Intranasal corticosteroids and adrenal suppression

Area of Science:

• Pediatric Allergy and Immunology
• Endocrinology
• Pharmacology

Background:

• Allergic rhinitis often coexists with asthma and atopic dermatitis.
• Intranasal corticosteroids (INS) are common treatments for allergic rhinitis.
• Potential systemic side effects of INS, including hypothalamic-pituitary-adrenal (HPA) axis suppression, require evaluation.

Purpose of the Study:

• To evaluate the impact of intranasal corticosteroids on the hypothalamic-pituitary-adrenal (HPA) axis in children.
• To determine the most effective tests for detecting HPA axis suppression in pediatric populations.
• To assess the clinical relevance of HPA axis suppression from INS use.

Main Methods:

• Review of literature on HPA axis suppression studies involving intranasal corticosteroids.
• Analysis of various cortisol measurement techniques, including morning plasma cortisol and 24-hour plasma cortisol.
• Examination of studies specifically investigating INS effects in children and adults.

Main Results:

• Overall, intranasal corticosteroids demonstrate a minimal effect on the HPA axis.
• Some studies showed decreased urinary cortisol with specific INS (budesonide, fluticasone propionate, beclomethasone dipropionate) in adults or healthy volunteers.
• Most studies, particularly in children, showed no significant HPA axis suppression with various INS, including mometasone furoate and fluticasone furoate.

Conclusions:

• Intranasal corticosteroids have a minimal impact on the HPA axis in children.
• 24-hour plasma cortisol tests are considered a good, non-invasive measure for assessing biologically active cortisol levels.
• Routine adrenal function monitoring is not recommended for children on INS alone, unless concurrently using inhaled corticosteroids or topical steroids.