A risk-benefit assessment of intranasal triamcinolone acetonide in allergic rhinitis

The efficacy of intranasal triamcinolone acetonide in seasonal and allergic rhinitis has been evaluated in clinical trials and has been compared with antihistamines and other intranasal corticosteroids. Intranasal corticoster oids are either as equally effective as or more effective than comparative drugs. Intranasal corticosteroids are particularly useful as they decrease membrane permeability and inhibit both early and late phase reactions to al lergens. They minimise the nasal secretory response and reduce the sensitiv ity of local nasal irritant receptors. A potential benefit of topical appli cation is the flushing action of the nasal mucosa, which may reduce allerge ns and secretions. In addition to seasonal and perennial rhinitis, intranasal corticosteroids have additional benefits when used to reduce inflammation in the treatment of sinusitis and may help in decreasing secondary rhinovirus infections. Fu rthermore, suboptimal control of asthma can be avoided by treatment of alle rgic rhinitis with intranasal corticosteroids. In clinical trials, common adverse effects for triamcinolone acetonide incl ude sneezing, dry mucosa, nasal irritation, sinus discomfort, throat discom fort, epistaxis and headache. Nasal candidiasis and septal perforation have been reported, although rarely. Posterior subcapsular cataract formation h as not been seen with triamcinolone acetonide. Recent literature evaluating systemic absorption of intranasal corticostero ids have shown surprising results where significant absorption has occurred with intranasal budesonide and fluticasone propionate. Growth and hypothal amic pituitary axis (HPA) function studies have been reviewed, with some in tranasal corticosteroids showing changes with continual use. A retrospectiv e study in children receiving daily triamcinolone acetonide for 12 months s howed no effect on height and bodyweight. Triamcinolone acetonide at standa rd dosages (110 or 220 mug once or twice a day) does not appear to suppress adrenal gland function and is effective in relieving most symptoms of alle rgic rhinitis. The International Consensus Conference Proceedings on Rhinitis now currentl y recommends the use of intranasal corticosteroids as first line therapy, s ince they have been found to be well tolerated and effective with minimal a dverse effects and, specifically, no cognitive impairment. The recommended maximum dose of aqueous triamcinolone acetonide in adults a nd children is 220 mug once a day. The aerosol form may be recommended in c hildren between 7 and 12 years old, up to 440 mug once a day or in divided doses. Duration of allergy treatment is generally for the length of each al lergy season. If symptoms are perennial, then a reduction of dosage is made to the lowest effective dose with monitoring every 3 months for risk and b enefit assessment. Complications to watch for include bleeding, and possibl e septal perforation and nasal candidiasis, although these are rare.