Topical nasal steroids for intermittent and persistent allergic rhinitis in children
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Published on: December 20, 2024
J J Al Sayyad1, Z Fedorowicz, D Alhashimi
1Ministry of Health, Bahrain, Medical Review Office, PO Box 12, Manama, Bahrain. JSayyad@health.gov.bh
Insights
Topical nasal steroids show weak evidence for treating childhood allergic rhinitis. More robust research is needed to confirm effectiveness and guide treatment decisions for this common condition.
Area of Science:
- Pediatric Allergy and Immunology
- Otolaryngology
- Pharmacology
Background:
- Allergic rhinitis affects 10-40% of children globally, with increasing prevalence.
- The rise in allergic rhinitis correlates with a rise in asthma comorbidities in children.
Purpose of the Study:
- To assess the efficacy and safety of topical nasal steroids for childhood allergic rhinitis.
- To evaluate these treatments for both intermittent and persistent forms of the condition.
Main Methods:
- Systematic review of randomized controlled trials comparing topical nasal steroids to placebo.
- Searched multiple databases including Cochrane, MEDLINE, and EMBASE up to September 2005.
- Data extraction and quality assessment by two independent reviewers; descriptive summary due to data limitations.
Main Results:
- Included three trials with 79 participants, comparing topical nasal steroids to placebo for perennial rhinitis.
- Limited and unreliable data on primary outcomes due to flawed or incomprehensible analysis in two trials.
- No data available for secondary outcomes; no adverse events reported.
Conclusions:
- Weak and unreliable evidence suggests potential effectiveness of Beconase® and flunisolide for childhood allergic rhinitis.
- Symptom reduction could not be confirmed; clinical judgment and patient factors should guide treatment.
- Further high-quality research is necessary to establish definitive treatment guidelines.
Background:
Allergic rhinitis is a very common chronic illness affecting 10% to 40% of children worldwide. There has been a significant increase in prevalence among children over the last two decades and this increase has been accompanied by a parallel increase in comorbid illnesses such as asthma.
Objectives:
To evaluate the therapeutic effectiveness and adverse event profiles of topical nasal steroids for intermittent and persistent allergic rhinitis in children.
Search Strategy:
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005), MEDLINE (1950 onwards) and EMBASE (1974 onwards) on 5(th) September 2005. CINAHL, mRCT(a meta-database of controlled trials), NRR (the National Research Register), LILACS, MedCarib, KOREAMED, IndMed, Samed, Panteleimon, Zetoc, ISI Proceedings, the GlaxoSmithKline Clinical Trials Database and the websites of AstraZeneca, Schering Plough and Aventis were also searched.
Selection Criteria:
Randomised controlled trials comparing topical nasal steroid preparations against each other or placebo, prescribed for allergic rhinitis in children.
Data Collection And Analysis:
Two authors independently assessed trial quality and extracted data from the included trials. The limited and variable quality of reported data precluded any pooling of results and only a descriptive summary is presented.
Main Results:
Three trials involving a total of 79 participants were included. All three trials, which compared topical nasal steroids against placebo for perennial rhinitis, provided some, albeit limited data, relevant to our primary outcomes; but in two of the trials the data analysis was flawed and in the third trial it was incomprehensible. None of the trials provided data relevant to our secondary outcomes. There were no adverse events reported from any of the interventions.
Authors' Conclusions:
The three included trials provided some weak and unreliable evidence for the effectiveness of Beconase(R) and flunisolide used topically intranasally for the treatment of intermittent and persistent allergic rhinitis in children. The reduction of severity in symptoms as assessed by the trialists could not be confirmed with the data provided and decisions on the use of these medications should, until such time as more robust evidence is available, be guided by the physician's clinical experience and patients' individual circumstances and preferences.
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