Corticosteroids in the treatment of pediatric allergic rhinitis

The goal of treatment in pediatric allergic rhinitis is to provide effectiv e prevention of or relief front allergic rhinitis symptoms as safely and ef fectively as possible. Removing or avoiding allergens is always advised; ho wever, pharmacotherapy is often necessity. Pharmacologic options include sy stemic decongestants, which are associated with irritability and insomnia, particularly in children. Antihistamines are widely used; however, first-ge neration antihistamines are known to cause dry mouth and sedation. Oral cor ticosteroids are very effective but can have unwanted systemic effects. Ove r the past decade, intranasal corticosteroids have been shown to be the mos t effective form of pharmacologic treatment for allergic rhinitis. Data sup port the use of intranasal corticosteroids as first-line therapy over oral antihistamines; nonetheless, some clinicians have been reluctant to prescri be these agents, particularly for children, because of concerns for systemi c effects. Overall, the newer corticosteroids, including mometasone furoate (NIF), beclomethasone dipropionate, and budesonide have an Improved risk-b enefit ratio compared with older corticosteroids and are now considered the drug of choice for pediatric allergic rhinitis. A good deal of evidence ex ists that confirms the lack of systemic effects from intranasal corticoster oids. However, reports of decreased bone growth in children receiving intra nasal budesonide short-term and beelomethasone dipropionate long-term have heightened concerns that some of these drugs may have systemic effects. A n ew intranasal corticosteroid, MF nasal spray, has been studied in children 3 to 12 years of age and has been shown to be effective. Intranasal NIF is available with once-daily dosing, which has the potential to decrease syste mic side effects.