Allergic Rhinitis in Children: Selecting an Intranasal Corticosteroid

Abstract

Allergic rhinitis affects up to 40% of children in the United States. Proper management of this disease is important for controlling symptoms, improving quality of life, and preventing the development or exacerbation of comorbid diseases such as asthma, sinusitis, otitis media, and respiratory infections. Intranasal corticosteroids (INSs) are recognized as the most effective medication class for controlling allergic rhinitis symptoms and are recommended by guidelines as first-line treatment for moderate to severe cases of allergic rhinitis in patients of all ages. Four once-daily, aqueous formulations of INSs are available in the United States for pediatric patients: budesonide aqueous nasal spray (BANS), fluticasone propionate nasal spray (FPNS), mometasone furoate nasal spray (MFNS), and triamcinolone acetonide aqueous nasal spray (TANS). The results of comparative studies of these INSs show that all four appear to be similar in efficacy and tolerability. The sensory attributes of these INSs do differ and these differences may play a role in the choice of an INS for each patient. Based on studies in adults, patient preference was found to be greater for the sensory attributes of BANS and TANS than for those of FPNS and MFNS, although a number of patients still showed a preference for the attributes of FPNS and MFNS. Similar studies of INS sensory attributes have not been conducted in children. Prescribing the INS with sensory attributes most pleasing to the individual patient may be important in improving patient acceptance of and satisfaction with treatment and perhaps lead to better adherence with therapy. (Pediatr Asthma Allergy Immunol 2005; 18[4]:216-229.)Adapted from Bousquet J, Van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma.