Related Experiment Videos
Do intranasal corticosteroids affect childhood growth?
1University of Wisconsin Children's Hospital, Madison 53792-4108, USA.
Insights
Topical intranasal corticosteroids (INS) are effective for allergic rhinitis. Newer INS with low bioavailability are unlikely to impact childhood growth, unlike older formulations.
Area of Science:
- Pediatric Endocrinology
- Allergy and Immunology
- Pharmacology
Background:
- Topical intranasal corticosteroids (INS) are the primary treatment for allergic rhinitis.
- Concerns exist regarding potential growth inhibition in children, similar to oral corticosteroids.
- Assessing the safety of INS on pediatric growth is crucial due to increasing prescriptions.
Purpose of the Study:
- To evaluate the potential impact of topical intranasal corticosteroids on childhood growth.
- To differentiate between INS formulations regarding their effects on growth.
- To inform clinical practice on selecting safer INS for children.
Main Methods:
- Review of existing evidence on INS and childhood growth.
- Analysis of pharmacokinetic properties of different INS, focusing on bioavailability.
- Identification of knowledge gaps and need for prospective studies.
Main Results:
- Some older INS, like beclomethasone dipropionate (BDP), may slow growth with prolonged use.
- Newer INS, such as fluticasone propionate (FP) and mometasone furoate, have low bioavailability and are unlikely to affect growth.
- Evidence suggests a link between systemic absorption and growth suppression.
Conclusions:
- The risk of growth suppression from INS is likely formulation-dependent.
- Newer INS with reduced systemic bioavailability appear safer for pediatric growth.
- Optimizing INS selection based on therapeutic-to-bioavailability ratio minimizes growth risks.
Abstract:
Topical intranasal corticosteroids (INS) are the most effective treatment for allergic rhinitis and are being increasingly prescribed to children. Due to the potent inhibition of childhood growth seen with oral corticosteroids, it is important to examine whether INS could have similar effects. The evidence available suggests that some INS, such as beclomethasone dipropionate (BDP), may slow growth when used regularly for prolonged periods. However, newer INS such as fluticasone propionate (FP) and mometasone furoate, which have substantially reduced bioavailability via gastrointestinal absorption, are unlikely to do so. Well-designed prospective studies are needed to distinguish those INS with reduced or absent effects on growth. In practice, choosing an INS which optimises the ratio of therapeutic effect to systemic bioavailability will probably reduce the risk of growth suppression to a negligible level.