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Published on: December 20, 2024

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

Supaluk Chatmaitri1, Ongon Boonnijasin1, Apiradee Wisitsartkul2

  • 1Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
|August 19, 2026
PubMed

Insights

Regular intranasal corticosteroid (INCS) use showed early benefits for pediatric perennial allergic rhinitis (PAR) symptom control compared to as-needed use. However, these clinical advantages diminished over time, suggesting as-needed INCS may be a viable alternative for some patients.

Area of Science:

  • Pediatric Allergy and Immunology
  • Respiratory Medicine
  • Pharmacology

Background:

  • Intranasal corticosteroids (INCS) are the primary treatment for allergic rhinitis (AR).
  • Daily adherence to INCS can be challenging for pediatric patients.
  • Limited evidence exists comparing regular versus as-needed INCS for pediatric perennial allergic rhinitis (PAR).

Purpose of the Study:

  • To assess the efficacy and safety of regular versus as-needed INCS in children with PAR.
  • To evaluate the anti-inflammatory effects of different INCS dosing strategies.
  • To compare symptom scores, quality of life, and nasal cytology between treatment groups.

Main Methods:

  • An 8-week, randomized, double-blind, double-dummy trial involving 70 children (aged 6-18) with PAR.
  • Participants were assigned to regular or as-needed intranasal fluticasone furoate.
  • Outcomes included symptom scores, visual analog scales, quality of life, nasal cytology, and adverse events.

Main Results:

  • Regular INCS showed superior early improvements in total, nasal, and ocular symptom scores and nasal airflow compared to as-needed use.
  • These early clinical differences were not sustained by week 8.
  • Regular INCS led to greater reductions in nasal eosinophils and basophilic cells, while as-needed use resulted in lower cumulative INCS exposure.
  • Adverse events were similar, with epistaxis noted only in the as-needed group.

Conclusions:

  • Regular INCS use provides initial clinical and anti-inflammatory benefits over as-needed use in pediatric PAR.
  • The clinical benefits of regular INCS did not persist throughout the 8-week study period.
  • As-needed INCS demonstrated symptom improvement from baseline and may be a suitable alternative for symptom management in select pediatric PAR patients.
Abstract

Keywords:
Fluticasone furoateRhinoconjunctivitis Quality of Life-36 questionnaireallergic rhinitisintranasal corticosteroidpeak nasal inspiratory flowpediatricsperennial allergic rhinitistotal nasal symptom scoretotal ocular symptom scorevisual analog scale

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