Flunisolide nasal spray for perennial rhinitis in children. Beclomethasone dipropionate aerosol in the treatment of children with severe perennial rhinitis. Beclomethasone dipropionate in pediatric perennial extrinsic rhinitis.
Twenty-seven children with perennial rhinitis entered a double-blind cross-over study comparing nasal sprays of flunisolide---a new topical corticosteroid---and placebo. Symptoms were assessed over two consecutive monthly periods with each treatment. Weekly diary cards, monthly clinical assessments, and end-of-trial preferences all favoured the active drug. At the end of the trial 20 patients preferred the treatment month with flunisolide, four preferred the placebo month, and two rated the periods equally. Side effects were mild, the commonest being transient nasal stinging. Seventeen children who derived benefit from flunisolide continued with the treatment for a six-month open-study period. Many reduced the dosage from three times to twice or once daily without losing benefit. The effect of flunisolide on the pituitary-adrenal axis was assessed in seven children by measuring the 0900 blood cortisol concentrations at two-month intervals over the six months. No effect was observed. The results show that flunisolide is effective and safe for the treatment and prophylaxis of perennial rhinitis in children. Twenty-two children suffering from severe perennial rhinitis were treated with intranasal beclomethasone dipropionate (300 microgram/day) and an identical placebo aerosol in a double-blind cross-over trial. The results confirmed the value of beclomethasone dipropionate in improving nasal symptoms and signs due to perennial rhinitis, and allergic eye symptoms caused by associated conjunctivitis. A double-blind, crossover trial of beclomethasone dipropionate intranasal aerosol was undertaken in 30 children suffering from long-term perennial extrinsic rhinitis refractive to conventional therapy with a success rate of 83%. There were no side effects. Maximum improvement was a seen a week after initiation of the active drug. Nasal blockage and rhinorrhoea were most responsive. It is suggested the beclomethasone dipropionate is an effective and safe treatment of children suffering from extrinsic perennial rhinitis.
The three included trials provided some weak and unreliable evidence for the effectiveness of Beconase® and flunisolide used topically intranasally for the treatment of intermittent and persistent allergic rhinitis in children. The reduction of severity in symptoms as assessed by the trialists could not be confirmed with the data provided and decisions on the use of these medications should, until such time as more robust evidence is available, be guided by the physician's clinical experience and patients' individual circumstances and preferences.