Intranasal corticosteroids. Treatment of allergic rhinitis: the role of topical antihistamines. Use by children and women during pregnancy

Patients suffering from serious skin diseases, including chronic diseases, are well aware of the existence of corticosteroids (corticoids or CS).

Drugs in this group are referred to for the treatment of allergic rashes, various dermatitis.

Those who are prescribed corticosteroids for the first time are afraid: is the doctor recommending too strong a medicine?

Known to Russians from popular TV shows, Dr. Myasnikov is convinced: if the problem is serious, hormone-containing drugs must be used, and only then, gradually, move on to easier medications. The main thing is to strictly follow the doctor’s recommendations.

Corticosteroids are found in every body; they are produced by the adrenal glands and participate in metabolic processes.

Pharmacists managed to synthesize this substance and create drugs aimed at suppressing various painful symptoms in the body.

Corticosteroids are conventionally divided into two groups, the difference between which is in the scope of their effect.

The first group consists of glucocorticoid hormones, they are responsible for carbohydrate, protein, and fat metabolism. You can find out more about what glucocorticosteroids are, and also view the list of medications.

The second group includes mineralocorticoid hormones, they participate in water-salt metabolism. When prescribing corticosteroid medications to a patient, the doctor usually means glucocorticoids.

Corticosteroid therapy aims to block the formation of substances in the body called prostaglandins, which trigger the onset of the inflammatory process.

The difficulty in the work of pharmacists was that prostaglandins are found in different cells and tissues of the body and are endowed with all sorts of functions, not all of which cause harm to human health.

The main advantage of modern drugs is their selective effect on the body, aimed only at those areas that require medical intervention.

By the way, corticosteroid injections are now successfully used in veterinary medicine for dogs and cats if they have to deal with severe inflammation.

Due to the ability of corticosteroid drugs to relieve swelling and inflammation, and soothe itching, they are often prescribed for the treatment of skin diseases.

Another area of application of drugs in this group is urology. Used for phimosis(this is the name for a disease in which the opening of the foreskin narrows significantly) corticosteroids help the patient avoid surgery.

With esophagitis (a disease of the esophagus), the damaged mucous membrane is restored faster, the symptoms of heartburn and pain during swallowing are eliminated. The medicine is also effective for gastritis.

Corticosteroids are prescribed for rheumatism, for arthritis, sinusitis, bronchial asthma and pneumonia, for certain blood diseases and the presence of neoplasms, for the treatment of otitis and eye diseases (for example, conjunctivitis, iritis, iridocyclitis), various viral infections and neurological problems.

Medicines in this group are actively also used in dentistry, as well as for the treatment of patients diagnosed with facial paralysis.

Ointments and creams made on the basis of corticosteroids are divided into 4 groups depending on what hormones are included in the preparations.

These classes are: weak, moderate, strong and very strong. Combination drugs are included in a separate category.

Weak

Ointments and creams in this class are made using prednisolone and hydrocortisone.

Moderate

The drugs in this class are based on components such as prednicarbate and flumethasone.

Strong

Potent drugs of this class are based on synthetic hormonal drugs halomethasone, metazone, betamethasone, methylprednisolone.

Very strong

This group of drugs is based on clobetasol propionite.

Combined

This group (or rather, a subclass) includes drugs that, along with corticosteroids, contain substances that can resist bacterial and fungal infections.

Examples of a combination drug are Flucinar and Belosalik ointments.

Release forms

Given the wide range of uses of corticosteroids for the treatment of various diseases, pharmacists have provided a sufficient variety of forms of these drugs:

oral corticosteroids (for oral administration) – tablets, capsules;
for injections - liquid preparations in ampoules;
for local use (topical preparations) - ointments, creams, gels, liniments, powders;
inhaled corticosteroids – aerosol, spray;
nasal and intranasal agents – spray, nasal drops;
for the eyes - eye drops.

The choice among the many corticosteroid drugs should be left to the doctor: he better understands the patient’s health status and knows what effect this or that medicine will have on the body, what the mechanism of action is, possible consequences and complications from the use of drugs from this group, especially if they are expected to be taken for a long time.

However, treatment can become more effective if the patient has sufficient information about the medications that are prescribed to him.

Here are the best drugs most often prescribed:

When purchasing medications at a pharmacy, you should accurately indicate their names.

For example, in addition to the drug Fucidin G, there is simply Fucidin. And these are not substitute drugs; each of them has its own, special purpose.

Your doctor will tell you how to take the medicine correctly and how to use it to maximize the benefits. But some general rules are worth remembering.

If the doctor prescribed pills, it is advisable to take the first one at 6 a.m., the next one no later than 2 p.m.: it is according to this “schedule” that natural corticosteroids would enter the blood.

Taking the medication should be combined with meals. By the way, some changes need to be made to the menu, enriching it with proteins. But there should be a minimum amount of carbohydrates and salt in dishes.

Additionally, you will need calcium supplements and vitamin D - this will help protect the body from osteoporosis. Liquids should be drunk up to one and a half liters per day. Alcohol is strictly contraindicated.

Injections are given strictly according to the doctor’s instructions- in the dosage and quantity indicated in the recipe. Overdoses are especially dangerous as they can lead to adverse reactions.

The optimal duration of treatment with corticosteroid drugs is from five to seven days, and the longest is up to three months.

However, doctors treat such long periods with great caution, so that irreversible processes do not begin to occur in the body and the functions of any organs are not impaired.

The doctor selects a treatment method individually for each patient. She may be:

Use by children and women during pregnancy

The risk of adverse reactions to drugs in this group is especially high in children. If a doctor prescribes a corticosteroid ointment for a child, it is for a minimal course and for treating very small areas of skin.

Children under one year of age are allowed drugs containing no more than one percent hydrocortisone.

Starting from the age of two, you can use Metazon ointment - it has a prolonged effect, so lubricating the affected area of skin once a day is enough. Advantan ointment is effective for atopic dermatitis.

During pregnancy hormonal drugs are used only in situations where the expected result of treatment “overrides”, and significantly, the possible risk from using this medicine.

It is advisable to use ointments of weak or moderate strength that are less dangerous for the expectant mother.

We invite you to watch a video about the use of local glucocorticosteroids for atopic dermatitis in children:

Contraindications to the use of corticosteroids are:

Problems can also arise from illiterate use of drugs, violation of dosages and timing of treatment.

Among the side effects: loss of skin elasticity, acne, active growth of facial hair, formation of stretch marks, areas lacking natural pigmentation.

There is also a risk of weakened immunity, weight gain, swelling, increased blood sugar, and, in women, menstrual irregularities.

Sometimes uncontrolled use of corticosteroids leads to eye diseases, depression, and the patient’s appearance may even change as a result of atrophy of individual muscles or fat deposits on the face.

To ensure stability of the dosage form, purified water, cellulose and other auxiliary compounds are added to them.

The rapid positive effect of hormonal agents is explained by their powerful anti-inflammatory effect. The synthetic corticosteroid fluticasone, contained in the drugs Flixonase or Nazarel, affects the formation of mediators in the body that cause the inflammatory process. It inhibits the formation of biologically active substances (leukotrienes, histamine, prostaglandins), which are involved in the body's defense reaction.

In addition, fluticasone inhibits cell proliferation, that is, the formation of new macrophages, neutrophils, lymphocytes, and eosinophils. This property affects the local immunity of the nasal mucosa.

The positive effect from the use of hormones occurs within 2-4 hours and is expressed in a decrease in swelling of the mucous membrane, cessation of sneezing and itching in the nose, restoration of nasal breathing, and a decrease in the formation of secretions.

Fluticasone, like other corticosteroids, does not have any effect on the formation of its own hormones in the body. It does not suppress the adrenal glands, pituitary gland, or hypothalamus. When administered intranasally (nasal drops), it is 90% bound by blood plasma and quickly eliminated from the body through the kidneys and liver.

The anti-edematous, anti-inflammatory, anti-allergic effect after topical use of hormonal drugs lasts about a day. Therefore, they are prescribed no more than once a day. But there is also a negative property of products with synthetic corticosteroids. They suppress local immunity; with prolonged and uncontrolled use, it can be significantly weakened.

It is not recommended to use hormonal drugs on your own. It is necessary to consult with a doctor who will determine the indications for their use, prescribe the dose, frequency of use, course duration and monitor the effectiveness of therapy.

The use of hormonal drugs for allergic rhinitis and sinusitis

A runny nose caused by exposure to various allergens is in second place in terms of frequency of occurrence after infectious rhinitis. Allergic sinusitis, more often sinusitis, is also diagnosed. The time of their occurrence, the brightness of the clinical picture and the duration of the pathological process largely depend on the properties of the allergen. Seasonal allergic rhinitis, or hay fever, can occur in autumn or spring and is caused by pollen from flowering plants.

An episodic runny nose occurs under the short-term influence of a specific allergen (for example, contact with animal fur). With constant exposure to allergens (house or book dust), the symptoms of allergic rhinitis are also constant.

Regardless of the characteristics of the allergen, a runny nose or sinusitis occurs with a similar clinical picture. Due to the release of a huge amount of inflammatory mediators (histamine, prostaglandins), the inflammatory process begins. The capillaries of the mucous membrane of the nose and sinuses expand, and the permeability of their walls increases. Through them, blood plasma leaks into the intercellular space of the membrane and mixes with the secretion produced by epithelial cells.

As a result, the mucous membrane thickens, partially or completely blocking the nasal passages and making it difficult to breathe through the nose. Congestion is accompanied by copious clear discharge, frequent sneezing and constant itching or burning in the nose.

With allergic sinusitis, the formation of secretion in the sinuses increases, which can accumulate due to swelling of the drainage ducts. There are no symptoms of intoxication (fever, headache, weakness) since the inflammation is not of infectious origin.

Nasal drops containing corticosteroids are successfully used for allergic rhinitis or sinusitis. They are necessarily included in the complex treatment regimen along with antihistamines, vasoconstrictors, immunomodulatory and barrier agents. With the correct selection of drugs from all these groups, their positive qualities are enhanced, and the negative effects are smoothed out.

For example, the suppression of local immunity when using hormonal drugs is successfully compensated by the prescription of immunomodulatory drugs. Corticosteroid drugs can be used not only to treat allergic rhinitis, but also to prevent it, before the expected onset of the allergen (before the flowering of a certain plant).

Flixonase nasal drops in the form of a spray are prescribed by a doctor strictly individually. With a clear clinical picture of allergies, with a combination of runny nose and conjunctivitis, in the first two days it is possible to take 2 injections into each nostril once a day. When symptoms weaken, the dose is reduced to 1 injection once a day. The course should be no more than 5-7 days, at the discretion of the attending physician.

As a prophylactic agent, Flixonase is used 1 dose 1 time per day in the first 5-6 days of flowering of the allergen plant. The product is approved for use in pediatrics in children over 4 years of age, 1 injection into each nostril once a day according to strict indications.

Avamis or Nazarel nasal drops containing the synthetic corticosteroid fluticasone are used for the same indications and in the same doses as Flixonase. Depending on the effect obtained and the severity of the clinical picture, the dosage of hormonal drugs in adults and children may change under the strict supervision of a doctor.

Polydex nasal drops are a combination product that includes drugs from three groups. These are antibiotics (polymyxin, neomycin), a vasoconstrictor (phenylephrine) and a hormonal agent (dexmethasone).

The prescription of Polydexa is justified in cases where a person with an allergic rhinitis or sinusitis experiences a layer of infectious inflammation caused by bacterial microflora. The appearance of intoxication symptoms against the background of allergic rhinitis, a change in the mucous nature of nasal discharge to purulent, clearly indicates this.

Polydex nasal drops are prescribed for children from 2 to 15 years old, 1-2 drops 3 times a day, for adults - 2 drops up to 5 times a day. The course of treatment is determined by the doctor and lasts 5-7 days.

Using hormonal nasal drops for vasomotor rhinitis

A runny nose caused by a violation of the neuro-reflex regulation of capillary tone is called vasomotor. It can be caused by a sharp change in temperature when leaving heat to cold, when lighting changes from darkness to bright light, or when inhaling strong odors.

One of the forms of vasomotor rhinitis is the so-called rhinitis of pregnancy, which occurs with a sharp increase in the amount of female sex hormones and with an increase in the volume of circulating blood. Very often, vasomotor rhinitis is combined with allergic rhinitis.

The effectiveness of using hormonal agents for vasomotor rhinitis has been proven by many studies. They are an important part of complex therapy, without having a systemic effect on the body and without causing addiction. Nazarel, Nazocort, Aldecin can be used for treatment. In each specific case, especially during pregnancy, the dosage and duration of the course are determined by the attending physician strictly individually.

Side effects and contraindications for hormonal treatment

The effectiveness of using hormonal nasal drops leaves no doubt, but it must be remembered that various side effects are possible. They occur most often with unreasonable or uncontrolled use of hormonal drugs.

Dryness and irritation of the mucous membrane, nosebleeds, unpleasant taste and smell, rashes on the skin and mucous membranes may occur. With long courses, osteoporosis, adrenal suppression, and bronchospasm may develop.

The use of hormonal nasal drops is contraindicated in case of intolerance to the components of the drug, in children under 4 years of age, in nursing mothers. During pregnancy, their use should be very careful, only when absolutely necessary and under constant medical supervision.

The use of products with synthetic corticosteroids, including hormonal nasal drops, is justified and very effective for certain forms of runny nose and sinusitis. But they should be used only as prescribed by a doctor, with strict adherence to all recommendations.

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What hormonal sprays and nasal drops are there?

A runny nose is an unpleasant symptom that accompanies any cold and inflammation of the ENT organs. Treatment of rhinitis depends on the type of disease. For severe swelling caused by an allergic reaction and inflammation of the mucous membrane, special nasal drops and hormonal sprays are indicated.

Indications for use

Hormonal drops for nasal congestion help relieve swelling and inflammation without having a vasoconstrictor effect. The main active ingredients of such drugs are glucocorticosteroids, which normalize vascular tone, unlike conventional sprays for the common cold.

Hormonal sprays are indicated for the following diseases:

Long-term treatment of a runny nose with vasoconstrictor drops often leads to the development of a medicated form of rhinitis. The body gets used to the action of the drugs and can no longer independently regulate the secretion of mucus from the nose.

The patient has constant nasal congestion; the use of drops has a temporary effect. In this case, sprays and nasal drops with hormones are the only optimal option for normalizing breathing and treating a runny nose.

Glucocorticosteroids have a pronounced anti-inflammatory effect. For allergic forms of runny nose, the use of drugs in this group will quickly relieve swelling and inflammation.

Popular drugs

All hormonal drugs for the common cold contain a glucocorticosteroid.

The active ingredient of the medicine may be:

Sprays for the common cold work locally and do not have a systemic effect on the entire body. The doctor should select the drug and duration of treatment.

To treat chronic or allergic rhinitis, the spray should be used long-term, for two or three weeks, depending on the severity of the symptoms.

Pregnancy is not an absolute contraindication to the use of intranasal hormonal sprays. Women carrying a child can use medications from this group, but only as prescribed by a doctor. This is due to the lack of data on the effects of glucocorticoids on the fetus.

Sprays with beclomethasone

Beclomethasone is used to treat rhinitis due to the rapid absorption of the drug by the mucous membrane. The effect appears a few minutes after using the drug.

The names of hormonal nasal sprays based on beclomethasone are Beconase, Nasobek and Aldecin.

Baconase

Beconase spray is used to treat rhinitis of any nature, including those caused by infections. The medicine is recommended for the treatment of allergic rhinitis, since with regular use it helps to reduce the intensity of symptoms that occur when an allergic reaction recurs.

Absolute contraindications for the use of Beconase are tuberculosis, candidiasis of the skin and childhood. Individual intolerance to the drug is manifested by urticaria and dermatitis.

Nasobek

Nasobek spray is used for chronic and allergic rhinitis, and also as an adjuvant in the treatment of sinusitis.

It comes in a small plastic bottle equipped with a dispenser. One click on the dispenser provides injection of one therapeutic dose of medication. Absolute contraindications for the drug include:

first trimester of pregnancy;
systemic fungal infections;
viral diseases;
tuberculosis;
bleeding from the nose.

If the patient regularly experiences nosebleeds, it is necessary to consult an otolaryngologist. In this case, taking hormonal sprays may be prohibited, since glucocorticosteroids affect vascular tone.

Aldecin

Aldecin spray is indicated for the treatment of rhinitis and is used as an adjuvant in the treatment of polyposis of the nasal mucosa. The use of the drug helps reduce swelling of the mucous membrane.

Beclomethasone has an anti-inflammatory effect, so the medicine can be used for sinusitis in conjunction with other drugs recommended by a doctor.

Contraindications to the use of Aldecin do not include pregnancy and lactation. However, women are advised to consult with their doctor about the safety of treatment with this drug.

Like other drugs containing beclomethasone, Aldecin spray is contraindicated in the following cases:

systemic fungal and bacterial infections;
tuberculosis;
nosebleeds and damage to the mucous membrane;
individual intolerance to the components of the drug.

Important! Sprays with glucocorticosteroids can impair tissue regeneration, so they are not used after surgery or nasal injuries.

Medicines containing beclomethasone can be used in children over 6 years of age.

Fluticasone-based drugs

The corticosteroid fluticasone has a pronounced anti-edematous effect and reduces inflammation of the mucous membrane. Sprays with this active substance form the basis for the treatment of allergic rhinitis.

Popular intranasal fluticasone-based drugs are Avamys, Flixonase and Nazarel.

Avamis

A special feature of Avamis spray is that it can be used by children aged two years and over and pregnant women, but only as prescribed by a doctor.

An absolute contraindication to the use of Avamis spray is liver dysfunction.

Flixonase

Flixonase spray allows you to quickly relieve allergic swelling of the nasal mucosa. The medicine can be used in the treatment of hay fever. This spray is not prescribed to pregnant women and children under four years of age.

Nazarel

Nazarel is used to treat allergic rhinitis.

The drug is not prescribed to women during lactation, since there is a high probability of excretion of the active substance into breast milk.

Children under four years of age should not use the medicine.

The instructions do not contain contraindications for the use of the spray by pregnant women, but doctors recommend refraining from using the medicine in the first trimester.

Hormonal intranasal medications can cause a number of side effects. In case of individual intolerance, urticaria or allergic dermatitis may appear on the face. Local side effects are common - dry mucous membranes, short-term nosebleeds, itching and irritation of the nasopharynx.

Sprays with mometasone

The most popular drug with mometasone is Nasonex spray. The medicine is available in various dosages and is intended for the treatment of allergic sinusitis and chronic rhinitis. Due to its prolonged action, the drug is used only once a day. One application of the spray is enough to ensure free breathing for the whole day.

For rhinitis of an allergic nature, the medicine can be prescribed to children over two years of age.

The spray is also prescribed as a therapeutic agent against the runny nose against the background of adenoid vegetations in children.

During pregnancy, the spray can be used, but in a short course. Long-term use of the medicine may harm the fetus.

Desrinit spray also contains mometasone. In general, the effects, side effects and contraindications of different hormonal intranasal sprays do not differ.

Conclusion

When using a product based on synthetic glucocorticoids, it should be remembered that the therapeutic effect is achieved only with regular use of the drug. Unlike vasoconstrictor drops, such sprays do not provide immediate relief. The result becomes noticeable 5-7 days after the start of treatment.

In the treatment of sinusitis, hormonal agents are used as an auxiliary therapeutic agent to reduce swelling of the mucous membrane.

Due to the characteristics of pharmacodynamics, intranasal hormonal drugs are available only in the form of a spray with a dispenser. This form of release allows you to avoid overdose, which often happens when using drops.

The course of treatment with hormonal drugs is selected individually for each patient. In order to prevent seasonal exacerbation, the spray can be used according to the instructions one and a half to two weeks before the allergen plants begin to bloom.

Directory of main ENT diseases and their treatment

All information on the site is for informational purposes only and does not claim to be absolutely accurate from a medical point of view. Treatment must be carried out by a qualified doctor. By self-medicating you can harm yourself!

Corticosteroids - names of drugs, indications and contraindications, features of use in children and adults, side effects

Introduction (characteristics of drugs)

Natural corticosteroids

Synthetic corticosteroids

Forms of release of corticosteroids

Preparations for internal use (in tablets and capsules)

Prednisolone;
Celeston;
Triamcinolone;
Kenacort;
Cortineff;
Polcortolon;
Kenalog;
Metipred;
Berlicourt;
Florinef;
Medrol;
Lemod;
Decadron;
Urbazon et al.

Preparations for injections

Prednisolone;
Hydrocortisone;
Diprospan (betamethasone);
Kenalog;
Flosteron;
Medrol et al.

Preparations for local use (topical)

Prednisolone (ointment);
Hydrocortisone (ointment);
Lokoid (ointment);
Cortade (ointment);
Afloderm (cream);
Laticort (cream);
Dermovate (cream);
Fluorocort (ointment);
Lorinden (ointment, lotion);
Sinaflan (ointment);
Flucinar (ointment, gel);
Clobetasol (ointment), etc.

Topical corticosteroids are divided into more and less active ones.

Weakly active agents: Prednisolone, Hydrocortisone, Cortade, Lokoid;

Moderately active: Afloderm, Laticort, Dermovate, Fluorocort, Lorinden;

Highly active: Akriderm, Advantan, Kuterid, Apulein, Cutivate, Sinaflan, Sinalar, Sinoderm, Flucinar.

Very highly active: Clobetasol.

Corticosteroids for inhalation

Beclamethasone in the form of metered aerosols (Becotide, Aldecim, Beclomet, Beclocort); in the form of becodisks (powder in a single dose, inhaled using a diskhaler); in the form of a dosed aerosol for inhalation through the nose (Beclomethasone-nasal, Beconase, Aldecim);
Flunisolide in the form of metered aerosols with a spacer (Ingacort), for nasal use (Sintaris);
Budesonide – dosed aerosol (Pulmicort), for nasal use – Rhinocort;
Fluticasone in the form of Flixotide and Flixonase aerosols;
Triamcinolone - metered-dose aerosol with a spacer (Azmacort), for nasal use - Nazacort.

Indications for use

Indications for the use of glucocorticoids

Rheumatism;
rheumatoid and other types of arthritis;
collagenoses, autoimmune diseases (scleroderma, systemic lupus erythematosus, periarteritis nodosa, dermatomyositis);
blood diseases (myeloblastic and lymphoblastic leukemia);
some types of malignant neoplasms;
skin diseases (neurodermatitis, psoriasis, eczema, seborrheic dermatitis, discoid lupus erythematosus, atopic dermatitis, erythroderma, lichen planus);
bronchial asthma;
allergic diseases;
pneumonia and bronchitis, fibrosing alveolitis;
glomerulonephritis;
ulcerative colitis and Crohn's disease;
acute pancreatitis;
hemolytic anemia;
viral diseases (infectious mononucleosis, viral hepatitis and others);
external otitis (acute and chronic);
treatment and prevention of shock;
in ophthalmology (for non-infectious diseases: iritis, keratitis, iridocyclitis, scleritis, uveitis);
neurological diseases (multiple sclerosis, acute spinal cord injury, optic neuritis;
during organ transplantation (to suppress rejection).

Indications for the use of mineralocorticoids

Addison's disease (chronic deficiency of adrenal hormones);
myasthenia gravis (an autoimmune disease manifested by muscle weakness);
disorders of mineral metabolism;
adynamia and muscle weakness.

Contraindications

hypersensitivity to the drug;
severe infections (except tuberculous meningitis and septic shock);
chicken pox;
immunization with live vaccine.

Glucocorticosteroids should be used with caution in diabetes mellitus, hypothyroidism, gastric and duodenal ulcers, ulcerative colitis, high blood pressure, liver cirrhosis, cardiovascular failure in the stage of decompensation, increased thrombus formation, tuberculosis, cataracts and glaucoma, and mental illness.

high blood pressure;
diabetes;
low potassium levels in the blood;
glaucoma;
renal and hepatic failure.

Adverse reactions and precautions

the appearance of edema due to sodium and water retention in the body;
increased blood pressure;
increased blood sugar levels (even the development of steroid diabetes mellitus is possible);
osteoporosis due to increased calcium secretion;
aseptic necrosis of bone tissue;
exacerbation or occurrence of gastric ulcer; gastrointestinal bleeding;
increased thrombus formation;
weight gain;
the occurrence of bacterial and fungal infections due to decreased immunity (secondary immunodeficiency);
menstrual irregularities;
neurological disorders;
development of glaucoma and cataracts;
skin atrophy;
increased sweating;
the appearance of acne;
suppression of the tissue regeneration process (slow wound healing);
excess facial hair growth;
suppression of adrenal function;
mood instability, depression.

Long courses of corticosteroids can lead to changes in the patient's appearance (Cushing's syndrome):

excessive deposition of fat in certain areas of the body: on the face (the so-called “moon face”), on the neck (“bull neck”), chest, and abdomen;
the muscles of the limbs are atrophied;
bruising on the skin and stretch marks (stretch marks) on the abdomen.

With this syndrome, there is also growth retardation, disturbances in the formation of sex hormones (menstrual irregularities and male hair growth in women, and signs of feminization in men).

How to use corticosteroids?

Treatment with corticosteroids

During intensive therapy (in the case of acute, life-threatening pathology), the drugs are administered intravenously and, once the effect is achieved, are discontinued at once.

alternating therapy– use glucocorticoids with short and medium duration of action (Prednisolone, Methylprednisolone) once from 6 to 8 am every 48 hours;
intermittent therapy– short, 3-4-day courses of taking the drug with 4-day breaks between them;
pulse therapy– rapid intravenous administration of a large dose (at least 1 g) of the drug for emergency care. The drug of choice for such treatment is Methylprednisolone (it is more accessible for administration to the affected areas and has fewer side effects).

Daily doses of drugs (in terms of Prednisolone):

Low – less than 7.5 mg;
Medium – 7.5 -30 mg;
High – mg;
Very high – above 100 mg;
Pulse therapy – above 250 mg.

Treatment with corticosteroids should be accompanied by the prescription of calcium and vitamin D supplements to prevent osteoporosis. The patient's diet should be rich in proteins, calcium and include a limited amount of carbohydrates and table salt (up to 5 g per day), liquid (up to 1.5 l per day).

Corticosteroids for children

Corticosteroids during pregnancy and lactation

1. Threat of premature birth (a short course of hormones improves the readiness of the premature fetus for birth); the use of surfactant for the child after birth has allowed us to minimize the use of hormones for this indication.

2. Rheumatism and autoimmune diseases in the active phase.

3. Hereditary (intrauterine) hyperplasia of the adrenal cortex in the fetus is a difficult disease to diagnose.

Corticosteroids for bronchial asthma

Corticosteroids for allergies

Corticosteroids for psoriasis

Drug interactions

Antacids (drugs that reduce gastric acidity) reduce the absorption of glucocorticoids taken orally.
Barbiturates, Diphenin, Hexamidine, Carbamazepine, Rifampicin, Diphenhydramine accelerate the metabolism (conversion) of glucocorticoids in the liver, and Erythromycin and Isoniazid slow it down.
Glucocorticoids accelerate the elimination of Butadione, salicylates, barbiturates, Digitoxin, Diphenin, Penicillin, Isoniazid, Chloramphenicol from the body.
Glucocorticoids when taken together with Isoniazid can cause mental disorders; with reserpine – depressive states.
Tricyclic antidepressants (Amitriptyline, Coaxil, Imipramine and others) in combination with glucocorticoids can cause an increase in intraocular pressure.
Glucocorticoids (with long-term use) enhance the effectiveness of adrenomimetics (Adrenaline, Dopamine, Norepinephrine).
Theophylline in combination with glucocorticoids contributes to the appearance of a cardiotoxic effect; enhances the anti-inflammatory effect of glucocorticoids.
Amphotericin and diuretics in combination with corticosteroids increase the risk of hypokalemia (low potassium levels in the blood) and increased diuretic effects (and sometimes sodium retention).
The combined use of mineralocorticoids and glucocorticoids increases hypokalemia and hypernatremia. With hypokalemia, side effects of cardiac glycosides may occur. Laxatives may potentiate hypokalemia.
Indirect anticoagulants, Butadione, Ethacrynic acid, Ibuprofen in combination with glucocorticoids can cause hemorrhagic manifestations (bleeding), and salicylates and Indomethacin can cause the formation of ulcers in the digestive organs.
Glucocorticoids enhance the toxic effect of paracetamol on the liver.
Retinol preparations reduce the anti-inflammatory effect of glucocorticoids and improve wound healing.
The use of hormones together with Azathioprine, Methandrostenolone and Chingamin increases the risk of developing cataracts and other adverse reactions.
Glucocorticoids reduce the effect of Cyclophosphamide, the antiviral effect of Idoxuridine, and the effectiveness of glucose-lowering drugs.
Estrogens enhance the effect of glucocorticoids, which may make it possible to reduce their dosage.
Androgens (male sex hormones) and iron supplements enhance erythropoiesis (the formation of red blood cells) when combined with glucocorticoids; reduce the process of hormone elimination, contribute to the appearance of side effects (increased blood clotting, sodium retention, menstrual irregularities).
The initial stage of anesthesia when using glucocorticoids is lengthened and the duration of anesthesia is reduced; Fentanyl doses are reduced.

Rules for withdrawing corticosteroids

Prices for corticosteroids

Hydrocortisone – suspension – 1 bottle 88 rubles; eye ointment 3 g – 108 rubles;
Prednisolone – 100 tablets of 5 mg – 96 rubles;
Metypred – 30 tablets of 4 mg – 194 rubles;
Metypred – 250 mg 1 bottle – 397 rubles;
Triderm - ointment 15 g - 613 rubles;
Triderm – cream 15 g – 520 rubles;
Dexamed – 100 ampoules of 2 ml (8 mg) – 1377 rubles;
Dexamethasone – 50 tablets of 0.5 mg – 29 rubles;
Dexamethasone – 10 ampoules of 1 ml (4 mg) – 63 rubles;
Oftan Dexamethasone – eye drops 5 ml – 107 rubles;
Medrol – 50 tablets of 16 mg – 1083 rubles;
Flixotide – aerosol 60 doses – 603 rubles;
Pulmicort – aerosol 100 doses – 942 rubles;
Benacort – aerosol 200 doses – 393 rubles;
Symbicort - aerosol with a dispenser of 60 doses - 1313 rubles;
Beclazon - aerosol 200 doses - 475 rubles.

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Allergic rhinitis (AR) is a disease of the nasal mucosa, the basis of which is allergic inflammation caused by causally significant allergens. Although AR itself is not a serious disease, it can change the social life of patients, affect attendance and performance at school, and work performance.

Epidemiology of AR

AR is a disease that is growing every year throughout the world. Over the past 30 years, the incidence in economically developed countries has increased by 100% in every decade. The increase in the frequency and severity of allergic diseases is associated with many factors, among which environmental deterioration is in the first place. According to the Russian Ministry of Health, from 13% to 35% of the population of our country suffer from allergic diseases, of which AR accounts for 60-70%. The prevalence of AR is especially high in the pediatric population, where, according to various studies, it reaches from 10% to 28.7%. An increase in incidence occurs at early school age; boys are more often affected. An increased risk of AR is observed in children with a hereditary predisposition to atopy: it has been found that the likelihood of AR increases to 70% if both parents suffer from atopic diseases. Bronchial asthma (BA) and AR are often comorbidities. According to H. Milgrom, D. Y. Leung, up to 78% of patients with asthma suffer from AR and 38% of patients with AR have asthma.

Pathogenesis of AR

AR is an IgE-mediated inflammation of the nasal mucosa. Sensitization can be caused by a variety of allergens. In the nasal mucosa, the allergen binds to allergen-specific IgE antibodies, which triggers the activation of mast cells. In the early phase of the allergic response, histamine, tryptase, prostaglandin D2, leukotrienes (B4 and C4), kinins, thromboxane A2 (cyclooxygenase pathway), hydroxyeicosatetraenoic acids, lipoxins (5-lipoxygenase pathway) and platelet activating factor are released. Mediators of the allergic reaction stimulate the nerve endings of the parasympathetic nerves, which carry impulses to the central nervous system, from where they travel to the conjunctiva of the eyes (nasoocular reflex). Symptoms of AR (vasodilation, hyperemia, increased vascular permeability, edema, cellular infiltration by basophils and mast cells) are also realized by eosinophils, macrophages, and T-lymphocytes. With an exacerbation of allergic rhinitis, the activity of the cilia of the ciliated epithelium of the nasal mucosa decreases by more than 1.5 times.

Clinical picture of AR

Allergic inflammation of the nasal mucosa is manifested by rhinorrhea, sneezing, itching, and nasal congestion. Intermittent (seasonal) AR develops more often in children aged 4-6 years, but can occur earlier. Symptoms appear during the flowering period of plants to which the patient is sensitive. Other allergic reactions may occur: conjunctivitis, uveitis, damage to the gastrointestinal tract, etc. Clinical symptoms of the disease recur during the flowering period of certain plant species. Persistent (year-round) AR is characterized by constant nasal congestion, as well as frequent sneezing. The most common allergens are household allergens and mold spores. Exacerbations of year-round AR are associated with exposure to nonspecific irritating factors (pungent substances, perfumes, smoke, etc.). Patients' sense of smell decreases, they complain of increased fatigue, headache, frequent nosebleeds, and dry cough. During rhinoscopy, swelling and pallor of the mucous membrane and mucous discharge are observed. Constant nasal congestion can interfere with sleep. Breathing through the mouth leads to dry mucous membranes and lips. If the disease develops at an early age, changes in the facial skeleton and malocclusion may occur. Prolonged swelling of the mucous membrane contributes to the occurrence of sinusitis.

AR classification

According to the frequency of manifestations of AR, there are:
a) acute (episodic) AR - symptoms develop acutely as a result of contact with allergens (waste products of domestic or wild animals, mites, house dust);
b) persistent (year-round) AR;
c) seasonal AR (hay fever, pollen allergy) is characterized by annual seasonality of symptoms (during the flowering period of specific plants). In central Russia there are three peaks of hay fever:
- spring (April-May, flowering of bushes and trees);
- summer (June-July, grass flowering);
- autumn (July-October, allergies to pollen of wormwood, ragweed).
Depending on the duration of AR, it can be:
a) intermittent AR (symptoms are observed< 4 дней в неделю или < 4 недель в году);
b) persistent (year-round) AR: symptoms appear > 2 hours/day, > 4 days a week and > 4 weeks a year.
By severity (assessed subjectively depending on the quality of life): mild, moderate and severe.
Depending on the presence or absence of complications: uncomplicated and complicated (sinusitis, nasal polyposis, eustachian tube dysfunction, otitis media, etc.).
Depending on the type of allergen: pollen, fungal, household, food, epidermal.

Diagnosis of AR

The diagnosis of AR is established on the basis of complaints, medical history, clinical manifestations, endoscopic picture and specific allergological diagnostics aimed at identifying the causative allergens (IgE determination and cytological examination of nasal discharge, skin testing). It is necessary to pay attention to the family history. Nasal provocation test, active anterior rhinomanometry and acoustic rhinometry allow objective assessment of nasal breathing. According to WHO recommendations, patients with persistent AR should be carefully examined for the presence of asthma. Differential diagnosis of AR is carried out with acute respiratory infections, nasal polyps, anatomical abnormalities, adenoiditis and other diseases.

AR treatment

Elimination of allergens

Therapeutic measures should be, first of all, aimed at eliminating etiologically significant factors. It is recommended to limit your stay outside during the flowering period of plants, especially in dry, hot and windy weather; use air conditioners and air filters indoors; If possible, go to other climatic zones during the flowering period. To eliminate the symptoms of AR, it is recommended to exclude from the diet those food groups that have cross-allergenic properties with plant pollen.

Drug therapy

Cromony

Cromones (sodium cromoglicate and sodium nedocromil) have a moderate anti-inflammatory effect on the mucous membrane of the upper respiratory tract and are used to prevent allergic diseases of the nose, eyes and bronchi. Cromones generally have a high safety profile. They reduce the release of mediators of allergic inflammation. The short duration of their action requires frequent administration (up to 4-6 times a day), which significantly reduces compliance; it is recommended to use them in the initial stages of the disease, as well as in mild forms of rhinitis.

Topical corticosteroids

Topical corticosteroids have a pronounced anti-inflammatory effect, are most effective for all types of AR, and reduce all symptoms, in particular nasal congestion. However, their long-term use can lead to undesirable reactions, primarily to atrophy of the mucous membrane with possible nosebleeds.

Antileukotriene drugs

Antileukotriene drugs are divided into leukotriene antagonists and leukotriene synthesis inhibitors. Leukotrienes are mediators of the early phase of an immediate allergic reaction. Leukotriene receptor antagonists are effective in relieving symptoms of AR. These drugs are also widely used for the treatment of mild forms of asthma in combination with AR.

Decongestants

Decongestants (oxymetazoline, xylometazoline, naphazoline, etc.) restore nasal breathing. Vasoconstrictor drugs can only be used in short courses. Their use for more than 3-5 days can lead to the development of “rebound syndrome” and drug-induced rhinitis.

Allergen-specific immunotherapy (ASIT)

ASIT consists of introducing an allergen to which the patient is hypersensitive in increasing doses into the patient’s body, resulting in a decrease in the formation of specific IgE.

Antihistamines

Antihistamines are divided into two generations. 1st generation drugs are characterized by incomplete and reversible binding to H1 receptors, so they often need to be taken again during the day. 1st generation antihistamines, in addition to histamines, block other receptors, including M-cholinergic and α-adrenergic receptors, which leads to a decrease in exocrine secretion and an increase in the viscosity of secretions; rapid development of tachyphylaxis. Due to their high lipophilicity, these drugs penetrate well through the blood-brain barrier, causing drowsiness, loss of coordination, lethargy, and dizziness. 2nd generation drugs, as a rule, do not have the disadvantages of 1st generation drugs. Their features are:

good tolerability, high safety profile and effectiveness;
less pronounced sedative effect (varies for different drugs in this group), high selectivity;
more active inhibition of the development of the inflammatory process;
rapid onset of action;
prolonged action (up to 24 hours);
rare development of tachyphylaxis;
inhibition of the release of inflammatory mediators; decreased expression of adhesion molecules (ICAM-1) on epithelial cells, influence on cytokines.

Local antihistamines are used in the acute stage of AR. Since the drug acts directly at the site of allergic inflammation, it is characterized by a rapid onset of therapeutic action - 5-20 minutes after use. Topical antihistamines also have some anti-inflammatory effects. Although this effect is less pronounced than that of topical corticosteroids, the likelihood of side effects is lower. H1-histamine blockers for topical use include azelastine, antazoline, demitendene and levocabastine (Table).

Currently, levocabastine and azelastine are the most widely used drugs in the world for the treatment of AR. They are prescribed as monotherapy for mild forms of AR. When prescribed early, drugs can prevent the development of seasonal AR. For moderate and severe forms of AR, simultaneous use of oral antihistamines is recommended.

The 2nd generation antihistamine drug levocabastine selectively blocks H1-histamine receptors, thereby reducing the severity of allergic reactions mediated by the action of histamine. It quickly eliminates the symptoms of AR. With a single intranasal administration of the drug (50 mcg/dose), 30-40 mcg of levocabastine is absorbed. The half-life is 35-40 hours. In a multicenter, randomized, double-blind study that included 244 patients with AR, it was shown that levocabastine and azelastine have comparable efficacy, but the rate of onset of effect was higher for levocabastine. In a pilot study involving patients with a history of AR, it was shown that intranasal administration of levocabastine 5 minutes before allergen exposure significantly reduced the severity of the allergic reaction. In this case, the duration of the protective effect is at least 24 hours. The high clinical efficacy and safety profile of levocabastine in AR have been shown in a number of double-blind, placebo-controlled studies. Evidence-based studies have found that levocabastine in the form of a nasal spray is superior in clinical effectiveness to sodium cromoglycate in a similar form. Of great interest are studies in which levocabastine was compared with a systemic antihistamine. A multicenter randomized clinical trial involving 207 patients with perennial allergic rhinoconjunctivitis compared the effectiveness of levocabastine (nasal spray and eye drops) and cetirizine (oral). In general, the therapeutic efficacy in both groups was comparable, but it was noted that the effect when using levocabastine occurred much faster (after 5 minutes). In particular, 1 hour after using the drug, relief of AR symptoms was noted by 76% of patients receiving levocabastine, and only 38% of patients receiving cetirizine. Another clinical study included 30 children aged 6 to 16 years suffering from year-round AR. The main group received cetirizine, the control group received levocabastine in the form of a nasal spray. The clinical efficacy of the drugs was comparable, with fewer adverse events noted in the group of patients receiving levocabastine. According to a study in adult patients with year-round AR, after three months of use of levocabastine, a significant reduction in symptoms was observed, with no adverse effects recorded. Unlike intranasal corticosteroids, levocabastine has a high safety profile. On the Russian market, the drug levocabastine in the form of a nasal spray is presented under the trade name Tizin® Alergy. Vials of 10 ml (100 doses) contain levocabastine hydrochloride at a concentration of 0.54 mg/ml, in terms of levocabastine - 0.5 mg/ml. Contraindications to its use are hypersensitivity to any of the components of the drug and age under 6 years. Apply intranasally 2 doses (100 mcg) in each nasal passage 2-4 times a day after cleansing the nasal passages before use.

The incidence of AR is increasing every year. There is a large selection of drugs to treat this pathology. All of them are aimed at different parts of the pathogenesis of AR. Levocabastine (Tizin® Alergy) selectively blocks H 1 -histamine receptors, thereby reducing the severity of allergic reactions mediated by the action of histamine.

Since levocabastine (Tizin® Alergy) eliminates the symptoms of AR (sneezing, itching in the nasal cavity, rhinorrhea), improves nasal breathing, acts pathogenetically and has a high level of safety, its use in this disease is recommended.

Literature

Aberg N., Sundell J., Eriksson B., Hesselmar B., Aberg B. Prevalence of allergic disease in schoolchildren in relation to family history, upper respiratory tract infections, and residential characteristics // Allergy. 1996; 51: 232-237.
Allergic diseases. Diagnosis and treatment. Pract. hand-ed. R. Petterson. Per. from English M., 2000, p. 733.
Geppe N. A., Snegotskaya M. N., Konopelko O. Yu. New in the prevention and treatment of seasonal allergic rhinitis in children // Attending Physician. 2010. No. 1. P. 20-26.
Geppe N. A., Ozerskaya I. V., Malyavina U. S. Mucociliary system of the respiratory tract in bronchial asthma and allergic rhinitis // Treating Doctor. 2011. No. 9. pp. 17-20.
Geppe N. A., Farber I. M., Starostina L. S. and others. Selection of rational methods of treatment for acute infectious and persistent allergic rhinitis of mild and moderate severity in children // District pediatrician. 2010. No. 4. pp. 10-11.
Milgrom H., Leung D. Y. M. Allergic rhinitis. In: Kliegman R. M., Stanton B. F., St. Gemell J. W. Schor N. F., Behrman R. E, eds. Nelson Textbook of Pediatrics. 19 th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chapter 137.
Belousov Yu. B. Allergy. Mechanisms of development of allergic reactions. 2007
Astafieva N. G., Udovichenko E. N., Gamova I. V. and others. Allergic and non-allergic rhinitis: comparative characteristics // Attending Physician. 2013. No. 5.
Lopatin A. S., Gushchin I. S., Emelyanov A. V. et al. Clinical recommendations for the diagnosis and treatment of allergic rhinitis // Consilium medicum. 2001; adj.: 33-44.
Revyakina V. A. Modern view on the problem of allergic rhinitis in children // Attending Physician. 2001. No. 3. P. 22-27.
Drannik G. N. Clinical immunology and allergology. M.: Medical Information Agency, 2003. 604 p.
Hampel F. C. Jr., Martin B. G., Dolen J., Travers S., Karcher K., Holton D. Efficacy and safety of levocabastine nasal spray for seasonal allergic rhinitis // Am J Rhinol. 1999, Jan-Feb; 13 (1): 55-62.
Lange B., Lukat K. F., Rettig K. et al. Efficacy, cost-effectiveness, and tolerability of mometasonefuroate, levocabastine, and disodium cromoglycate nasal sprays in the treatment of seasonal allergic rhinitis // Ann. Allergy Asthma Immunol. 2005, Sep; 95 (3): 272-282.
Knorr B., Matz J., Bernstein J. A. et al. Montelucast for Chronic Asthma in 6 to 14 year old Children. A randomized, double-blind trial // JAMA, 1998, vol. 279, no. 15, p. 1181-1186.
Geppe N. A., Kolosova N. G. Directions for non-drug treatment of rhinitis in children // Pediatrics. Supplement to the journal Consilium Medicum. 2012. No. 3. P. 71-74.
Bousquet J., Annesi-Maesano I., Carat F. et al. DREAMS Study Group, Characteristics of intermittent and persistent allergic rhinitis // Clin Exp Allergy. 2005; 35: 728-732. Fokkens W. J., Lund V. J., Mullol J. et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012 // Rhinol.Suppl. 2012. Vol. 23. 3. P. 1-298.
Borisova E. O. Antihistamines: stages of development // Pharmaceutical Bulletin. 2005, No. 17, 380.
Korsgren M., Andersson M., Borg O. et al. Clinical efficacy and pharmacokinetic profiles of intranasal and oral cetirizine in a repeated allergen challenge model of allergic rhinitis // Ann. Allergy Asthma Immunol. 2007, Apr; 98 (4): 316-321.
Okubo K., Uchida E., Nogami S. Levocabastine nasal spray significantly improves perennial allergic rhinitis: a single-blind placebo-controlled study // Auris Nasus Larynx. 2010, Aug; 37 (4): 436-442.
Corren J., Rachelefsky G., Spector S., Schanker H., Siegel S., Holton D., Karcher K., Travers S. Onset and duration of action of levocabastine nasal spray in atopic patients under nasal challenge conditions // J Allergy Clin Immunol. 1999, Apr; 103(4):574-580.
Bachert C., Wagenmann M., Vossen-Holzenkamp S. Intranasal levocabastine provides fast and effective protection from nasal allergen challenge // Rhinology. 1996, Sep; 34 (3): 140-143.
Dahl R., Pedersen B., Larsen B. Intranasal levocabastine for the treatment of seasonal allergic rhinitis: a multicentre, double-blind, placebo-controlled trial // Rhinology. 1995, Sep; 33 (3): 121-125.
Schata M., Jorde W., Richarz-Barthauer U. Levocabastine nasal spray better than sodium cromoglycate and placebo in the topical treatment of seasonal allergic rhinitis // J Allergy Clin Immunol. 1991, Apr; 87 (4): 873-878.
Drouin M. A., Yang W. H., Horak F. Faster onset of action with topical levocabastine than with oral cetirizine // Mediators Inflamm. 1995; 4(7):S5-S10.
Arreguín Osuna L., García Caballero R., Montero Cortés M. T., Ortiz Aldana I. Levocabastine versus cetirizine for perennial allergic rhinitis in children // Rev Alerg Mex. 1998, May-Jun; 45 (3): 7-11.
Pacor M. L., Biasi D., Maleknia T., Carletto A., Lunardi C. Efficacy of levocabastine in perennial rhinitis // Clin Ter. 1996, Jun; 147(6):295-298.
Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA (2)LEN and AllerGen) // Allergy. 2008; 63, Suppl 86: 8-160.
Lopatin A. S. Rhinitis: pathogenetic mechanisms and principles of pharmacotherapy. M.: Litterra, 2013. 368 p.

M. N. Snegotskaya 1, Candidate of Medical Sciences
N. A. Geppe,Doctor of Medical Sciences, Professor
I. A. Dronov,Candidate of Medical Sciences
M. D. Shakhnazarova,Candidate of Medical Sciences
M. V. Penkina

To ensure stability of the dosage form, purified water, cellulose and other auxiliary compounds are added to them.

The use of hormonal drugs for allergic rhinitis and sinusitis

Using hormonal nasal drops for vasomotor rhinitis

Side effects and contraindications for hormonal treatment

Sinusitis (32)
Nasal congestion (18)
Medicines (32)
Treatment (9)
Folk remedies (13)
Runny nose (41)
Other (18)
Rhinosinusitis (2)
Sinusitis (11)
Snot (26)
Frontit (4)

Nasal spray for sinusitis - list of the best sprays for treatment

Sprays are considered to be a fairly popular, functional and convenient pharmacological form of medicine. Especially often, this kind of system is used in preparations intended for the treatment of the nasopharynx. A small hand pump allows you to efficiently and quickly deliver a properly dosed dose of medication through your nasal passage and directly into your sinuses. Nasal sprays for sinusitis are topical medications and do not cause problems with the liver, pancreas, intestines and other organs as when taking the tablet form of drugs. Thanks to the convenient dispenser and uniform distribution of the active component throughout the mucous membrane, the patient using sprays gets better results compared to conventional nasal drops.

What are they?

Sprays are different. Most modern drugs of this type, present on pharmacy shelves, alleviate the course of the disease and relieve its symptoms, and only a few of them actually eliminate the cause of the problem.

Vasoconstrictor sprays

This type of medication relieves symptoms of nasal congestion and slightly dries out the mucous membranes. In addition, swelling of the membrane is reduced and breathing through the nose is normalized. You can use this kind of drugs for no more than a week, since the body quickly gets used to the systemic effect and the positive effect disappears, replaced by even greater nasal congestion and even drug-induced rhinitis. All vasoconstrictor sprays are contraindicated for pregnant and nursing mothers.

Vibrocil is a complex vasoconstrictor spray based on phenylephrine and dimethindene maleate. Provides not only air patency of the nasal passages, but also has an antiallergic effect, simultaneously reducing heavy exudation. The spray can be used by children from six years of age. To obtain a lasting effect, one full injection into each nostril is sufficient. There are practically no side effects if you do not use it for more than a week in a row.
Sanorin is a drug based on naphazoline. The inexpensive spray has a systemic effect on the vessels of the mucous membranes, reducing swelling. The effect of use lasts for three to four hours. Contraindicated in children under twelve years of age and patients with arterial hypertension. Side effects include burning in the mucous membranes, headache and tachycardia. This type of spray can be used for no more than five days in a row, one spray three times a day.
Tizin is a vasoconstrictor based on xylometazoline. The therapeutic effect of the spray appears a few minutes after use and lasts for six to eight hours. The product can be used by children from six years of age. Possible side effects are reactive hyperemia, headache, burning of the mucous membrane. Tizin spray should not be used together with monoamine oxygenxylase inhibitors.

Moisturizing sprays

This type of nasal spray moisturizes the nasal mucosa, eliminates allergens and gently cleanses the sinuses. Almost all such drugs have no contraindications and can be used from the first days of life, since they contain only a prepared saline solution.

Salin is a preparation based on ionized salt water. Can be used from the first day of life, effectively and quickly moisturizes the mucous membranes of the nose and paranasal sinuses, and provides gentle thinning of mucus. Has no side effects.
Aqua Maris is a combined spray system with a convenient dispenser based on purified ocean water. Helps thin mucus, removes pathogenic microbes from cavities, and moisturizes the mucous membrane. The drug has no contraindications or age restrictions.
Morenazole is a moisturizing spray based on ionized sea water. It has a cleansing and thinning effect, has no side effects or contraindications.

It is worth noting that it is also a good idea to use nasal rinsing for sinusitis, for which saline solutions are usually used.

Mucolytic sprays for sinusitis

This type of spray helps not only thin out sticky mucus, but also effectively remove it from the sinuses.

Sinuforte is a medicine for the effective treatment of sinusitis diseases. The components of the spray have a plant base (cyclamen) and when they come into contact with the mucous membranes, they quickly dilute stagnant snot, irritating the membranes, which in turn stimulate the removal of secretions from the nasal passages. In addition, the general condition of the nasopharynx is normalized and swelling is reduced. Sinuforte spray can be used by children from twelve years of age, two injections once a day. The average course of treatment is from six to fourteen days. Possible adverse reactions are excessive lacrimation, burning in the nose, redness of local areas on the face. The spray should not be used by pregnant women, people under twelve years of age, patients with hypertension, polyposis and cystic sinusitis, as well as people with allergies.
Rinofluimucil is a combined mucolytic nasal spray based on tuaminoheptane and acetylcysteine. It has anti-inflammatory, mucolytic and pronounced antioxidant effects, reduces swelling and hyperemia. Can be used by children over six years of age. Dosage: 1-2 sprays three times a day for no more than a week. Possible side effects include dry mucous membranes, rapid heartbeat, allergic reactions, and central nervous system stimulation. Contraindicated for pregnant women, patients with glaucoma, thyrotoxicosis and those taking MAO inhibitors, as well as for allergy sufferers.

Corticosteroid sprays

The above type of sprays significantly slows down inflammatory processes, but can only be used for a short period of time and strictly as prescribed by a doctor. Effective against very strong blockages of the nasal air passages, some types of sinusitis and polyps. Compared to broad-spectrum systemic corticosteroids in tablet form, this type of hormonal liquid does not have such strong side effects because it is applied topically.

Beconase is a spray based on an intranasal corticosteroid from the adrenal cortex. It has a powerful anti-allergic, anti-edematous and anti-inflammatory effect, and partially enters the circulatory system. The spray can be used strictly according to the instructions prescribed by your doctor, and a clear therapeutic effect is observed five days after the start of the course. Baconase can be used for a long period of time. Side effects include nosebleeds, burning of mucous membranes, and rarely allergic reactions and perforation of the nasal septum. Can be used by children over the age of six and pregnant women; it is contraindicated in patients with hypersensitivity to a component of the drug.
Nasonex is a local antiallergic and anti-inflammatory spray based on adrenal hormones. Inhibits the development of infections, does not penetrate the blood, and is more effective against allergies of various etymologies. Can be used by children from two years of age and pregnant women; the medicinal effect is visible a day after use. The dose of the drug is determined exclusively by the attending physician, usually 2 injections into each nostril throughout the day, the course of treatment is from six to twelve days. Possible side effects are burning sensation, exacerbation of pharyngitis, headache, and very rarely - perforation of the nasal septum. Contraindicated in children under two years of age, patients with tuberculosis of any form, people with nasal injuries, as well as those who have fungal or viral forms of diseases of the respiratory system.

Antibiotic sprays

Topical antibiotic sprays are a good alternative to broad-spectrum antimicrobials in tablet form.

Bioparox is an inhalation antibiotic spray based on fusangin, which has a powerful bacteriostatic effect on most pathogenic microorganisms. Can be used both through the nasal passages and through the mouth. Approved for use by children from 2.5 years of age, the course of treatment does not exceed a week. Dosage - one to two doses of medication three times a day. Possible side effects: allergic reactions, dryness and burning of mucous membranes, nausea, redness of the eyes, and in rare cases, anaphylactic shock. Prescribed with caution for pregnant women, contraindicated for allergy sufferers and persons under 2.5 years of age.
Isofra is an antibiotic spray based on framycetin. It has pronounced antimicrobial activity and does not enter the bloodstream. Course of intranasal use: one injection three times a day for no more than ten days. Contraindicated for children under one year of age and people with allergies. Possible adverse reactions: systemic symptomatic allergy.

Useful video

Treat yourself correctly, choose sprays that are appropriate for your situation, and if necessary, be sure to contact a specialized ENT clinic!

Corticosteroid nasal sprays

When writing articles for the site, I so often had to explain what nasal corticosteroids are that I decided to talk about this class of drugs separately.

Nasal corticosteroids (or glucocorticoids) are steroid hormones sprayed into the nasal cavity. They are synthetic analogues of natural steroid hormones produced by the human adrenal glands.

For diseases of the nose and paranasal sinuses, nasal corticosteroids are prescribed because of their unique powerful anti-inflammatory and antiallergic effects, which cannot be obtained with the use of other drugs. So, for nasal polyposis, there is currently no alternative to hormones at all.

Unfortunately, among the methods and means of treatment available in the arsenal of an ENT doctor, nasal corticosteroids are consistently the second most offensive among patients. (In the first place is a piercing of the maxillary sinus.) The very word “hormones” often scares people. Untruths, truths, and half-truths about hormones have been living in the public consciousness for decades, intricately mixed and giving rise to classic urban legends.

What problems are associated with the administration of hormones? The human adrenal glands (glands that produce corticosteroids) work on a “feedback” principle. When the level of hormones in the blood plasma is high (above normal), the adrenal glands “receive an order” to reduce the production of their own hormones. Reducing the workload over time can lead to atrophy of the adrenal tissue as unnecessary, and a person can no longer do without the introduction of hormones from the outside. Also, long-term use of corticosteroids can lead to the development of gastric ulcers, decreased immunity, increased blood pressure, the appearance of edema, sexual dysfunction, and growth retardation in children.

Now for the good news. Modern nasal corticosteroids are not actually absorbed from the nasal cavity (and stomach if swallowed) into the bloodstream, which makes the previous paragraph irrelevant. Thus, bioavailability (the percentage of the drug entering the bloodstream) for mometasone fuorate is less than 0.1%. To date, there have been no documented cases of adrenal suppression or other systemic effects when using the drug for twelve months.

According to the literature and my own observations, the most common side effect of nasal corticosteroids is minor nosebleeds. (8% of patients – data on mometasone from the instructions for use of the drug).

So, nasal corticosteroids are virtually devoid of side effects that can occur when prescribing hormones in tablets and injections, are highly effective in the treatment of many diseases of the nose and paranasal sinuses, and have no alternative in the treatment of nasal polyposis.

Intranasal corticosteroids: characteristics of drugs

Corticoids are hormonal substances produced by the human adrenal cortex. There are several types of them - mineralo- and glucocorticoids. Drugs that contain only one type of these hormonal substances are called corticosteroids. Intranasal corticosteroids are the most commonly used form of these medications in otolaryngology.

Properties of corticosteroids

Synthetic glucocorticoids have the same properties as natural ones. Nasal corticosteroids, like other forms of hormonal drugs, have pronounced anti-inflammatory and antiallergic effects. The anti-inflammatory effect is based on the inhibition of the production of active substances (leukotrienes, prostaglandin) that take part in the protective function of the body. There is also a delay in the proliferation of new protective cells, which significantly affects local immunity. Hormonal drugs exert their antiallergic effect by inhibiting the release of allergy mediators, in particular histamine. As a result, a long-lasting (during the day) anti-edematous effect is achieved.

Thanks to all the above properties, nasal hormonal preparations are indispensable for many inflammatory and allergic diseases of the nose.

Use of nasal corticosteroids

Currently, in the practice of an ENT doctor, the use of hormonal groups of drugs is widespread, based on their high effectiveness. They are most often prescribed for diseases that arise from contact with an allergen:

Nasal corticosteroids effectively eliminate local allergic manifestations, namely sneezing, nasal congestion, and rhinorrhea.

Drugs are also prescribed for vasomotor rhinitis in pregnant women. In this situation, they significantly improve nasal breathing, but do not contribute to a complete cure.

When polyps are detected in the nasal cavity, the use of nasal hormonal drugs, at the moment, has no alternative among other methods of drug treatment.

Before directly using a nasal hormonal agent, it is important to establish the cause of the disease.

It must be remembered that these drugs do not affect the pathogen itself (viruses, bacteria), but only eliminate the main local manifestations of the disease.

Contraindications

In most cases, glucocorticoid drugs are well tolerated by patients. Despite this, there are a number of restrictions on their use:

Hypersensitivity to the components of the drug.
Tendency to nosebleeds.
Young children's age.

Pregnant women are prescribed hormonal medications with caution, and are not recommended for use during breastfeeding.

Side effects

Most often, undesirable clinical manifestations from the body occur with their prolonged and uncontrolled use.

Pain in the nasopharynx area.
Dryness of the nasal mucosa.
Bleeding from the nasal passages.
Headaches, dizziness, drowsiness.

If you use corticosteroid drugs in high doses for a long time, the risk of developing candidiasis in the nasopharynx increases.

The possibility of such clinical manifestations remains quite low, since intranasal hormonal drugs, unlike tablets, act only locally and are not absorbed into the bloodstream.

Release forms

Intranasal hormonal drugs are available in the form of drops and sprays. It is necessary to instill the medicine into the nose in a supine position, with the head thrown back and moved to the side for better penetration of the drug into the nasal cavity.

If the technique of instilling the medicine is not followed, a person may experience pain in the forehead and a feeling of the drug’s taste in the mouth. Unlike drops, nasal sprays are much more convenient to use because they do not require any preparation before use.

Their main advantage remains that, thanks to the presence of a dispenser, the drug is difficult to overdose on.

Types of intranasal hormonal drugs

Currently, on the pharmaceutical market there are a large number of hormonal drugs that are similar in their effects, but have varying degrees of pronounced effectiveness.

The table below shows the most common nasal corticosteroid drugs and their analogues.

It is worthwhile to dwell in detail on the features of the main drugs in order to understand the advantages of each of them.

Flixonase

In addition to the main substance - fluticasone propionate, the drug contains a number of auxiliary components: dextrose, cellulose, phenylethyl alcohol and purified water.

Flixonase is produced in bottles with a dispenser of 60 and 120 doses (one dose contains 50 mcg of active substance). The anti-inflammatory effect of the drug is moderate, but it has a fairly strong anti-allergic property.

The clinical effect of the drug develops 4 hours after administration, but a significant improvement in the condition occurs only on the 3rd day from the start of therapy. If the symptoms of the disease decrease, the dosage can be reduced.

The average course duration is 5–7 days. The drug is allowed to be taken for prophylactic purposes during seasonal allergies. Unlike other hormonal drugs, Flixonase does not have a negative effect on the hypothalamic-pituitary system.

The drug is strictly prohibited for use in case of herpetic infection, and, in addition to the adverse reactions common with other hormones, it can provoke the development of glaucoma and cataracts. The drug is approved for use in children only from 4 years of age.

Alcedin

The drug is available in 8.5 g cylinders with a dispenser and mouthpiece in the form of a white, opaque suspension. Contains the active substance - beclomethasone (in one dose - 50 mcg). In addition to anti-inflammatory and anti-allergic properties, it also exhibits an immunosuppressive effect. When using standard doses, the drug does not have a systemic effect.

When injecting Alcedin into the nasal cavity, direct contact of the applicator with the mucous membrane should be avoided. After each dose, you must rinse your mouth. In addition to common indications for use with other hormonal drugs, it can be used as part of complex therapy for bronchial asthma (not used during an attack).

Alcedine can increase blood glucose levels, so it should be taken with caution by people with diabetes. Also, special attention when taking it is given to people with hypertension, dysfunction of the liver and thyroid gland.

The drug is contraindicated for women in the first trimester of pregnancy and during breastfeeding, as well as children under 6 years of age.

Nasonex

The main component of the drug is mometasone furoate, a synthetic glucocorticosteroid with pronounced anti-inflammatory and antihistamine effects. Available in the form of a white suspension in plastic bottles of 60 and 120 doses.

In its action and method of application, Nasonex is similar to Flixonase but, unlike it, it has an effect on the hypothalamic-pituitary system. The first clinical effect after administration of the drug is observed 12 hours later, which is significantly later than when taking Flixonase.

Very rarely, prolonged and uncontrolled use of the drug can lead to an increase in intraocular pressure and disruption of the integrity of the nasal septum (its perforation).

Nasonex is not prescribed to persons with pulmonary tuberculosis, acute infectious diseases, as well as to people who have recently undergone injuries or surgical interventions in the nasopharynx. There are no absolute contraindications to taking this drug in pregnant women.

However, after the birth of a child, he should definitely be examined for the safety of adrenal function. It is prescribed to children from the age of two.

Avamis

A hormonal drug which, unlike others, has a powerful anti-inflammatory effect. It contains fluticasone furoate and excipients. It is produced, like previous drugs, in bottles of 30, 60 and 120 doses.

The clinical effect after the first dose becomes noticeable after 8 hours. If accidentally swallowed during instillation, Avamys is not absorbed into the bloodstream and does not have a systemic effect.

The drug has a number of advantages in comparison with other nasal hormones and, first of all, this is due to the good tolerability of the drug and the absence of serious contraindications to its use.

The only thing that requires caution is the administration of Avamis to people with severely impaired liver function. The use of the drug by pregnant and lactating women is not recommended due to the insufficient number of studies conducted on its effect.

Avaris is prescribed to children from the age of two. Cases of overdose with this drug have also not been recorded.

Polydexa

The drug is significantly different from all previous ones. This is a combination drug that includes drugs from three groups, namely antibiotics (neomycin and polymyxin sulfate), vasoconstrictors (phenylephrine hydrochloride) and hormones (dexamethasone 0.25 mg).

Due to the presence of an antibiotic, Polydex is active against bacterial infections (the only exceptions are representatives of the cocci group). Therefore, its use is justified for persons with allergic nasopharyngeal diseases in the presence of an infectious pathogen.

Polydex is produced in the form of drops and spray. Drops, as a rule, are used only in the treatment of inflammatory ear diseases, but their use for the treatment of inflammatory processes in the nose is also acceptable. The drops are produced in yellow-brown bottles with a capacity of 10.5 ml. The spray, unlike ear drops, contains phenylephrine and is available in a blue bottle (volume 15 ml), protected from daylight.

The average duration of drug therapy is 5-10 days; with prolonged use of the drug, there is a high risk of developing candidiasis and nasopharyngeal dysbiosis.

The use of Polydex is absolutely contraindicated for viral diseases of the nasopharynx, closed-angle glaucoma, severe renal impairment, as well as during pregnancy and breastfeeding.

The drug is not prescribed for children under two years of age. It is prohibited to use Polydex simultaneously with antibacterial aminoglycoside drugs.

Comparative characteristics of nasal corticosteroids

Given the variety of nasal hormonal drugs, it is often difficult for a person to distinguish between them by action and to give preference to any of them. The following table is presented, the main purpose of which is to simplify the understanding of the main differences between nasal corticosteroids.

Despite the fact that hormonal drugs in the form of nasal sprays do not enter the general bloodstream, the risk of adverse reactions remains high. Given this, the choice of corticosteroids should be approached with the utmost seriousness.

Only the attending physician can prescribe these medications. The patient should take only the prescribed dosage and observe the duration of taking the drug.

Intranasal corticosteroids. Treatment of allergic rhinitis: the role of topical antihistamines. Use by children and women during pregnancy

Weak

Moderate

Strong

Very strong

Combined

Release forms

Use by children and women during pregnancy

The use of hormonal drugs for allergic rhinitis and sinusitis

Using hormonal nasal drops for vasomotor rhinitis

Side effects and contraindications for hormonal treatment

What hormonal sprays and nasal drops are there?

Indications for use

Popular drugs

Sprays with beclomethasone

Baconase

Nasobek

Aldecin

Fluticasone-based drugs

Avamis

Flixonase

Nazarel

Sprays with mometasone

Conclusion

Corticosteroids - names of drugs, indications and contraindications, features of use in children and adults, side effects

Introduction (characteristics of drugs)

Natural corticosteroids

Synthetic corticosteroids

Forms of release of corticosteroids

Preparations for internal use (in tablets and capsules)

Preparations for injections

Preparations for local use (topical)

Corticosteroids for inhalation

Indications for use

Indications for the use of glucocorticoids

Indications for the use of mineralocorticoids

Contraindications

Adverse reactions and precautions

How to use corticosteroids?

Treatment with corticosteroids

Corticosteroids for children

Corticosteroids during pregnancy and lactation

Corticosteroids for bronchial asthma

Corticosteroids for allergies

Corticosteroids for psoriasis

Drug interactions

Rules for withdrawing corticosteroids

Prices for corticosteroids

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Epidemiology of AR

Pathogenesis of AR

Clinical picture of AR

AR classification

Diagnosis of AR

AR treatment

The use of hormonal drugs for allergic rhinitis and sinusitis

Using hormonal nasal drops for vasomotor rhinitis

Side effects and contraindications for hormonal treatment

Nasal spray for sinusitis - list of the best sprays for treatment

What are they?

Vasoconstrictor sprays

Moisturizing sprays

Mucolytic sprays for sinusitis

Corticosteroid sprays

Antibiotic sprays

Useful video

Corticosteroid nasal sprays

Intranasal corticosteroids: characteristics of drugs

Properties of corticosteroids

Use of nasal corticosteroids

Contraindications

Side effects

Release forms

Types of intranasal hormonal drugs

Flixonase

Alcedin

Nasonex

Avamis

Polydexa