As-Needed Versus Regular Intranasal Corticosteroid Therapy in Pediatric Perennial Allergic Rhinitis: A Randomized...

Intranasal corticosteroids (INCS) are the most effective monotherapy for allergic rhinitis (AR), but daily adherence remains challenging. Evidence comparing regular versus as-needed INCS use in pediatric perennial allergic rhinitis (PAR) is limited.

To evaluate the efficacy, safety, and anti-inflammatory effects of regular versus as-needed INCS in pediatric PAR.

In this 8-week, randomized, double-blind, double-dummy trial, 70 children aged 6-18 years with PAR were assigned (1:1) to regular or as-needed intranasal fluticasone furoate. Key outcomes included total, nasal, and ocular symptom scores (TSS, TNSS, TOSS), visual analog scale (VAS), parent-assessed scores, Rhinoconjunctivitis Quality of Life-36 (RCQ-36), peak nasal inspiratory flow (PNIF), nasal cytology, INCS exposure, and adverse events.

Sixty-eight patients completed the trial (as-needed, n=33; regular, n=35). Regular treatment demonstrated greater improvements in TSS, TNSS, TOSS, VAS, PVAS, and PNIF than as-needed treatment at selected early time points (all P<0.05). However, these differences were not sustained through week 8. No significant between-group differences were observed in PTSS, PTNSS, PTOSS, or RCQ-36 scores. At week 8, regular treatment yielded greater reductions in mucosal eosinophils and basophilic metachromatic cells (P<0.05). Cumulative INCS exposure was lower with as-needed treatment (P<0.05). Adverse events were comparable, although epistaxis occurred only in the as-needed group (P=0.02).

Regular INCS use was associated with greater early clinical and antiinflammatory benefits than as-needed use in pediatric PAR, without increased adverse events. However, between-group clinical differences were not sustained through week 8. As-needed treatment also improved outcomes from baseline and may be an alternative for symptom control in selected patients.