What role do intranasal corticosteroids play in the management of rhinitis, and how should they be prescribed?

Intranasal corticosteroids are the most effective treatment for rhinitis, including allergic and non-allergic types, and are recommended for regular use in moderate to severe, persistent cases ¹.

They should be prescribed at the lowest effective dose, especially in children, with growth monitoring advised due to potential impact, although second-generation corticosteroids like mometasone, fluticasone furoate, or fluticasone propionate have minimal systemic absorption ².

Intranasal corticosteroids may be started two weeks prior to a known allergen season to achieve maximal effect, which may not be seen until after two weeks of treatment ².

In cases of persistent rhinitis, if symptoms do not improve with initial treatment or if anatomical obstruction is suspected, referral to an ear, nose, and throat specialist should be considered ².