What is the preferred nasal corticosteroid (steroid) choice in pediatric (paediatric) patients?

From the Guidelines

For pediatric patients requiring nasal steroids, mometasone furoate (Nasonex) and fluticasone propionate (Flonase) are generally preferred first-line options due to their favorable safety profiles and once-daily dosing. When choosing a nasal steroid for pediatric patients, it is essential to consider the potential effects on growth, as well as the safety and efficacy of the medication. According to the study by 1, intranasal fluticasone propionate, mometasone furoate, and budesonide show no effects on growth compared with placebo at recommended doses. However, growth suppression was detected in children treated with intranasal beclomethasone dipropionate at twice the recommended dose. The study by 1 also supports the use of intranasal corticosteroids, such as fluticasone propionate and mometasone furoate, as effective treatments for allergic rhinitis with minimal systemic absorption. Some key points to consider when prescribing nasal steroids to pediatric patients include:

• Dosage: For children 2-11 years old, mometasone is typically dosed at 50 mcg (1 spray) in each nostril once daily, while fluticasone propionate is dosed at 50 mcg (1 spray) in each nostril once daily.
• Administration technique: Instruct patients to aim the spray away from the nasal septum and shake the bottle before use.
• Potential side effects: Local irritation, epistaxis, or headache may occur, but are generally mild.
• Importance of compliance: Regular use for at least 1-2 weeks is necessary to achieve maximum benefit. As stated in the study by 1, preparations containing propylene glycol and benzalkonium chloride may result in local irritation or ciliary dysfunction, respectively. Therefore, it is crucial to choose a nasal steroid that is safe and effective for pediatric patients, and to monitor them regularly for any potential side effects. In terms of specific medications, mometasone furoate and fluticasone propionate are preferred due to their favorable safety profiles and once-daily dosing. Overall, the goal of treatment is to reduce nasal inflammation, congestion, rhinorrhea, and other symptoms of allergic rhinitis while minimizing potential side effects and promoting optimal growth and development in pediatric patients.

From the FDA Drug Label

Children age 4 to 11 should use a lower dose of Fluticasone Propionate Nasal Spray, USP for a shorter period of time Ages | Children 4 to 11 years of age | Users 12 years of age and older Dosage | 1 spray in each nostril once daily | Up to 2 sprays in each nostril once daily Duration before checking with a doctor | Up to 2 months of use a year | Up to 6 months of daily use When used long-term, intranasal glucocorticoids like Fluticasone Propionate Nasal Spray, USP may cause the growth rate of some children to be slower.

The choice of nasal steroid in paediatrics, specifically for children aged 4-11, is Fluticasone Propionate Nasal Spray, USP at a dose of 1 spray in each nostril once daily. The duration of use should be limited to up to 2 months a year before checking with a doctor, due to the potential for long-term use to cause slower growth rates in children 2.

From the Research

Nasal Steroid Choice in Paediatrics

• The choice of nasal steroid in paediatrics is crucial for the effective management of allergic rhinitis and other nasal conditions.
• Studies have shown that mometasone furoate nasal spray (MFNS) is a safe and effective treatment option for children with perennial allergic rhinitis 3, 4.
• MFNS has been shown to reduce nasal symptoms, improve quality of life, and is well-tolerated in children aged 3-11 years 4.
• The safety profile of MFNS in children is similar to that of other intranasal corticosteroids, with common adverse events including epistaxis, headache, and pharyngitis 3, 4.
• Other intranasal corticosteroids, such as beclomethasone dipropionate, budesonide, flunisolide, fluticasone propionate, and triamcinolone acetonide, are also available and have been shown to be effective in treating allergic rhinitis 5.
• The choice of nasal steroid should be based on individual patient needs, potency, and patient preference, as well as dosing regimens and delivery devices 5.
• Mometasone furoate nasal spray has also been shown to be effective in relieving cough and nasal symptoms associated with allergic rhinitis 6, and is safe for use in children with nasal polyps 7.