Safety Profile of Intranasal Corticosteroids in Allergic Rhinitis: A Comprehensive Review

Area of Science:

• Pharmacology
• Allergology
• Clinical Medicine

Background:

• Intranasal corticosteroids (INCS) are primary treatments for allergic rhinitis (AR).
• Patient adherence and treatment acceptance are influenced by concerns about local and systemic adverse events (AEs).
• Safety perceptions often outweigh efficacy differences in formulation selection, especially for pediatric patients and long-term therapy.

Purpose of the Study:

• To evaluate the safety profile of currently available INCS formulations.
• To assess the impact of pharmacokinetic and pharmacodynamic properties on INCS safety.
• To compare local and systemic AEs across different INCS formulations.

Main Methods:

• Review of available evidence on INCS formulations.
• Analysis of pharmacokinetic and pharmacodynamic properties influencing safety.
• Assessment of reported local and systemic adverse events.

Main Results:

• Local AEs (epistaxis, nasal irritation) are common but generally mild and self-limiting.
• Clinically significant nasal complications are rare.
• Systemic AEs (HPA axis suppression, ocular toxicity, growth impairment) are not consistently demonstrated with low-exposure formulations at recommended doses.
• Modern INCS formulations (mometasone furoate, fluticasone propionate, fluticasone furoate, ciclesonide) show minimal systemic exposure due to extensive first-pass metabolism.
• Differences in local tolerability and sensory characteristics are more clinically relevant than systemic safety outcomes.
• Pediatric evidence is reassuring regarding growth, despite historical concerns.

Conclusions:

• Modern INCS formulations are generally well-tolerated with a favorable safety profile for both adults and children.
• Formulation-dependent differences primarily impact local tolerability and patient adherence.
• Long-term use of INCS at recommended doses is supported by current evidence for effective AR management.