title: The effects of intranasal triamcinolone acetonide and intranasal fluticasone propionate on short-term bone growth and HPA axis in children with allergic rhinitis.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effects of triamcinolone acetonide (TAA) and fluticasone propionate (FP) aqueous nasal sprays on short-term lower-leg growth velocity and hypothalamic-pituitary-adrenal (HPA-axis function in pediatric subjects.
  
  
  METHODS
  In this controlled, double-blinded (TAA) or single-blinded (FP), four-way crossover trial, 59 subjects (mean age: 7.2 years) were randomized to receive each of four 2-week treatments in random order: TAA nasal spray 110 microg, TAA nasal spray 220 microg, FP nasal spray 200 microg, and placebo, administered by a third party once daily with a 2-week washout period between treatments. Lower-leg growth velocity was measured by knemometry, and HPA-axis function was measured using 12-hour overnight urinary cortisol levels.
  
  
  RESULTS
  Forty-nine subjects completed all four treatments and were included in the analyses. Mean growth velocity (+/- standard error) was 0.46 (+/- 0.06) mm/week for placebo, 0.37 (+/- 0.06) and 0.31 (+/- 0.06) mm/week for TAA nasal spray 110 and 220 microg, respectively, and 0.37 (+/- 0.06) mm/week for FP nasal spray. The treatment effect on mean growth velocity compared with placebo was -19.6% with TAA 110 microg, -32.6% with TAA 220 microg, and -21.7% with FP; none of these effects was considered statistically or clinically significant according to predefined criteria. No significant differences in changes in urine cortisol/creatinine ratios were observed between TAA 110 microg or 220 microg and placebo (4.38, 3.60, and -0.67, respectively, P > or = 0.157). In contrast, the change in mean urine cortisol/creatinine ratio values for FP (-3.59) were significantly lower compared with TAA 220 microg (P = 0.033) and placebo (P = 0.003). Knemometry exhibited less time-dependent variability than overnight urinary cortisol measurements.
  
  
  CONCLUSIONS
  Neither TAA nor FP had a clinically significant effect on lower-leg growth velocity. In contrast to FP, TAA nasal spray did not significantly affect HPA-axis function when used over a 2-week interval.
authors.affiliation: Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. skonerd@chplink.chp.edu
authors.forename: David P
authors.initials: DP
authors.lastname: Skoner
authors.forename: Deborah
authors.initials: D
authors.lastname: Gentile
authors.forename: Betty
authors.initials: B
authors.lastname: Angelini
authors.forename: Robert
authors.initials: R
authors.lastname: Kane
authors.forename: Deborah
authors.initials: D
authors.lastname: Birdsall
authors.forename: Donald
authors.initials: D
authors.lastname: Banerji
mesh_terms: D000281:Administration, Intranasal; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects; D001846:Bone Development / Q000187:drug effects*; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003404:Creatinine / Q000652:urine; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004341:Drug Evaluation; D005260:Female; D000068298:Fluticasone; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D008297:Male; D015588:Observer Variation; D010414:Pennsylvania; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy*; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000730:Androstadienes; D005938:Glucocorticoids; D003404:Creatinine; D000068298:Fluticasone; D014222:Triamcinolone Acetonide; D006854:Hydrocortisone