mites). Less commonly, rhinitis can be caused by a non-allergic cause such as infections or drugs.

The treatment of rhinitis includes, where possible, avoiding the trigger (allergen) and the use of medications. Medications are available either over-the-counter (e.g. antihistamines and decongestants) or by prescription (e.g., corticosteroids, mast cell stabilizers, leukotriene modifiers, anti-IgE monoclonal antibodies).

Inhaled nasal corticosteroids are commonly used to improve the symptoms of both allergic and non-allergic causes of rhinitis.

The "Drug Class Review on Nasal Corticosteroids" compares the safety and effectiveness of eight drugs. A summary of the findings is below.

How do nasal corticosteroids compare in allergic rhinitis?

In adults with seasonal allergic rhinitis, beclomethasone improves symptoms similarly to budesonide, flunisolide, fluticasone, mometasone, and triamcinolone. For preventing symptoms, prophylaxis with mometasone is superior to beclomethasone in reducing symptoms before and during peak-season, but mometasone is associated with higher rates of headaches.

In adults with perennial allergic rhinitis, there were very few differences in the following drugs for improving symptoms: beclomethasone, budesonide, fluticasone, and mometasone.

In children, limited evidence suggests that beclomethasone, fluticasone, and mometasone similarly improve symptoms of both seasonal and perennial allergic rhinitis.

Data are lacking for children and adults with non-allergic rhinitis. [full review]

How do nasal corticosteroids compare in safety in adults?

Common side effects of these drugs include nasal irritation and nose bleeds. In general, the rate of such side effects did not differ when similar doses of corticosteroids were compared in adults with allergic rhinitis.

Data are lacking for more serious side effects, which include cataract. A single study found that beclomethasone did not appear to increase the risk of cataract compared to placebo, but the evidence is weak. [full review]

How do nasal corticosteroids compare in safety in children?

In children with allergic rhinitis, serious side effects of these medications include growth retardation and lenticular opacities (a type of cataract).

Compared to placebo, fluticasone, mometasone, and budesonide did not appear to slow down growth after 12 months. Evidence for beclomethasone is mixed - one trial found that compared to placebo, beclomethasone did reduce the height increase after 12 months, whereas another small study found that over 3 years the height increase was similar to what was expected.

A single small study found that budesonide was associated with the development of lenticular opacities. The opacities were transient and the clinical significance is not known. [full review]

Does age or gender influence the safety or effectiveness of nasal corticosteroids?

There is insufficient evidence for how these drugs compare in patients of different ages, genders, or ethnicity, and patients with other health conditions such as asthma. [full review]

Drugs included in this review

Further information

Image th-ncort.jpgThis PubMed Clinical Q&A was reviewed by Marian McDonagh, PharmD.

For the full report and evidence tables, please see:
Selover D, Dana T, Smith C, et al. Drug Class Review: Nasal Corticosteroids: Final Report Update 1 [Internet]. Portland (OR): Oregon Health & Science University; 2008 Jun. Available at: http://www.ncbi.nlm.nih.gov/books/NBK47237/.