Intranasal Corticosteroid Therapies for Allergic Rhinitis

Allergic rhinitis is a pervasive inflammatory disorder of the nasal mucosa precipitated by airborne allergens and characterised by sneezing, nasal congestion, rhinorrhoea and pruritus. Intranasal corticosteroids (INCS) represent the first-line therapeutic modality for moderate-to-severe presentations, owing to their potent local anti-inflammatory actions mediated via glucocorticoid receptor binding and suppression of type 2 cytokine–driven eosinophilic infiltration. Widely used agents include fluticasone propionate, fluticasone furoate, mometasone furoate, budesonide and triamcinolone acetonide, each formulated as aqueous solutions or suspensions. These therapies not only ameliorate nasal symptoms but also confer relief of associated ocular discomfort and enhance overall quality of life. Systemic absorption is minimal, yielding a favourable safety profile, though local adverse events such as epistaxis, nasal dryness and, rarely, septal perforation may occur. Long-term risks to the hypothalamic-pituitary-adrenal axis and paediatric growth are low when recommended doses are observed. Advances in formulation science have sought to optimise particle size, mucosal deposition and onset of action, while preservative-free sprays and combination preparations with antihistamines aim to improve adherence. Given that allergic rhinitis affects up to 40 per cent of children and 30 per cent of adults worldwide, INCS therapies remain indispensable in reducing disease burden, restoring sleep quality and preserving daytime productivity.

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Intranasal Corticosteroid Therapies for Allergic Rhinitis publication trend

The graph below shows the total number of articles in intranasal corticosteroid therapies for allergic rhinitis across all publications each year (not limited to Nature Index journals).

Technical terms

Intranasal corticosteroids (INCS): Anti-inflammatory medications administered via the nasal passages to attenuate allergic inflammation.
Allergic rhinitis: An immunoglobulin E-mediated inflammation of nasal mucosa in response to allergen exposure.
Total nasal symptom score (TNSS): A composite index quantifying the severity of nasal congestion, itching, sneezing and rhinorrhoea in clinical studies.
Network meta-analysis: A statistical approach enabling indirect and direct comparisons among multiple treatments across distinct trials.
Hypothalamic-pituitary-adrenal (HPA) axis suppression: A potential systemic effect of corticosteroids characterised by reduced endogenous cortisol production.

References

1. Comparative efficacy and acceptability of licensed dose intranasal corticosteroids for moderate-to-severe allergic rhinitis: a systematic review and network meta-analysis. Frontiers in Pharmacology (2023).
2. Pharmacology, particle deposition and drug administration techniques of intranasal corticosteroids for treating allergic rhinitis. Clinical & Experimental Allergy (2022).
3. The Burden of Allergic Rhinitis: A Mini-Review. Global Journal of Otolaryngology (2018).
4. The Efficacy of Elonide Nasal Corticosteroids in Managing Allergic Rhinitis: A Randomized, Double-Blinded Trial. Journal of Clinical Medicine (2024).