Document Detail

Safety considerations of intranasal corticosteroids for the treatment of allergic rhinitis.
MedLine Citation:
PMID:  17479597     Owner:  NLM     Status:  MEDLINE    
Allergic rhinitis (AR) is a major chronic inflammatory disease of the upper airways. AR is increasing in prevalence and causes negative effects on quality of life, impairs performance and productivity, and imposes a serious economic burden. More than 20% of the American population suffers from AR. Intranasal corticosteroids (INS) are an effective and safe first-line treatment for AR, with potent anti-inflammatory properties and a high therapeutic ratio. The systemic bioavailability of the majority of INS is relatively low; however, the pharmacokinetics of absorption, first-pass metabolism, volume of distribution, half-life, and clearance of INS varies considerably, depending on lipophilicity, receptor affinity, and lipid conjugation in the nasal tissue. The short-term (e.g., effect on linear lower-leg growth rate) and long-term (e.g., effect on height) systemic side effects of INS in patients with AR are determined by these important characteristics. AR is present in up to 75% of patients with asthma, and patients with AR are three times more likely to develop asthma compared with patients without AR. Therefore, the overall increased systemic steroid burden resulting from concomitant use of inhaled corticosteroids (ICS) and INS in adult and pediatric patients with comorbid AR and asthma warrants critical monitoring of systemic side effects. This review evaluates the overall safety of INS in AR and the importance of systemic safety considerations of INS, particularly when coadministered with ICS.
Michael S Blaiss
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Allergy and asthma proceedings : the official journal of regional and state allergy societies     Volume:  28     ISSN:  1088-5412     ISO Abbreviation:  Allergy Asthma Proc     Publication Date:    2007 Mar-Apr
Date Detail:
Created Date:  2007-05-07     Completed Date:  2007-07-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9603640     Medline TA:  Allergy Asthma Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  145-52     Citation Subset:  IM    
Department of Pediatrics and Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
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MeSH Terms
Administration, Inhalation
Administration, Intranasal
Adrenal Cortex Hormones / administration & dosage*,  adverse effects*,  therapeutic use
Anti-Allergic Agents / administration & dosage*,  adverse effects*,  therapeutic use
Asthma / drug therapy*,  epidemiology
Bone and Bones / drug effects
Cataract / chemically induced
Chronic Disease
Drug Administration Schedule
Drug Monitoring
Glaucoma / chemically induced
Hydrocortisone / metabolism
Hypothalamo-Hypophyseal System / drug effects,  metabolism
Pituitary-Adrenal System / drug effects,  metabolism
Rhinitis, Allergic, Perennial / drug therapy*,  epidemiology
Rhinitis, Allergic, Seasonal / drug therapy*,  epidemiology
United States / epidemiology
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Anti-Allergic Agents; 50-23-7/Hydrocortisone

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