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Allergies > Corticosteroids

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Corticosteroids

There are two ways in which corticosteroids can be taken:

- Topical corticosteroids are applied directly to the nose using pump sprays or dry powder
- Systemic corticosteroids are given by mouth or by injection

Both topical and systemic corticosteroids are effective at treating allergic rhinitis, but topical corticosteroids are most commonly used because they are safer.

Topical Corticosteroids

Topical corticosteroids are used to treat the following symptoms of allergic rhinitis:

- a blocked nose
- a runny nose
- sneezing
- an itchy nose

How Effective are Topical Corticosteroids

Topical corticosteroids are very good at treating a blocked nose, a runny nose, sneezing, and an itchy nose.

They are effective in people suffering from either seasonal or perennial allergic rhinitis. If taken before the pollen season begins, they may reduce the symptoms of seasonal allergic rhinitis during the pollen season

How do Topical Corticosteroids Work?

When people with allergic rhinitis encounter a foreign body (allergen) to which they are allergic, their body produces an immune response that causes inflammation of the lining of the nose (see what causes allergic rhinitis). This inflammation causes the typical symptoms of allergic rhinitis such as sneezing, itching, a runny nose.

Topical corticosteroids have strong anti-inflammatory properties. They reduce the release of substances that are involved in causing nasal inflammation, and can decrease the movement of immune components into the nose lining. They may also increase the amount of allergen that is required to produce an allergic response.

Are Topical Corticosteroids Safe to use?

People are often worried about using steroids because they think they can cause side effects such as reduced growth.

There is indeed a risk of side effects with long-term use of systemic steroids, which are taken orally or by injection. However, topical corticosteroids (which are applied directly to the nose by a spray) are generally safe for use in adults. This is because the amount of steroid reaching the rest of the body is generally too small to have any harmful effects. Only minor side effects such as dryness, sore throat, and nosebleeds may occur.

The effect of long-term topical corticosteroid use in children has not been fully investigated. Only the lowest doses should therefore be given to children, or long-term use should be avoided.

If you are taking inhaled corticosteroids for treatment of asthma, you should consult your doctor if you are considering taken other corticosteroids for allergic rhinitis, as this may increase the risk of developing side effects.

How do i get Topical Corticosteroids?

The following table gives some examples of topical corticosteroids available in the UK, US, and Canada for the treatment of allergic rhinitis. Only brand name drugs are listed, but generic versions may also be available. Many can be obtained from your pharmacist, although some may require a prescription. Your doctor can advise you on the most appropriate one for you.

How should i take Topical Corticosteroids?

Topical corticosteroids are available as pump sprays or dry powder that can be applied to the nose. Saline sprays and washes can be used to clear mucus and other debris from the nose before application. You should not directly spray onto the inner nose wall between the nostrils.

Topical corticosteroids should be taken once or twice a day. They may take 12 h to start working, and the maximum effects may not be reached for a few days or even weeks. People who suffer from pollen allergies should begin treatment before the start of the pollen season.

What Drugs can i take at the same time?

In some cases, a combination of different drugs may be useful in treating allergic rhinitis. Your doctor can advise you on whether you may benefit from this.

Antihistamines and decongestants

Antihistamines are good at treating sneezing, an itchy nose, and a runny nose, but they are less good at treating a blocked nose. They may therefore be used at the same time as oral decongestants, which are effective at relieving a blocked nose.

Combinations of antihistamines and decongestants can counteract all the symptoms of allergic rhinitis on a short-term basis.

Topical corticosteroids and antihistamines

Topical corticosteroids and antihistamines are both very good at treating a runny nose, sneezing, and an itchy nose, and topical corticosteroids are also good at treating a blocked nose. If you have severe allergic rhinitis, your doctor may advise that you use both topical corticosteroids and antihistamines to control your symptoms.

Systemic Corticosteroids

Systemic steroids are taken by mouth or by injection.

They are effective at treating most symptoms of allergic rhinitis, but may cause serious side effects. They may be prescribed to adults with very severe allergic rhinitis.

How do Systemic Corticosteroids work?

When people with allergic rhinitis encounter a foreign body (allergen) which they are allergic to, their body produces an immune response that causes inflammation of the lining of the nose (see what causes allergic rhinitis). This inflammation causes the typical symptoms of allergic rhinitis such as sneezing, itching, a runny nose etc.

Corticosteroids have strong anti-inflammatory properties. They reduce the release of substances that are involved in causing nasal inflammation, and can decrease the movement of immune components into the nose lining. Systemic corticosteroids have a strong effect as they are taken up into the blood stream.

Are Systemic Corticosteroids Safe?

Short-term use of systemic corticosteroids is generally safe in adults. However, they may cause some serious side effects and this is why they are only given to people with severe disease.

The major side effects include reduced growth, slow bone development, and changes in hormone levels. Because of this, children and pregnant women should not use systemic corticosteroids.

It must be remembered that whilst systemic corticosteroids (those taken by injection or by mouth) may cause serious side effects, topical corticosteroids (those taken as nasal sprays or drops) are generally safe.

Who should use Systemic Corticosteroids?

Systemic corticosteroids are usually only given to adults who have very severe allergic rhinitis. Often, these people cannot be treated using other drugs.

If you think you may need systemic corticosteroids, you should talk to your doctor. You should ask him or her to explain the possible side effects from taking these drugs.

How do i take Corticosteroids?

You can only use systemic corticosteroids if they are prescribed to you by your doctor.
They are taken by mouth (tablets) or by an injection.

To reduce the risk of side effects, only short-term courses (3 weeks) are usually given.

References

van Cauwenberge P, Bachert C, Passalacqua G, et al. Consensus statement on the treatment of allergic rhinitis. European Academy of Allergology and Clinical Immunology. Allergy 2000;55:116–134.

Dykewicz MS, Fineman S, Skoner DP, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1998;81:478–518.

Virant FS. Allergic rhinitis. Immunol Allergy Clin North Am 2000;20:265–282.