Intranasal Corticosteroids Topical Characteristics: Side Effects, Formulation, and Volume

Petty, David A; Blaiss, Michael S.

doi:10.2500/ajra.2013.27.3949

Cited by 15 publications

(13 citation statements)

References 17 publications

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“…However, there is no evidence to support one intranasal delivery modality over the others . Intranasal treatment produces minimal side effects contrarily to oral corticosteroids due to a lower systemic absorption . Moreover, lower drug doses can be administrated by intranasal route because the drug fraction delivered beyond the nasal valve is low, quickly removed by mucociliary clearance, and eventually eliminated through the digestive tract .…”

Section: Introductionmentioning

confidence: 99%

Effect of three-drug delivery modalities on olfactory function in chronic sinusitis

et al. 2014

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In vitro differences in drug deposition pattern between both intranasal modalities were demonstrated. Threshold discrimination identification and RNT were similar between three groups at baseline. Threshold discrimination identification improved by 5.5, 5.8, and -1.1 for sonic nebulization, oral, and nasal spray groups, respectively (P = 0.010). This improvement was clinically relevant for oral and nebulized administration. It was similar between oral and nebulized administration but significantly higher than nasal spray administration. Retronasal psychophysical olfactory tests improved similarly for the three groups (P = 0.231) CONCLUSION: Effectiveness of sonic nebulized and oral administration is demonstrated on orthonasal olfactory. The clinical benefit is better than with nasal spray.

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Section: Introductionmentioning

confidence: 99%

Effect of three-drug delivery modalities on olfactory function in chronic sinusitis

et al. 2014

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“…Forward steps with basic science, pathophysiology, 25 clinical trials, clinical guidelines, and evidence-based medicine 1,2,4,5,10,11,13,[14][15][16][17]20,21 and one step back with analysis of real-life outcomes (including analysis of failures) 3,6,7,9,12,13,18,19,23,24 will keep us progressing in the right direction, toward better patient care. Forward steps with basic science, pathophysiology, 25 clinical trials, clinical guidelines, and evidence-based medicine 1,2,4,5,10,11,13,[14][15][16][17]20,21 and one step back with analysis of real-life outcomes (including analysis of failures) 3,6,7,9,12,13,18,19,23,24 will keep us progressing in the right direction, toward better patient care.…”

Section: Progressmentioning

confidence: 99%

Editorial

Corey¹

2013

Am J Rhinol�Allergy

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T he current issue of the American Journal of Rhinology and Allergy highlights two major themes that frequently confront the allergist/rhinologist: chronic rhinosinusitis with nasal polyps (CRSwNPs) and allergic rhinitis (AR). Also addressed in this issue is the rare clinical occurrence of hereditary angioedema (HAE), which deserves attention because of newly developed therapies to prevent potentially life-threatening consequences. In a series of excellent articles, the basic challenges confronting the allergist/rhinologist regarding definition, diagnosis, and treatments of these disorders are rigorously evaluated. ALLERGIC RHINITISThe ideal definition of AR would help clinicians and researchers to distinguish it from nonallergic rhinitis (NAR) and mixed rhinitis (AR ϩ NAR). Bernstein 1 points out this may be difficult because of overlapping symptoms. A careful history followed by skin (or in vitro) testing to assess allergic status is recommended. Although Bernstein suggests that therapeutic response may aid diagnosis, more research is needed to determine if this assumption is correct. Providing insight into therapeutic response is the article by Gawlik et al. 2 , in which the mechanism of action of intranasal azelastine therapy is evaluated in NAR. These authors report that an untreated NAR control group showed greater substance P release in nasal lavage fluids after challenge with hypertonic saline than did an azelastine pretreated group. A different approach to defining AR is taken by Larenas-Linnemann et al. 3 who studied patients diagnosed with AR by Mexican allergists. They categorized patients according to U.S. coding practices as seasonal AR and perennial AR and compared it with the European Allergic Rhinitis and Its Impact on Asthma classifications of intermittent versus persistent and mild versus moderate-severe. They observed that the physicians tended to "overdiagnose" perennial AR and intermittent-persistent compared with the patient's assessment.Comorbidities, risk factors, and physiological triggers of AR are explored by several authors. Haavisto et al., 4 using acoustic rhinometry, measured nasal patency changes induced by physical exercise in AR and asthma and found lower area before and after exercise in the allergic group. All three groups (allergic, asthmatic, and controls) experienced improved (ϳ15%) nasal volume/area after exercise. Increased body mass index in AR patients was found by Ciprandi et al. 5 to be associated with increased markers of inflammation compared with normal weight controls and may increase risk for early bronchial impairment. In Western countries, the incidence of concomitant AR and asthma is common, with some estimates as high as 50%. 1 Hong et al. 6 studied the comorbidity of AR and asthma in two southern Chinese cities via a hospital-based cross-sectional survey. The prevalence of concomitant bronchial asthma was only 5.33%.

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“…Although the optimal modality of administration (oral, intranasal spray and nasal nebulization) remains controversial for corticosteroids (6) , they are usually delivered by inhalation route which offers minimal systemic side-effects (7) . This route of administration is supported by level 1A evidence (2) .…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of intranasal drug delivery by nebulization in chronic rhinosinusitis: a systematic review

Reychler

Domachowski

Latiers

et al. 2018

Rhin

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Background: Treatment of chronic rhinosinusitis (CRS) aims to treat the underlying inflammation or infection. Although the optimal modality of administration remains controversial, inhalation route is usually preferred. The aim of this systematic review was to summarize the efficacy of intranasal corticoisteroids or antibiotics delivery by nebulization on symptoms, histology, endoscopy scores, nasal obstruction, clinical outcomes and quality of life in CRS.Method: This systematic review followed the PRISMA guidelines. Randomized controlled, comparative and cohort studies evaluating effects of treatment by nebulization in sinusitis were identified and reviewed from two databases (PubMed and Scopus). Two reviewers independently assessed study quality and reviewed the selected studies.Results: 600 references were retrieved and 12 studies evaluating 377 patients were included in the systematic review. Different devices were used. Efficacy of nasal delivery by nebulization was systematically observed on symptoms and size of polyps and frequently on inflammatory parameters in all studies. The presence of polyps improved the efficacy of the nebulization. This way of delivery appears not convincing regarding antibiotics. Few side effects were noted in the retrieved studies and only for nebulized antibiotics. Conclusions:This systematic review highlighted that based on the present literature nebulization is not better than nasal spray to the delivery of corticosteroids due to the positive results on symptoms, endoscopic appearance and histological outcomes. For antibiotics delivery, the nebulization is not of added value.

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Intranasal Corticosteroids Topical Characteristics: Side Effects, Formulation, and Volume

Abstract: Physicians need to be aware of the different INS attributes to try to match patients' preferences in order to achieve better adherence and improve outcomes in sufferers of allergic rhinitis.

Cited by 15 publications

References 17 publications

Effect of three-drug delivery modalities on olfactory function in chronic sinusitis

Effect of three-drug delivery modalities on olfactory function in chronic sinusitis

Editorial

Clinical efficacy of intranasal drug delivery by nebulization in chronic rhinosinusitis: a systematic review

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