A Risk-Benefit Assessment of Intranasal Triamcinolone Acetonide in Allergic Rhinitis

Abstract

The efficacy of intranasal triamcinolone acetonide in seasonal and allergic rhinitis has been evaluated in clinical trials and has been compared with antihistamines and other intranasal corticosteroids. Intranasal corticosteroids are either as equally effective as or more effective than comparative drugs. Intranasal corticosteroids are particularly useful as they decrease membrane permeability and inhibit both early and late phase reactions to allergens. They minimise the nasal secretory response and reduce the sensitivity of local nasal irritant receptors. A potential benefit of topical application is the flushing action of the nasal mucosa, which may reduce allergens and secretions. In addition to seasonal and perennial rhinitis, intranasal corticosteroids have additional benefits when used to reduce inflammation in the treatment of sinusitis and may help in decreasing secondary rhinovirus infections. Furthermore, suboptimal control of asthma can be avoided by treatment of allergic rhinitis with intranasal corticosteroids. In clinical trials, common adverse effects for triamcinolone acetonide include sneezing, dry, mucosa, nasal irritation, sinus discomfort, throat discomfort, epistaxis and headache. Posterior subcapsular cataract formation has not been seen with triamcinolone acetonide. Recent literature evaluating systemic absorption of intranasal corticosteroids have shown surprising results where significant absorption has occurred with intranasal budesonide and fluticasone propionate. Growth and hypothalamic pituitary axis (HPA) function studies have been reviewed, with some intranasal corticosteroids showing changes with continual use. A retrospective study in children receiving daily triamcinolone acetonide for 12 months showed no effect on height and bodyweight. Triamcinolone acetonide at standard dosages (110 or 220microg once or twice a day) does not appear to suppress adrenal gland function and is effective in relieving most symptoms of allergic rhinitis. The International Consensus Conference Proceedings on Rhinitis now currently recommends the use of intranasal corticosteroids as first line therapy, since they have been found to be well tolerated and effective with minimal adverse effects and, specifically, no cognitive impairment. The recommended maximum dose of aqueous triamcinolone acetonide in adults and children is 220microg once a day. The aerosol form may be recommended in children between 7 and 12 years old, up to 440microg once a day or in divided doses. Duration of allergy treatment is generally for the length of each allergy season. If symptoms are perennial, then a reduction of dosage is made to the lowest effective dose with monitoring every 3 months for risk and benefit assessment. Complications to watch for include bleeding, and possible septal perforation and nasal candidiasis, although these are rare.

Triamcinolone‐impregnated nasal dressing following endoscopic sinus surgery: A randomized, double‐blind, placebo‐controlled study

“…In a risk‐benefit analysis, it has been associated with markedly few adverse side effects 4. As such, The International Consensus Conference Proceedings on Rhinitis recommend intranasal steroids as a first line therapy in allergic rhinosinusitis 5. However, in the postoperative time frame, the use of topical corticosteroid sprays, in an effort to prevent recurrence of chronic rhinosinusitis with polyposis, has met with mixed results 6.…”

Indications et complications des corticoïdes en ophtalmologie

“…La diffusion systémique des corticoïdes administrés par la voie intranasale diffère d'une molécule à l'autre. Le budésonide et le fluticasone propionate passent significativement dans la circulation générale [9]. Il semble que l'administration intranasale de corticoïdes n'induit pas de cataracte (n = 225 dont 70 % traités béclométasone dipropionate) [10], même si quelques cas sont rapportés [11].…”

Treatment of Allergic Rhinitis: Anticholinergics, Glucocorticotherapy, Leukotriene Antagonists, Omalizumab and Specific-Allergen Immunotherapy

“…The placebo improved symptoms of sneezing, nasal blockage, rhinorrhoea and pruritus (Di Lorenzo et al, 1999). Furthermore, it is recommended the use of triamcinolone as the intranasal corticosteroid of choice in AR at a recommended dose of 220 micrograms once a day (Gawchik & Saccar, 2000).…”