Relevance of Pharmacokinetics and Bioavailability of Intranasal Corticosteroids in Allergic Rhinitis

Ole      D. Wolthers

Abstract

Intranasal corticosteroids offer effective symptomatic treatment of allergic rhinitis in children and adults. When used in recommended doses and administration regimens side effect profiles are acceptable and the risk of serious systemic adverse reactions is small. In children, assessments with the sensitive measure of knemometry has found reassuring results. Rigorous comparisons of specific intranasal corticosteroids in clinical use are not available and we have no knowledge as to whether variations in pharmacokinetic properties or bioavailability may reflect significant clinical differences. When the evidence on pharmacokinetics, bioavailability, systemic activity, side effects and efficacy are taken together, however, the most recently launched compounds fluticasone propionate, mometasone furoate, fluticasone furoate and ciclesonide seem preferable to older products. The documented once-daily administration, the quick onset of action and the concurrent effect on eye symptoms of the new drugs support the suggestion. Evidence for intranasal corticosteroids in pre-school children has not been provided. In this paper, a brief review of recent patents for the treatment of allergic rhinitis is also presented.

Keywords: Allergic rhinitis, intranasal corticosteroids, pharmacokinetics, systemic activity, knemometry, fluticasone propionate, mometasone furoate, fluticasone furoate ciclesonide