There is an increasing trend toward topical intranasal
corticosteroids as the preferred treatment for seasonal or
perennial allergic rhinitis. This trend is based on the fact that the chronic, mucosal
inflammation that accompanies
allergic rhinitis responds to anti-inflammatory drugs such as topical
corticosteroids. Intranasal
corticosteroids, given before the natural
antigen challenge, reverse preexisting
inflammation and prevent nasal priming by
antigens. One intranasal
corticosteroid,
beclomethasone dipropionate, has been available by prescription in the United States for more than a decade and has an established efficacy and safety profile in patients with
allergic rhinitis.
Beclomethasone dipropionate has become the standard to which other intranasal
corticosteroid preparations are compared. In comparison with earlier
corticosteroids (eg,
hydrocortisone,
prednisolone,
dexamethasone,
betamethasone) that caused adrenal suppression and other systemic adverse reactions, the actions of new
corticosteroids, including
beclomethasone dipropionate, are confined to the site of application. These drugs are also more rapidly metabolized, less irritating to the nasal mucosa, and have a longer duration of action. When given intranasally to relieve the
sneezing, congestion, and
rhinorrhea associated with seasonal and
perennial allergic rhinitis, the newer
corticosteroids have proved safe and effective. Despite the fact that topical nasal
corticosteroids such as
beclomethasone dipropionate are responsible for important improvements in the treatment of both allergic and nonallergic
rhinitis as well as nasal polyposis and chronic
sinusitis, these drugs may be underused, particularly in the pediatric population. Because of the concern of systemic side effects in younger children, less effective
therapies are sometimes used.