Intranasal Corticosteroids In Children Research Articles

Intranasal fluticasone furoate in pediatric allergic rhinitis: randomized controlled study

BackgroundIntranasal corticosteroids are the most efficacious anti-inflammatory medications for allergic rhinitis (AR). However, the efficacy and safety of intranasal corticosteroids in children have not yet been subject to specific research in China. The aim of this study was to investigate the efficacy and safety of fluticasone furoate nasal spray (FFNS) in a Chinese pediatric population.MethodsIn this phase 4 randomized, double-blind, placebo-controlled, multicenter study, pediatric AR patients aged 2–12 years were randomized 1:1:1, receiving either FFNS 55 µg or 110 µg or placebo. Electronic diary cards were completed to record symptoms, rescue medication use, and treatment compliance. Anterior rhinoscopy and overall response to therapy were evaluated and recorded.ResultsPatients treated with FFNS at either dose experienced a significantly greater reduction in daily reflective total nasal symptom score compared with placebo. This was maintained in a younger subset of patients (2–6 years). Drug-related adverse events occurred in <20% of patients in all groups. FFNS was well tolerated at both doses.ConclusionsThis study demonstrates favorable efficacy and safety profiles for FFNS 55 µg or 110 µg in Chinese pediatric populations (2–12 years), supporting its use in clinical treatment for AR children, including younger children aged 2–6 years.ImpactThe aim of this study was to investigate the efficacy and safety of intranasal fluticasone furoate in Chinese pediatric allergic rhinitis.This research not only addresses the deficiency in efficacy and safety data for intranasal corticosteroids in very young patients (aged 2–6 years) worldwide but also demonstrates that fluticasone furoate nasal spray shows a favorable benefit/risk profile at different dose levels.Our data will be of interest to the broad readership of Pediatric Research and will positively contribute to the dialog regarding the treatment of allergic rhinitis in children aged 2–6 years.

How can we improve medical adherence to intranasal corticosteroids in children?

ObjectiveTo evaluate the factors which may be related to nonadherence to intranasal corticosteroids (ICS) in the treatment of allergic rhinitis (AR) in children. MethodsA prospective study was conducted on children with AR diagnosis in a tertiary referral hospital. All participants were provided with mometasone furoate nasal sprays for 30 days after the diagnosis. Caregivers were called back when the therapy was over and completed a questionnaire about the factors that may influence the adherence to the treatment. Afterwards each caregiver completed the Turkish language validated Morisky Medical Adherence Scale (MMAS-8) form. Each factor was evaluated according to MMAS-8 score and all variables were analyzed statistically. ResultsA total number of 76 children with a mean age of 7.82 years were included in the study. The mean overall MMAS-8 score was 2.80. There was only one factor significantly related to low adherence; the number of dependent children to the caregiver (p = 0.011). Besides this 71.51% of the answers to MMAS-8 scale were compatible with good adherence. ConclusionThe clinician must consider the factors which may lead to non-adherence while setting up a treatment plan. The demographic and sociocultural factors must be taken into consideration and treatment schedule should be made in respect of daily activities of the children. Moreover the father can be involved in the therapy plan and back up the mother as they are usually the responsible parent for children's medical therapy.

The tall and the short: Repainting the landscape about the growth effects of inhaled and intranasal corticosteroids.

Earlier 1-year growth studies that used older inhaled corticosteroid (ICS) formulations consistently showed that ICS, but not intranasal corticosteroids (INCS), produced a small ∼1 cm/y growth effect that appeared to be nonprogressive and noncumulative. Studies that lasted for >1 year showed that such treatment during childhood did not affect final adult height. Collectively, these studies led to the beliefs that (1) the small short-term effect on growth is unimportant, (2) there is no long-term harm, and (3) any small risk is easily outweighed by the benefit. This led to the cavalier use of ICS and INCS in children and approval of some INCS for over-the-counter sales for children as young as 2 years of age. Literature search using Pub-Med. More recent studies, with improved scientific designs, have challenged and overturned the earlier beliefs. Moreover, some of the newer ICS formulations have negative, robust growth studies (designed per FDA guidance and detected no growth effect). This review focused on the new evidence and how it will change the way that we use ICS and INCS in children with allergy and asthma in both clinical practice and research, with a renewed focus on safety. There also are significant implications for future iterations of asthma guidelines. The goal was to identify the proper amount of new concern about ICS and INCS, not to generate undue steroid "phobia."

Impact of Intranasal Corticosteroids on Asthma Outcomes in Allergic Rhinitis: A Meta-analysis

S Lohia, RJ Schlosser, ZM Soler. Allergy. 2013;68(5):569–579 To perform an updated systematic review with meta-analysis to assess the impact of intranasal corticosteroid (INCS) medications on asthma outcomes in patients with allergic rhinitis and asthma. A systematic review and meta-analysis were performed on articles published before May 2012. Randomized controlled trials evaluating the efficacy of intranasal corticosteroids in children and adults were identified from PubMed, Cochrane, and Medline databases and were assessed for systematic …

The Use of Intranasal Corticosteroids in Children

Objective: Investigate the use of intranasal corticosteroids (ICS) by otolaryngologists with a predominantly pediatric practice, a national inquiry has been conducted in a European country. Method: Participants: 212 otolaryngologists, representing around 10% of the specialty, answered the survey (M/F ratio=179/33). The mean age of this population was 52 ± 8.4 years, with a mean time in practice of 20.7 ± 9 years. Results: Disease treated by ICS were chronic rhinosinusitis in 39.2% for a mean duration of 30 days in 62.2% of the cases, aergic rhinitis in 69.2 %, nasal polyposis in 67.2%, and OME in 30.2%. Acute rhinosinusitis was considered for treatment by intranasal corticosteroids by only 8.5% of otolaryngologists. Adenoid hypertrophy was treated in 16% of cases by ICS. Symptoms considered for treatment by ICS were nasal obstruction (88.6%), rhinorrhea (67.6%), nasal itching (66.1%), ocular symptoms (41.2%), sneezing (63%), olfactory troubles (73.2%), dyspnea (76%), edema of nasal mucosa (76.2%). Fever was never an indication (75%). Conclusion: According to this nationwide survey nasal polyposis and allergic rhinitis are the most frequent indications for ICS treatment in children.

Intranasal Corticosteroids of the New Generation in the Therapy of the Children with Allergic Rhinitis

According to a recent epidemiological studies the avarage rate of prevalence of allergic rhinitis (AR) in children, in USA is between 20- 40% and in Western Europe up to 20%. The disease most ferquently appeared in children age 4 to 11. In this study authors analysed the results of the recent studies according to the literature data about the efficacy and safety of the intranasal corticosteroids in children with allergic rhinitis. These drugs as well as antihistamines and decongestants, are the first line therapy choice in allergic rhinitis. According to the numerous experimental and clinical studies, intranasal corticosteroids of the new generation decrease the intensity of allergic inflammmation by induction of apoptosis of eosinopils and by decreased expression of intercelular adhesion molecules (ICAM) and proinflammatory mediators as TNF-alpha, IL-8, Il-4, Il-5. All studies in children showed no significant bioavailability and no effect on plasma cortisol level in therapy with new generation of intranasal corticosteroids.The leading symptom of allergic rhinitis, nasal congestion, was markedly reduced.Intranasal corticosteroids decrease the intensity of simptoms in comorbid diseases in children as sinusitis, secretory otitis media and asthma attacks. The local adverse effects of intranasal corticosteroids such as iritabillity of nasal mucosa, dryness of the nose and mouth, headache and epistaxis are rare. The results of recent studies showed that intranasal corticosteroids of the new generations have high safety profile and are recommended as the first line therapy choice in children with moderate to severe type of persisent allergic rhinitis.

Triamcinolone Acetonide Aqueous Nasal Spray: Safe and Effective in Young Children

Allergic rhinitis affects up to 42% of children by age 6 years, but few studies have evaluated the effects of intranasal corticosteroids in children aged 2 to 5 years. To address concerns that intranasal corticosteroids may affect the hypothalamic-pituitary axis and growth of young children, researchers conducted a manufacturer-funded, randomized, double-blind, placebo-controlled study of triamcinolone acetonide aqueous nasal spray (TAA AQ) in children aged 2 to 5 years who had allergic rhinitis. Children with symptoms of allergic rhinitis for at least 1 …

Topical intranasal corticosteroids in 4-11 year old children with persistent bilateral otitis media with effusion in primary care: double blind randomised placebo controlled trial

Objective To determine the clinical effectiveness of topical intranasal corticosteroids in children with bilateral otitis media with effusion.Design Double blind randomised placebo controlled trial.Setting 76 Medical Research Council General Practice...

Molecular and clinical pharmacology of intranasal corticosteroids: clinical and therapeutic implications

Intranasal corticosteroids (INSs) are effective treatments for allergic rhinitis, rhinosinusitis, and nasal polyposis. In recent years, increased understanding of corticosteroid and glucocorticoid receptor pharmacology has enabled the development of molecules designed specifically to achieve potent, localized activity with minimal risk of systemic exposure. Pharmacologic potency studies using affinity and other assessments have produced similar rank orders of potency, with the most potent being mometasone furoate, fluticasone propionate, and its modification, fluticasone furoate. The furoate and propionate ester side chains render these agents highly lipophilic, which may facilitate their absorption through nasal mucosa and uptake across phospholipid cell membranes. These compounds demonstrate negligible systemic absorption. Systemic absorption rates are higher among the older corticosteroids (flunisolide, beclomethasone dipropionate, triamcinolone acetonide, and budesonide), which have bioavailabilities in the range of 34-49%. Studies, including 1-year studies with mometasone furoate, fluticasone propionate, and budesonide that evaluated potential systemic effects of INSs in children have generally found no adverse effects on hypothalamic-pituitary-adrenal axis function or growth. Clinical data suggest no significant differences in efficacy between the INSs. Theoretically, newer agents with lower systemic availability may be preferable, and may come closer to the pharmacokinetic/pharmacologic criteria for the ideal therapeutic choice.

Mometasone Furoate Nasal Spray is Safe and Effective for One-Year Treatment of Children With Perennial Allergic Rhinitis

Systemic safety of intranasal corticosteroids in children is an important concern for parents and physicians. Long-term safety and efficacy of mometasone furoate nasal spray (MFNS) was assessed in children with perennial allergic rhinitis (PAR).

Safety of Mometasone Furoate Nasal Spray in Children with Allergic Rhinitis as Young as 2 Years of Age: A Randomized Controlled Trial

Current treatment guidelines recommend intranasal corticosteroids or nonsedating antihistamines as first-line therapy for allergic rhinitis (AR). Because of concerns regarding the systemic safety of intranasal corticosteroids in children, the present study was conducted to evaluate systemic activity of mometasone furoate nasal spray (MFNS) in children as young as 2 years of age with AR. This was a randomized, third-party blind, parallel-group, placebo-controlled trial conducted at a single research center with 56 subjects from 2 to <6 years of age. Subjects were randomized to 100 µg MFNS or placebo once daily in the morning (one 50 µg spray/nostril) for 42 consecutive days. The primary variables were serum cortisol concentration and 24-hour urinary free cortisol, corrected for creatinine (UFC) at end of treatment. Baseline values for serum cortisol (AUC(0–24)) were comparable for MFNS and placebo (225.2 µg/hour/dL and 232.3 µg/hour/dL, respectively), as were baseline values for UFC (75.8 µg/gm per 24 hours, and 76.0 µg/gm per 24 hours, respectively). At end point, serum cortisol (AUC(0–24)) values were 216.7 µg/hour/dL in the MFNS group and 201.1 µg/hour/dL in the placebo group. The UFC values at end point were 51.6 µg/gm 24 hours and 98.4 µg/gm 24 hours in the MFNS and placebo groups, respectively. No significant differences were observed between treatments, and neither treatment was associated with significant changes from baseline in serum cortisol or urinary free cortisol. This study demonstrates that treatment with MFNS 100 µg once daily in the morning in patients as young as 2 years of age had negligible systemic exposure and did not appear to affect hypothalamic-pituitary-adrenal (HPA) axis function. (Pediatr Asthma Allergy Immunol 2006; 19[3]:146–153.