What is the recommended treatment for rhinitis using nasal corticosteroids (NS), such as fluticasone propionate (FP)?

From the Guidelines

Nasal corticosteroids like fluticasone propionate (FP) are the first-line treatment for allergic rhinitis, with recommended dosing of 1-2 sprays (50-100 mcg) in each nostril once or twice daily. For optimal effectiveness, patients should first clear their nasal passages by gently blowing their nose, then shake the bottle well before use. The spray should be directed away from the nasal septum toward the outer wall of the nasal cavity while gently inhaling. Regular daily use is essential, as these medications work by gradually reducing inflammation rather than providing immediate relief. Patients should expect improvement within 3-7 days, though full benefits may take 2-3 weeks to develop. Treatment should continue throughout allergy season or as directed by a healthcare provider. Nasal corticosteroids work by reducing inflammation in the nasal passages, decreasing mucus production, and inhibiting the release of inflammatory chemicals that cause allergy symptoms. Side effects are typically mild and may include nasal irritation, dryness, or occasional nosebleeds. Using proper technique and rinsing the tip of the applicator after use helps prevent complications and maintain effectiveness.

Key Points

• Nasal corticosteroids are the most effective medication class for controlling symptoms of allergic rhinitis, as stated in the 2008 practice parameter 1.
• The combination of an intranasal corticosteroid and an intranasal antihistamine may be recommended for initial treatment of moderate to severe seasonal allergic rhinitis in persons aged 12 years or older, according to the 2017 joint task force on practice parameters 1.
• Fluticasone propionate plus azelastine has been shown to provide the greatest symptom reduction in some studies, with an absolute improvement of greater than 40% relative to either agent alone 1.
• The recommended dosing of fluticasone propionate is 1-2 sprays (50-100 mcg) in each nostril once or twice daily, with regular daily use essential for optimal effectiveness.

Administration and Technique

• Patients should clear their nasal passages by gently blowing their nose before use.
• The bottle should be shaken well before use.
• The spray should be directed away from the nasal septum toward the outer wall of the nasal cavity while gently inhaling.
• The tip of the applicator should be rinsed after use to prevent complications and maintain effectiveness.

From the FDA Drug Label

Fluticasone Propionate Nasal Spray, USP is an effective, allergy medicine that you can buy without a prescription. It works directly in the nose to help block your allergic reactions. Fluticasone Propionate Nasal Spray, USP relieves allergy symptoms caused by pollen, mold, dust and pets. Fluticasone Propionate Nasal Spray, USP works right in your nose to help block your allergic reaction at the source to relieve the symptoms that make you uncomfortable. Because of the way it works, it may take several days for Fluticasone Propionate Nasal Spray, USP to reach maximum effect. That’s why it’s best to use Fluticasone Propionate Nasal Spray, USP regularly, once a day

The recommended treatment for rhinitis using nasal corticosteroids, such as fluticasone propionate, is to use the medication regularly, once a day to relieve allergy symptoms caused by pollen, mold, dust, and pets.

• Key benefits of fluticasone propionate nasal spray include relieving sneezing, itchy nose, runny nose, itchy, watery eyes, and nasal congestion.
• It is essential to follow the instructions and use the medication as directed to get the best results 2.

From the Research

Nasal Corticosteroids for Rhinitis

• Nasal corticosteroids, such as fluticasone propionate (FP), are recommended as first-line treatment for moderate to severe allergic rhinitis 3, 4, 5, 6.
• These medications are effective in relieving nasal congestion, itching, rhinorrhea, and sneezing, and are considered safe with minimal systemic side effects 4, 5.
• Intranasal corticosteroids have been shown to be more effective than oral antihistamines and other medications in controlling nasal symptoms of allergic rhinitis 3, 6.
• The choice of nasal corticosteroid may depend on factors such as potency, patient preference, dosing regimens, and delivery device 4.
• Patient adherence to treatment is crucial for effective management of allergic rhinitis, and may be influenced by patient preferences and knowledge about the medication 6, 7.

Efficacy of Nasal Corticosteroids

• Studies have demonstrated the efficacy of fluticasone propionate in reducing nasal symptom scores, with some studies showing equal or greater efficacy compared to oral antihistamines 3.
• Combination therapy of fluticasone propionate with an oral antihistamine may have comparable efficacy to intranasal corticosteroid alone 3.
• Other nasal corticosteroids, such as ciclesonide, have also been shown to be effective in relieving nasal symptoms of allergic rhinitis 5.

Safety and Adherence

• Nasal corticosteroids are generally considered safe, with minimal systemic side effects 4, 5.
• However, patients may have concerns about the safety of these medications, and may not always receive appropriate advice on how to use them 7.
• Patient adherence to treatment may be influenced by factors such as age, gender, socioeconomic status, education level, and smoking status 7.