Drugs in this Class
Mometasone Nasal Spray (Mometasone Furoate Monohydrate Nasal Spray, Nasonex Nasal Spray)
Flunisolide Nasal Spray (Nasarel Nasal Spray)
Fluticasone Furoate Nasal Spray (Veramyst Nasal Spray)
Budesonide Nasal Spray Solution (Rhinocort )
Beclomethasone Nasal Inhalation (Beconase AQ)
Triamcinolone Nasal Spray (Nasacort AQ)

Summarizing the Evidence

• Most scientific studies support that there are overall similarities in the effectiveness between all nasal corticosteroids when used for the treatment of allergic rhinitis. Individual responses may vary, therefore it may take "trial and error" to see which drug is the most effective for you.

• Beconase AQ is associated with a greater incidence of nasal irritation compared to the other nasal corticosteroids. Nasarel has been shown to have a higher incidence of bad taste in the mouth compared to other nasal corticosteroids.

• Scientific studies have compared nasal corticosteroids to other drugs used to treat allergic rhinitis (e.g. antihistamines, and azelastine nasal spray). Compared with other drugs used for allergic rhinitis, nasal corticosteriods are generally more effective at controlling the nasal symptoms of allergic rhinitis (e.g. sneezing, itching, runny nose, nasal congestion).

• The Joint Council on Allergy, Asthma and Immunology recommends antihistamines or nasal corticosteroids should be used as first-line therapy for the treatment of allergy symptoms. These recommendations do not identify a specific nasal corticosteroid as best.
• The American Academy of Allergy, Asthma and Immunology (AAAAI) recommends second generation antihistamines, nasal corticosteroids or intranasal antihistamines (such as Astelin) for the initial management of allergy symptoms.

Dosing and Administration

• Fluticasone (Flonase), triamcinolone (Nasacort HFA, Nasacort AQ), mometasone (Nasonex), and budesonide (Rhinocort Aqua) are generally used once daily. Beclomethasone (Beconase AQ) is generally used twice daily and flunisolide (Nasarel) is generally used two to three times daily.

Generic Availability

• Currently, flunisolide (Nasarel) and fluticasone (Flonase) are available as generics. The other nasal corticosteroids are not available generically.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

References:

1. Beconase AQ (package insert). Research Triangle Park, NC: GlaxoSmithKline; April 2005.
2. Rhinocort Aqua (package insert). Wilmington, DE. AstraZeneca. January 2005.
3. Nasarel (package insert). Miami, FL. IVAX Labs. January 2006.
4. Nasacort AQ (package insert). Bridgewater, NJ. Sanofi-Aventis; September 2006.
5. Flonase (package insert). Research Triangle Park, NC: GlaxoSmithKline; March 2004.
6. Nasonex (package insert). Kenilworth, NJ: Schering Corporation; September 2005.
7. DRUGDEX: System (electronic version). MICROMEDEX, Inc., Greenwood Village, Colorado, USA. Available at: http://www.tomescps.com (06/06/07).
8. May JR, Smith PH. Allergic Rhinitis. In: Pharmacotherapy A Pathophysiologic Approach. Dipiro JT, Talbert RL, Yee GC, et al (eds). 6th ed. McGraw-Hill. New York. 2005. pg. 1729-1740.
9. Meltzer EO, Orgel HA, Rogenes PR, Field EA. Nasal cytology in patients with allergic rhinitis: effects of intranasal fluticasone propionate. J Allergy Clin Immunol. 1994;94(4):708-715.
10. Sim TC, Hilsmeier KA, Alam R, Allen R, Lett-Brown MA, Grant JA. Effect of topical corticosteroids on the recovery of histamine releasing factors in nasal washings of patients with allergic rhinitis: a double-blind, randomized, placebo-controlled study. Am Rev Respir Dis. 1992;145:1316-1320.
11. Cameron LA, Durham SR, Jacobson MR, et al. Expression of IL-4, CE RNA, and IE RNA in the nasal mucosa of patients with seasonal rhinitis: effect of topical corticosteroids. J Allergy Clin Immunol. 1998;101:330-336.
12. Baroody FM, Rouadi P, Driscoll PV, et al. Intranasal beclomethasone reduces allergen-induced symptoms and superficial mucosal eosinophilia without affecting submucosal inflammation. Am J Respir Crit Care Med. 1998;157:899-906.
13. Duyck WD, Smitz J, Clement P. Efficacy and onset of action of fluticasone propionate aqueous nasal spray on nasal symptoms, eosinophil count, and mediator release after nasal allergen challenge in patients with seasonal allergic rhinitis. Allergy. 1998;53:375-382.
14. The Allergy Report. Am Acad Allergy, Asthma Immunol. 2000;Vol 2:1-31. Accessed: May 1, 2001. Available at: http://www.theallergyreport.org.
15. Meltzer EO. An overview of current pharmacotherapy in perennial rhinitis. J Allergy Clin Immunol. 1995;95(5 Pt 2):1097-1110.
16. McArthur JG, Higgins AJ. A comparison of budesonide and beclomethasone dipropionate aqueous sprays in the treatment of hay fever. Allergy. 1988;43(Suppl.):114.
17. Vanzieleghm, J. A comparison of budesonide and beclomethasone dipropionate nasal aerosols in ragweed-induced rhinitis. J Allergy Clin Immunol. 1986;79:887-892.
18. McArthur JG. A comparison of budesonide and beclomethasone dipropionate sprays in the treatment of seasonal allergic rhinitis. Clin Otolaryngol. 1994;19(6):537-542.
19. Al Mohaimeid H. A parallel-group comparison of budesonide and beclomethasone dipropionate for the treatment of perennial allergic rhinitis in adults. J Int Med Res. 1993;21(2):67-73.
20. Conley SF. Comparative trial of acceptability of beclomethasone dipropionate and a new formulation of flunisolide. Ann Allergy. 1994;72:529-532.
21. Ratner PH, Paull BR, Findlay SR, et al. Fluticasone propionate given once daily is as effective for seasonal allergic rhinitis as beclomethasone dipropionate given twice daily. J Allergy Clin Immunol. 1992;90(3 Pt 1):285-291.
22. Bryson HM, Faulds D. Intranasal fluticasone propionate: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in allergic rhinitis. Drugs. 1992; 43:760-775.
23. van As A, Bronsky EA, Dockhorn RJ, et al. Once daily fluticasone propionate is as effective for perennial allergic rhinitis as twice daily beclomethasone dipropionate. J Allergy Clin Immunol. 1993;91(6):1146-1154.
24. LaForce CF, Dockhorn RJ, Findlay SR, et al. Fluticasone propionate: an effective alternative treatment for seasonal allergic rhinitis in adults and adolescents. J Fam Pract. 1994;38(2):145-152.
25. Haye R, Gomez EG. A multicentre study to assess long-term use of fluticasone propionate aqueous nasal spray in comparison with beclomethasone dipropionate aqueous nasal spray in the treatment of perennial rhinitis. Rhinology. 1993;31(4):169-174.
26. Drouin M, Yang WH, Bertrand B, et al. Once daily mometasone furoate aqueous nasal spray is as effective as twice daily beclomethasone dipropionate for treating perennial allergic rhinitis patients. Ann Allergy Asthma Immunol. 1996;77:153-160.
27. LaForce C, Hampel F, Kiechel F, et al. Comparison of once-daily triamcinolone acetonide aqueous nasal spray and twice-daily Beconase AQO for the treatment of seasonal allergic rhinitis due to ragweed (abstract). J Allergy Clin Immunol. 1996;97(1 pt 3):433.
28. Jeal W, Faulds D. Triamcinolone acetonide: a review of its pharmacological properties and therapeutic efficacy in the management of allergic rhinitis. Drugs. 1997;53(2):257-280.
29. Johannessen TA. A comparison of fluticasone propionate, flunisolide and placebo in patients with seasonal allergic rhinitis to birch pollen - a multicentre trial (abstract). Clin Exper Allergy. 1990;20(1 Suppl):102.
30. Mandl M, Nolop K, Lutsky BN, and the 194-079 Study Group. Comparison of once daily mometasone furoate (Nasonex) and fluticasone propionate aqueous nasal sprays for the treatment of perennial rhinitis. Ann Allergy Asthma Immunol. 1997;79:370-378.
31. Small P, Houle PA, Day JH, et al. A comparison of triamcinolone acetonide nasal aerosol spray and fluticasone propionate aqueous solution spray in the treatment of spring allergic rhinitis. J Allergy Clin Immunol. 1997;100:592-595.
32. Bousquet J, Chanal I, Alquie MC, et al. Prevention of pollen rhinitis symptoms: comparison of fluticasone propionate aqueous nasal spray and disodium cromoglycate aqueous nasal spray. A multicenter, double-blind, double-dummy, parallel-group study. Allergy. 1993;48(5):327-333.
33. Meltzer EO, Orgel HA, Bush RK, et al. Evaluation of symptom relief, nasal airflow, nasal cytology, and acceptability of two formulations of flunisolide nasal spray in patients with perennial allergic rhinitis. Ann Allergy. 1990;64(6):536-540.
34. Conley SF. Comparative trial of acceptability of beclomethasone dipropionate and a new formulation of flunisolide. Ann Allergy. 1994;72:529-532.
35. Greenbaum J, Leznoff A, Schulz J, Mazza J, Tobe A, Miller D. Comparative tolerability of two formulations of Rhinalar (flunisolide) nasal spray in patients with seasonal allergic rhinitis. Ann Allergy. 1988; 61:305-310.
36. Nielsen NH, Frolund L, Bindslev-Jensen C, et al. A new formulation of flunisolide for nasal application reduces side effects. Allergy. 1989;44:233-234.
37. Fisher WG. Comparison of budesonide and disodium cromoglycate for the treatment of seasonal allergic rhinitis in children. Ann Allergy. 1994;73(6):515-520.
38. Dockhorn R, Aaronson D, Bronsky E, et al. Ipratropium bromide nasal spray 0.03% and beclomethasone nasal spray alone and in combination for the treatment of rhinorrhea in perennial rhinitis. Ann Allergy Asthma Immunol. 1999;82:349-359.
39. Ratner PH, van Bavel JH, Martin BG, et al. A comparison of the efficacy of fluticasone propionate aqueous nasal spray and loratadine, alone and in combination, for the treatment of seasonal allergic rhinitis. J Fam Pract. 1998;47:118-125.
40. D'Ambrosio FP, Gangemi S, Merendino RA, et al. Comparative study between fluticasone propionate and cetirizine in the treatment of allergic rhinitis. Allergol et Immunopathol. 1998;26:277-282.
41. Stern MA, Wade AG, Glas C, et al. Nasal budesonide offers superior symptom relief in perennial allergic rhinitis in comparison to nasal azelastine. Ann Allergy Asthma Immunol. 1998;81:354-358.
42. Van Bavel J, Findlay SR, Hampel FC, et al. Intranasal fluticasone propionate is more effective than terfenadine tablets for seasonal allergic rhinitis. Arch Intern Med. 1994;154:2699-2704.
43. Frolund L. Efficacy of an oral antihistamine, loratadine, as compared with a nasal steroid spray, beclomethasone dipropionate, in seasonal allergic rhinitis. Clin Otolaryngol. 1991;16:527-531.
44. Jordana G, Dolovich J, Briscoe MP, et al. Intranasal fluticasone propionate versus loratadine in the treatment of adolescent patients with seasonal allergic rhinitis. J Allergy Clin Immunol. 1996;97:588-595.
45. Schoenwetter W, Lim J. Comparison of intranasal triamcinolone acetonide with oral loratadine for the treatment of patients with seasonal allergic rhinitis. Clin Therap. 1995;17(3):479-492.
46. Bernstein DI, Creticos PS, Busse WW, et al. Comparison of triamcinolone acetonide nasal inhaler with astemizole in the treatment of ragweed-induced allergic rhinitis. J Allergy Clin Immunol. 1996;97:749-755.
47. Newson-Smith G, Powell M, Baehre M, et al. A placebo controlled study comparing the efficacy of intranasal azelastine and beclomethasone in the treatment of seasonal allergic rhinitis. Eur Arch Otorhinolaryngol. 1997;254:236-241.
48. Dykewicz MS, Fineman S, Skoner DP, et al. Diagnosis and management of rhinitis: parameter documents of the joint task force on practice parameters in allergy, asthma, and immunology. Ann Allergy Asthma Immunol. 1998;81(5):478-518.
49. Allen ED, Whitaker ER, Ryu G. Six-week trial of nebulized flunisolide nasal spray: efficacy in young children with moderately severe asthma. Pediatric Pulmonol. 1997;24:397-405.
    
50. FDA Talk Paper. November 9, 1998. FDA requires new pediatric labeling for inhaled, intranasal corticosteroids. Accessed May 1, 2001. Available at: http://www.fda.gov/bbs/topics/ANSWERS/ANS00922.html.
51. FDA statement. Class labeling for intranasal and orally inhaled corticosteroid containing drug products regarding the potential for growth suppression in children. Division of Pulmonary Drug Products. November 9, 1998. Accessed May 1, 2001. Available at: http://www.fda.gov/cder/news/cs-label.htm.
52. Allen DB. Systemic effects of intranasal steroids an endocrinologist's perspective. J Allergy Clin Immunol. 2000; 106(4 Suppl):179-190.
53. Schenkel EJ, Skoner DP, Bronsky EA, et al. Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics. 2000;105(2):E22.
54. Anonymous. Intranasal budesonide for allergic rhinitis. Med Lett Drugs Ther. 1994;36(926):63-64.
55. Brannan MD, Herron JM, Reidenberg P, Affrime MB. Lack of hypothalamic-pituitary-adrenal axis suppression with once-daily or twice-daily beclomethasone dipropionate aqueous nasal spray administered to patients with allergic rhinitis. Clin Ther. 1995;17(4):637-647.
56. American Academy of Allergy, Asthma and Immunology. Practice parameters for diagnosis and management of rhinitis. Available at: http://www.acaai.org/NR/rdonlyres/C39594CA-ABDF-4DBA-93EC-1CFB3429D305/0/rhinitis.PDF. Accessed May 24, 2006.
    

    Last Updated: March 2008

    Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.

    Back