The increasing use of intranasal steroids in the management of allergic rhinitis reflects their efficacy, tolerability, and safety. However, issues related to the safety of intranasal steroids continue to generate debate and confusion among clinicians. Consequently, there is often reluctance and uncertainty in prescribing these effective agents for the treatment of perennial and seasonal allergic rhinitis. Issues of particular concern are whether intranasal steroids adversely affect various homeostatic systems, influence growth and bone metabolism, and compromise ocular function. Furthermore, the expanding role of intranasal steroids in the pediatric, geriatric, and postmenopausal populations has raised concerns that these agents may result in a steroid burden that more readily causes adverse effects. An extensive review of the literature overwhelmingly supports the assertion that intranasal steroids are safe in prescribed doses and should allay the misconceptions regarding their appropriate use in the management of allergic rhinitis.
When considering the results for the individual symptoms, benefit was shown in the intranasal corticosteroids group. The effect size was larger for nasal blockage ( MD -, 95% CI - to -; 1702 participants; six studies) than for rhinorrhoea ( MD -, 95% CI - to -; 1702 participants; six studies) or loss of sense of smell ( MD -, 95% CI - to -; 1345 participants; four studies). There was heterogeneity in the analysis for facial pain/pressure ( MD -, 95% CI - to ; 243 participants; two studies). The quality of the evidence was moderate for nasal blockage, rhinorrhoea and loss of sense of smell, but low for facial pain/pressure.