Is the use of intranasal glucocorticosteroids (inGCSs) in children safe?
It's been 40 years since Niels Mygind publication in British Medical Journal on intranasal application of beclomethasonedipropionate aerosol in Allergic Rhinitis. Since then the new era in treatment of allergic and non-allergic upper airway diseases has begun. This publication presents current concepts on application of intranasal glucocorticosteroids in treatment of upper airway diseases and in particular of allergic rhinitis and rhinosinusitis. The non-questionable advantage of intranasal glucocorticosteroids is their strong anti-inflammatory local action with little impact on general health responsible for few and benign side effects. Main way of action of glucocorticosteroids is connected with binding to the intracellular glucocorticosteroid receptor and its impact on nuclear cytoplasmic transcriptional factors. Glucocorticosteroids suppress gene expression of factors responsible for generating and supporting inflammatory processes, pro-inflammatory cytokines and chemokines production, adhesive molecules expression. It appears that glucocorticosteroids has also other mechanisms of action, non-involving intracellular receptors, leading to inhibiting of early and late phase of allergic reaction. At the moment there are following glucocorticosteroids registered in Poland: beclomethasone, budesonide, fluticasone propionate, fluticasone fuorate, mometasonefuorate. Special attention earns fuorates as their lateral fuorate ester chain makes this molecules highly lipophilic, easily absorbed by nasal mucous membranes epithelium and cell membranes phospholipids. This minimizes their general action and maximizes local action. According to current state of knowledge topical glucocorticosteroids are used in the following upper airway diseases with different inflammatory mechanism: allergic rhinitis, non-allergic rhinitis, particularly NARES, acute rhinosinusitis, chronic rhinosinusitis with and without nasal polyps, adenoid hypertrophy and rhinitis in bronchial asthma.
Department of Environmental Hazards Prevention and Allergology, Medical University of Warsaw.
Anna
A
Nowicka
Department of Environmental Hazards Prevention and Allergology, Medical University of Warsaw.
Bolesław
B
Samoliński
D000281:Administration, Intranasal; D000730:Androstadienes / Q000008:administration & dosage / Q000009:adverse effects*; D001507:Beclomethasone / Q000008:administration & dosage; D002648:Child; D005260:Female; D005446:Fluocinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D000068656:Mometasone Furoate / Q000008:administration & dosage; D009297:Nasal Mucosa / Q000187:drug effects; D061214:Patient Safety; D011044:Poland; D065631:Rhinitis, Allergic / Q000188:drug therapy*
D000730:Androstadienes; D005938:Glucocorticoids; D000068656:Mometasone Furoate; D005446:Fluocinolone Acetonide; D001507:Beclomethasone