Uses and Misuses of Intranasal Corticosteroids and Cromolyn

Abstract

Corticosteroids modulate the effect of the allergic event but do not prevent mast cell degranulation and the release of vasoactive kinins. Cromolyn, on the other hand, prevents such reactions from occurring. Confusion still exists in the minds of many physicians as to when and how each of these treatment modalities should be used in the management of allergic rhinitis. Cromolyn should be a first-line drug for allergic rhinitis because of its safety, effectiveness, specificity, and the protective mechanism against acute challenges. Aerosol nasal corticosteroids are more nonspecific and thus can be helpful in situations where other factors such as rebound rhinitis and rhinitis of pregnancy coexist with nasal allergy. However, the local effects and potential systemic absorption of nasal corticosteroids must be considered. Both cromolyn and nasal corticosteroid aerosols are important tools in the management of allergic rhinitis, but they must be properly employed for maximum effectiveness.