Use of Intranasal steroids for rhinitis and sinusitis

Use of intranasal steroids for rhinitis and sinusitis have been a mainstay of treatment for allergic rhinitis and chronic rhinitis for decades.  Nasal spray delivery systems have been used for over 30 years. Basically, steroids are potent anti-inflammatory medications.  They can decrease a number of symptoms associated with nose allergies and irritation of the nasal membrane.  Symptoms may include:

• nasal congestion
• post nasal drip
• itchy nose, ears, or throat
• runny nose
• This irritation can occur with sinus infections

You may recognize some of the formulations that are available for nasal steroid use. These include nasal sprays such as Flonase (fluticasone), Rhinocort, and Nasacort.  All of these nasal sprays are available over-the-counter. The decision of the FDA to allow these medications to be available as an over-the-counter product underscores belief in their safety. However, patients should be aware of certain side effects. These include:

• headache
• nasal dryness
• nosebleeds
• sensation of nasal burning and irritation

It is known that small amounts of the steroid are absorbed into the bloodstream. Clearly these may affect the patient’s own steroid hormone levels. Patients using high doses of intranasal steroids in combination with inhaled steroids used to treat asthma should be used with physician supervision.

Overall, use of intranasal steroids for rhinitis and sinusitis represent an important class of medication in treating inflammation of the nose due to allergies and chronic infection. They are more potent than antihistamines in decreasing symptoms such as congestion, excessive mucus, and sneezing. Lastly, if patients are using any form of saline irrigation, we recommend using the nasal steroid after irrigating.