From the Guidelines
Inhaled corticosteroid products for allergic rhinitis include fluticasone propionate (Flonase, Flonase Sensimist), mometasone furoate (Nasonex), budesonide (Rhinocort), triamcinolone acetonide (Nasacort), beclomethasone dipropionate (Beconase, Qnasl), ciclesonide (Omnaris, Zetonna), and flunisolide (Nasarel) 1. These medications are typically administered as nasal sprays with recommended dosing of 1-2 sprays in each nostril once or twice daily, depending on the specific product. Some key points to consider when using these medications include:
- Most require consistent use for 1-2 weeks before maximum benefit is achieved.
- They work by reducing inflammation in the nasal passages, decreasing mucus production, and inhibiting the release of inflammatory chemicals that cause allergy symptoms.
- They are more effective than oral antihistamines for nasal congestion and can be used long-term with minimal side effects, which may include nasal irritation, mild bleeding, or headache.
- For best results, patients should clear their nasal passages before use and aim the spray away from the nasal septum to minimize irritation. It's also worth noting that 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 1.
From the FDA Drug Label
PACKAGE LABEL.PRINCIPAL DISPLAY PANEL - 50 mcg per spray (120 Metered Sprays, Carton Label) NDC 57483-180-11 C˙rcle™ Non-Drowsy FlutiCare® Fluticasone Propionate Nasal Spray, USP (Glucocorticoid)* 50 mcg per spray ALLERGY SYMPTOM RELIEVER 24 HOUR Relief of: • Itchy, Watery Eyes • Nasal Congestion • Runny Nose • Itchy Nose • Sneezing Full Prescription Strength #Compare to the active ingredient in Flonase® Allergy Relief Fluticasone propionate is a steroid medicine known as a glucocorticoid. 120 Metered Sprays 0.54 FL OZ (15.8 mL) Package/Label Principal Display Panel Rugby® Compare to the active ingredient in Nasonex® 24HR Allergy Non-Drowsy | Scent-Free Mist Mometasone Furoate Nasal Spray, 50 mcg Per Spray Allergy Symptom Reliever (Glucocorticoid) Allergy + Congestion Full Prescription Strength 24HR Relief of: • Nasal Congestion • Runny Nose • Sneezing • Itchy Nose *Mometasone furoate is a steroid medicine known as a glucocorticoid 120 SPRAYS 0.57 FL OZ (17.0 mL)
The available inhaled corticosteroid (ICS) products for the treatment of allergic rhinitis are:
From the Research
Inhaled Corticosteroid (ICS) Products for Allergic Rhinitis
The following ICS products are available for the treatment of allergic rhinitis:
- Beclomethasone dipropionate 4
- Budesonide 4
- Flunisolide 4
- Fluticasone propionate 4, 5, 6, 7
- Mometasone furoate 4, 7
- Triamcinolone acetonide 4
Characteristics of ICS Products
These ICS products are efficacious in treating seasonal allergic rhinitis and as prophylaxis for perennial allergic rhinitis 4. They relieve nasal congestion and itching, rhinorrhea, and sneezing that occur in the early and late phases of allergic response 4. The products have differences in potency, patient preference, dosing regimens, and delivery, device, and vehicle 4.
Combination Therapies
Fixed combinations of intranasal antihistamines and corticosteroids, such as azelastine and fluticasone propionate, have been patented and evaluated in clinical trials 7. These combination therapies have been found to be statistically significantly more efficacious in reducing total nasal symptom scores compared to individual components or placebo 7.
Safety of ICS Products
Recent studies have evaluated the safety of ICS products, including ciclesonide, fluticasone furoate, mometasone furoate, triamcinolone acetonide, fluticasone propionate, budesonide, and beclomethasone dipropionate 8. These studies have found no significant topical or systemic complications, although the long-term safety of these products without oversight by a healthcare professional is still a concern 8.