Do Steroid Nasal Sprays Affect Child Growth? Expert Insights - Pediatrics

Dr. Pei Rensheng reply Pediatrics

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Hello: On November 14, 2020, I searched for information on "update":
Older children and adults — For children aged 2 years and older, the approach to pharmacotherapy is essentially the same as that in adults and depends on the severity and persistence of symptoms.
Mild or episodic symptoms — Patients with mild or episodic symptoms related to predictable allergen exposures (such as visiting a relative's house with a pet) can be managed with one of the following options:
● A second-generation oral antihistamine: This can be administered regularly or as needed (ideally two to five hours before exposure for cetirizine and fexofenadine, while loratadine peaks eight hours after administration).
Cetirizine (approved for children ≥6 months), loratadine, and fexofenadine (both approved for children ≥2 years) are similarly effective and are available in syrup form.
(See 'Minimally-sedating agents' below.)
● An antihistamine nasal spray (e.g., azelastine or olopatadine): The FDA has approved the use of intranasal azelastine in children over 5 years of age and the use of intranasal olopatadine in children over 12 years of age (its safety and efficacy have not been evaluated in younger children).
(See 'Antihistamine nasal sprays' below.)
● A glucocorticoid nasal spray (more effective than antihistamines) administered regularly or as needed (table 1).
For predictable exposures, we suggest initiating therapy two days before, continuing through, and for two days after the end of exposure [16,17].
Mometasone furoate, fluticasone furoate, and triamcinolone acetonide are approved by the FDA for use in children ≥2 years of age [14,15].
● Cromolyn nasal spray administered regularly or as needed (ideally 30 minutes before exposure).
Taken in this manner, cromolyn is helpful for brief exposures (minutes to hours).
For prolonged exposures, administration should ideally begin four to seven days in advance.
Some parents and clinicians prefer to try cromolyn first in children because of its excellent safety profile.
(See 'Cromolyn sodium' below.)
It should be explained to patients that each of these therapies is more effective when taken regularly, although as-needed use may be sufficient for very mild symptoms.
Persistent or moderate-to-severe symptoms — Glucocorticoid nasal sprays are the most effective pharmacologic therapy for allergic rhinitis and are recommended by guidelines as the best single therapy for patients with persistent or moderate-to-severe symptoms, including seasonal symptoms [10,12].
All available preparations are similarly effective, although the newer agents (sometimes called second-generation) are more convenient and probably safer for long-term use than the older agents due to lower systemic absorption (table 1).
Glucocorticoid nasal sprays with low systemic absorption and once-daily dosing (all except flunisolide, which is not commonly used) may have a theoretical advantage in children, although this has not been proven.
Mometasone and fluticasone furoate are approved by the FDA for use in children ≥2 years of age [14].
Fluticasone propionate is approved for children ≥4 years of age.
(See 'Glucocorticoid nasal sprays' below.)
It appears that glucocorticoid nasal steroids remain the best treatment for children over 2 years of age with moderate to severe allergic rhinitis.
However, the article also mentions that although second-generation nasal sprays have very low systemic absorption, it cannot be confirmed that there are no adverse effects.
The best principle is: when symptoms improve, it is advisable to reduce the dosage or discontinue the medication as soon as possible.
Wishing you health, happiness, and safety.

Dr.
Pei Ren-Sheng, Attending Physician, Pediatrics, Taoyuan Hospital, Ministry of Health and Welfare.

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Reply Date: 2020/11/13