Systemic activity versus systemic adverse effects of nasal glucocorticoidsin the treatment of allergic rhinitis

Treatment with nasal glucocorticoids may be associated with systemic activi ty, which can be detected by sensitive measures of basal adrenal cortisol s ecretion, bone turnover and short-term growth (knemometry). The detection o f systemic activity, however, does not imply that nasal glucocorticoids cau se serious adverse systemic effects, such as an inability of the adrenals t o react to physiological stress. Studies assessing the ability of the adren al cortex to react to stimulation have found this to be intact. Long-term a ssessments of bone density and statural height are needed, and the possibil ity of additive effects of intranasal glucocorticoids in children receiving concomitant treatment with inhaled glucocorticoids has not yet been studie d. Children on longterm treatment with intranasal glucocorticoids should be followed with height measurements every 6 mo.