THE KID’S DOCTOR: Intranasal steroid sprays approved for children with allergies
Tuesday, May 17, 2016

  When considering allergy medications for your child, consult your pediatrician. 

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By Dr. Sue Hubbard, M.D.
  Climate changes that we are seeing are predicted to increase the length of pollinating seasons and therefore increase the amount of pollen produced, which will only make those with allergies (and children with developing allergies) even more miserable with symptoms of runny nose, sneezing, throat clearing and itchy eyes.  
  The use of intranasal steroids has been effective in controlling allergy symptoms. But the first thing to remember is that, unlike an antihistamine, intranasal steroids require several days of consistent use before you will see any real change in allergy symptoms. (I must repeat that line 10 times a day, especially to my teenage patients who want instant gratification!). 
  For anyone who knows the season for their allergies (depending on the pollen one is sensitive to), I recommend starting the intranasal steroid spray one to two weeks before symptoms typically begin. Using the nasal spray daily and continuing throughout the allergy season will provide the best results, and watching the pollen counts in your area will be important to time the use of intranasal steroids.
  Although some children seem to be more sensitive about using an intranasal steroid spray, it is well tolerated by most with few side effects. 
  Prescription intranasal steroid sprays have been approved for use in children as young as 2 years old and the over-the-counter sprays for children 4 years and older. The most commonly reported side effects are nasal irritation, burning and bloody noses. I always try to show my patients how to use the spray properly and to "aim" the spray toward the outer aspect of the inside of the nostril rather than towards the septum (middle), which may help reduce irritation and bloody noses. By spraying toward the outer aspect you also maximize the amount of area that is covered by the spray. 
  Everyone seems to have their "favorite" intranasal steroid, as some are an aqueous spray and others are an aerosolized puff. But in many cases the product choice may be based on the age of the patient, prescription vs OTC, insurance coverage and cost.  Although there are many to choose from, there have been no head to head studies with these medications and their efficacy is generally thought to be comparable. Discuss your choices with your own pediatrician.
  Lastly, there was a study done in 2014 published in The Journal of Allergy and Clinical Immunology, which measured growth rates in children between 5 and 8 years of age who were treated with an intranasal steroid, specifically Veramyst (fluticasone furoate) as compared to a placebo. The study did show a significant improvement in nasal allergy symptom scores, but there was a 0.27 cm (0.65 inch) reduction in growth rate over the course of the year as compared to placebo. Due to this study, I use the lowest effective dose for the shortest amount of time in younger patients, and I explain the reasoning to their parents. 
  Again, you can discuss this with your pediatrician before beginning intranasal steroids. Just make sure you use the intranasal spray consistently during the height of allergy season. I tell my own family, "It doesn't work as well if it sits on the counter for a few days between use!"
Dr. Sue Hubbard is an award-winning pediatrician, medical editor and media host. “The Kid’s Doctor” TV feature can be seen on more than 90 stations across the U.S. Submit questions at The Kid’s Doctor e-book, “Tattoos to Texting: Parenting Today’s Teen,” is now available from Amazon and other e-book vendors.
This column was printed in the May 15, 2016 - May 29, 2016 edition.

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