3. Steroid sprays not all equal in the treatment of allergic rhinitis
In a recent meta-analysis of efficacy, side-effects and relative cost of topical nasal steroids (TNS) prescribed for the treatment of allergic rhinitis, researchers from the UK found that a) in studies comparing TNS with oral antihistamines there was a clear benefit in favour of TNS; b) there is no evidence that one TNS is more effective than another; c) all sprays have a similar side-effect profile, with epistaxis being the commonest at 17-23% (and placebos producing epistaxis in 10-15% of cases). However, fluticasone was noted to cause a reduction in cortisol secretion while no reduction was seen with triamcinolone, beclomethasone, budesonide or mometasone (although there is little evidence that this is of significance in terms of skeletal growth). Cost-wise beclomethasone, dexamethasone and budesonide are usually considerably cheaper than the others. In his PhD thesis, Green drew similar conclusions regarding cost effectiveness but also made another important observation i.e. pre-school children tended to present as 'runners' while older children were more likely to present as 'blockers.' This raises the question of if/when to also use topical decongestants in the child whose nasal stuffiness persists on treatment with TNS
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J Laryngol Otol 2003;117:843-5
PhD Thesis University of the Witwatersrand, RJ Green 2003.