The role of intranasal corticosteroids in the management of pediatric allergic rhinitis

Allergic rhinitis (AR) is currently the most common chronic disease in children in the United States, affecting as many as 40% of the children in the population. AR can substantially decrease a child's quality of life and can contribute to school absenteeism. Intranasal corticosteroids (INS) are thought to be the most effective treatment choice for controlling the symptoms of AR. However, parent and physician concerns over INS safety in children have often led to INS being used as a second-line treatment option. More recently, safety studies have shown that the newer INS agents have improved safety profiles compared with older INS agents. The newer INS drugs have been found to have minimal adverse effects on growth and hypothalamic-pituitary-adrenal-axis function in children, which is a concern when prescribing corticosteroids. This review will discuss the pathophysiology, diagnosis, and classification of AR. The mechanism of action, efficacy, and safety of INS will also be discussed by focusing on clinical evidence. Furthermore, other considerations, such as parent or caregiver education and patient compliance, will be reviewed.