Do intranasal corticosteroids affect childhood growth?

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.