PHILADELPHIA — Although some may be concerned about the use of intranasal corticosteroids for the treatment of allergic rhinitis because to their potential long-term effect on children, the scope of systemic absorption ranges from 0.3% to 30% depending on the product, according to recent presentation at the annual meeting of the American Association of Nurse Practitioners.
“Millions of children are affected by allergic rhinitis. Untreated, these children are at increased risk for sinusitis, fatigue, inattentiveness, and even dental abnormalities,” Wendy L. Wright, MS, APRN, FNP, from Wright & Associates Family Healthcare, told Infectious Diseases in Children. “It is imperative that nurse practitioners assess for this condition and treat it.”
This advice addressed specific considerations, including worries about hypothalamic-pituitary-adrenal (HPA) axis suppression with long-term use and risk of developing conditions such as glaucoma, cataracts and osteoporosis. Wright claims that the reasons we do not see these commonly despite their prevalence as an over-the-counter drug is that most products are not systemically absorbed at a high enough degree.
Education on relevant studies, according to Wright, and how “[corticosteroid use] has not been impactful [in these areas]” may ease some parents of children who need to have their allergy symptoms better controlled. If a parent or patient is persistent in the refusal of steroids, other options are available. Cromolyn sodium for mild symptoms for those 2 years and older demonstrates efficacy with multiple daily doses, and olopatadine hydrochloride nasal sprays may benefit children aged 6 years or older.
Montelukast sodium products may prevent some symptoms but are not considered the first line of defense as a controller medication because they only blocks the effects of leukotrienes for children as young as 12 months. However, Wright warns that there is a current FDA warning regarding montelukast. Those who take this medication may experience mood destabilization, anger and suicidal ideation. There is uncertainty about why montelukast causes these reported symptoms.
“Encouraging parents to use intranasal corticosteroids — many of which are now sold over the counter — regularly and correctly is very important. I often remind parents to have the child keep their nose over their toes to avoid snuffing it in and having extra drain down their throat and that the opposite hand should spray the opposite nare,” Wright said. “This ensures that the child sprays the medication into the turbinates and nares rather than onto the septum.”
Wright also suggests that children who do not respond to intranasal corticosteroids should be referred to an allergist for immunotherapy, because subcutaneous and sublingual treatment should be considered. — by Katherine Bortz
Wright WL, et al. Treatment of Allergic Rhinitis/Acute Rhinosinusitis in Primary & Urgent Care”. Presented at: American Association of Nurse Practitioners National Conference; June 20-25, 2017; Philadelphia.
Disclosure: Infectious Diseases in Children was unable to confirm financial disclosures before publication.