What are the uses of nasal corticosteroids (steroids)?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: April 13, 2025 • View editorial policy

From the Guidelines

Nasal steroids are the most effective medication class for controlling symptoms of allergic rhinitis, and their use is recommended as a first-line treatment. According to the most recent and highest quality study 1, intranasal corticosteroids have been shown to be effective in reducing symptoms of allergic rhinitis, including sneezing, itching, rhinorrhea, and nasal congestion.

Some key points to consider when using nasal steroids include:

  • Proper administration technique, such as aiming the spray away from the nasal septum and waiting 5-10 minutes between applications of other nasal sprays
  • Starting with a low dose and gradually increasing as needed and under medical supervision
  • Potential side effects, such as nasal irritation, headache, or nosebleeds, which are usually mild and can be minimized with proper technique
  • The importance of consistent daily use, as nasal steroids may take several days to weeks to reach full effect

Common nasal steroids include fluticasone (Flonase), mometasone (Nasonex), budesonide (Rhinocort), and triamcinolone (Nasacort), and the typical adult dose is 1-2 sprays in each nostril once or twice daily. It is essential to follow specific medication instructions and consult a physician for guidance on proper use and potential interactions with other medications.

In terms of specific usage, the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 recommends the use of nasal corticosteroids as a first-line treatment for chronic rhinosinusitis 1. This recommendation is based on high-quality evidence showing the effectiveness and safety of nasal corticosteroids in reducing symptoms and improving quality of life for patients with chronic rhinosinusitis.

Overall, nasal steroids are a safe and effective treatment option for allergic rhinitis and chronic rhinosinusitis, and their use should be considered as a first-line treatment.

From the FDA Drug Label

Fluticasone Propionate Nasal Spray, USP not only relieves sneezing, itchy nose, runny nose and itchy, watery eyes, but also relieves nasal congestion. 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

Nasal Steroid Usage:

  • The recommended dosage for children aged 4-11 is 1 spray in each nostril once daily for up to 2 months before checking with a doctor.
  • The recommended dosage for users aged 12 and older is up to 2 sprays in each nostril once daily for up to 6 months of daily use.
  • It is essential to follow the instructions and consult a doctor if symptoms persist or if the medication is needed for an extended period 2.

From the Research

Nasal Steroids and Usage

  • Nasal steroids are widely used and accepted as safe and effective first-line therapy for allergic rhinitis 3, 4, 5
  • They are available in several forms, including beclomethasone dipropionate, budesonide, flunisolide, fluticasone propionate, mometasone furoate, and triamcinolone acetonide 3
  • Nasal steroids relieve nasal congestion and itching, rhinorrhea, and sneezing that occur in the early and late phases of allergic response, with studies showing almost complete prevention of late-phase symptoms 3
  • The rationale for topical intranasal corticosteroids in the treatment of allergic rhinitis is that adequate drug concentrations can be achieved at receptor sites in the nasal mucosa, leading to symptom control and reducing the risk of systemic adverse effects 3

Adverse Effects and Usage

  • Adverse reactions to nasal steroids are usually limited to the nasal mucosa, such as dryness, burning and stinging, and sneezing, together with headache and epistaxis in 5-10% of patients regardless of formulation or compound 3
  • Differences among nasal steroid agents are limited to potency, patient preference, dosing regimens, and delivery, device and vehicle 3
  • It is essential that patients learn correct techniques for administering nasal steroids and understand complications that can result from nasal steroid use 4

Treatment of Allergic Rhinitis

  • Nasal steroids are commonly used in combination with other therapies, such as antihistamines, to achieve optimal improvement in rhinitis symptoms 6, 7
  • Allergen immunotherapy is the only disease-modifying intervention available for allergic rhinitis 7
  • Treatment of rhinitis includes patient education, irritant or allergen avoidance, and pharmacotherapy, with medications such as intranasal corticosteroids, oral and intranasal antihistamines, intranasal anticholinergic agents, oral decongestants, and leukotriene receptor antagonists 7

References

4
Research

Topical nasal sprays: treatment of allergic rhinitis.

American family physician, 1994

5
Research

Use of nasal steroids in managing allergic rhinitis.

The Journal of allergy and clinical immunology, 1999

6
Research

Treatment of allergic rhinitis: H1-antihistamines and intranasal steroids.

Current drug targets. Inflammation and allergy, 2002

7
Research

Allergic and nonallergic rhinitis.

Allergy and asthma proceedings, 2019

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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