ORIGINAL ARTICLE Evaluating the Safety of Intranasal Steroids in the Treatment of Allergic Rhinitis Ketan Sheth, MD, MBA Given that intranasal corticosteroids (INCs) are widely considered first-line therapies for treatment of rhinitis, it is important for the clinician to be comfortable with the side-effect profile and be able to discuss potential safety concerns regarding these therapies. Among the safety concerns with the use of INCs are the potential for growth suppression both short and long term, the potential for hypothalamic-pituitary-adrenal axis suppression, ocular safety, and the use of INCs concomitantly with inhaled corticosteroids in asthma patients. As all clinicians are aware, each patient can have individual responses to both efficacy and safety; however, the data reviewed suggest that the benefits outweigh the potential risks. Understanding the potential concerns and the data behind these concerns should give clinicians the information to be able to discuss this with patients and parents to incorporate appropriate therapy for those with allergic rhinitis. Key words: allergic rhinitis, intranasal corticosteroids, safety, treatment A llergic Europeans, rhinitis 50 million (AR) affects Americans, almost and 94 10 million million Canadians.1 Because it is so prevalent, almost all primary care physicians will encounter this disease. Health Canada estimates that nonfood allergies are ‘‘the most common chronic condition in Canadians 12 years of age and older.’’1 In one study, 42% of children were diagnosed with AR by the age of 6 years. The prevalence of AR has increased dramatically in the past 30 years and continues to increase. Children with one component of atopy (AR, asthma, eczema) have a threefold greater risk of developing a second component.2 In 1998, the Joint Task Force on Practice Parameters in Allergy, Asthma, and Immunology defined rhinitis as ‘‘inflammation of the membrane lining the nose, character- ized by nasal congestion, rhinorrhea, sneezing, itching of the nose and/or post-nasal drainage.’’3 AR is the nasal symptoms that result from a hypersensitivity reaction to specific allergens occurring in sensitized patients, which is mediated by IgE antibodies, in which the end result is inflammation. Ketan Sheth: Lafayette Allergy and Asthma Clinic, Lafayette, IN, USA; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pharmacy, Purdue University, West Lafayette, IN, USA. Correspondence to: Ketan Sheth, MD, MBA, Lafayette Allergy and Asthma Clinic, 1345 Unity Place, Suite 145A, Lafayette, IN 47905 USA; e-mail: KSheth@unityhc.com. DOI 10.2310/7480.2008.00014 Management of AR is important for preventing the symptoms but also for preventing potential complications of the disease. The options for treatment include allergen avoidance, pharmacotherapy, and immunotherapy.4 Pharmacotherapy options for AR include antihista- mines (oral and intranasal), oral leukotriene receptor antagonists, and INCs. Treatment guidelines for AR support the use of INCs as first-line therapy. The Joint Task Force on Practice Parameters in Allergy, Asthma, and Immunology concluded that ‘‘extensive clinical and toxicological studies have generally demonstrated that nasal corticosteroids have an excellent benefit/risk profile in long term usage in children’’3 INCs are approved for use as low as age 2 years in pediatric patients. Given that INCs are widely considered first-line therapies for treatment of rhinitis, it is important for the clinician to be comfortable with the-side effect profile and be able to discuss potential safety concerns regarding these therapies. Among the safety concerns with the use of INCs are the potential for growth suppression both short and long term, the potential for hypothalamic-pituitary-adrenal (HPA) axis suppression, ocular safety, and the use of INCs concomi- tantly with inhaled corticosteroids in asthma patients. Growth An early study that examined the effect of the use of beclomethasone dipropionate (BDP) in AR raised con- cerns about the potential for growth suppression with INC Allergy, Asthma, and Clinical Immunology, Vol 4, No 3 (Fall), 2008: pp 125–129 125