Safety of Intranasal Steroids: an Updated Perspective.

Area of Science:

• Pharmacology
• Allergy and Immunology
• Pediatrics

Background:

• Intranasal corticosteroid sprays (INS) have been available as over-the-counter (OTC) medications since 2013.
• Clinicians require updated information on INS risks and safety for patient consultations.
• This review examines recent literature on INS safety, adverse reactions, and use in special populations.

Purpose of the Study:

• To review the recent medical literature regarding the safety profile of intranasal corticosteroid sprays (INS).
• To identify adverse reactions associated with INS use.
• To assess the safety of INS in special patient populations.

Main Methods:

• Review of recent medical literature on intranasal corticosteroid sprays (INS).
• Analysis of studies on local and systemic side effects.
• Evaluation of safety data in pediatric and HIV populations.

Main Results:

• INS rarely cause significant local side effects like severe epistaxis.
• No new systemic concerns (e.g., HPA axis suppression, growth, ocular effects) identified.
• Combination INS with antihistamines shows no new safety issues; combination with decongestants may cause tachyphylaxis/rebound congestion.
• INS are supported for children with growth monitoring; HIV patients on ritonavir should avoid INS due to adrenal suppression risk.

Conclusions:

• Newer generation INS should be used at the lowest effective dose.
• Clinicians can reassure patients about the minimal safety concerns of OTC INS.
• Regular follow-up, physical examinations, and addressing patient questions are recommended.
• Future research should evaluate new INS preparations and combinations.