Do topical nasal corticosteroids (TNCs) work in patients with a history of allergic rhinitis during the common cold?

Topical Nasal Corticosteroids During the Common Cold in Allergic Rhinitis Patients

Do not use topical nasal corticosteroids for symptomatic relief during the common cold, even in patients with a history of allergic rhinitis—there is no evidence supporting their efficacy for viral upper respiratory infections. 1

Evidence-Based Recommendation

The European Rhinologic Society explicitly states that there is currently no evidence to support the use of intranasal corticosteroids for symptomatic relief from the common cold. 1 This applies regardless of whether the patient has underlying allergic rhinitis.

Key Distinction: Allergic Rhinitis vs. Viral Infection

• For allergic rhinitis symptoms: Intranasal corticosteroids remain the most effective medication class for controlling sneezing, itching, rhinorrhea, and nasal congestion through their anti-inflammatory activity. 1

• For common cold symptoms: The mechanism of action—suppressing allergic inflammation by reducing eosinophils, mast cells, and cytokine production—does not address the viral pathophysiology of the common cold. 2, 3

What Actually Works for the Common Cold

• Short-term topical decongestants (3 days maximum) are appropriate for nasal congestion associated with acute viral infections, though patients must be warned about rhinitis medicamentosa risk with longer use. 1

• Antihistamines, analgesics, and decongestants (alone or in combination) have some general benefit in adults and older children with common cold, though benefits must be weighed against adverse effects. 1

Critical Clinical Pitfall

Do not confuse an acute exacerbation of allergic rhinitis triggered by allergen exposure with a common cold. If a patient with allergic rhinitis develops nasal symptoms during cold season, consider whether this represents:

• True viral infection: Intranasal corticosteroids will not help 1
• Allergic exacerbation: Continue or intensify intranasal corticosteroids 1, 4, 5
• Both conditions simultaneously: Treat the allergic component with intranasal corticosteroids while using symptomatic measures (decongestants, analgesics) for the viral symptoms 1

Practical Management Algorithm

For patients with allergic rhinitis who develop upper respiratory symptoms:

1. Assess symptom pattern: Viral symptoms typically include systemic features (fever, myalgias, sore throat), purulent discharge, and acute onset over 24-48 hours
2. Continue baseline intranasal corticosteroids if the patient was already using them for allergic rhinitis maintenance 5
3. Add short-term topical decongestants (≤3 days) for severe nasal obstruction to maintain nasal patency 1
4. Do not initiate intranasal corticosteroids specifically for cold symptom relief 1

Safety Consideration

While intranasal corticosteroids at recommended doses have no clinically significant systemic effects and can be used long-term for allergic rhinitis, 4, 5 their lack of efficacy for viral infections makes their use during the common cold both unnecessary and potentially misleading to patients about appropriate cold management. 1