Corticosteroids

Allergic rhinitis is the formal term for seasonal and perennial allergies that affect the nasal passages and throat after someone inhales an allergen—an offending protein.

Treatments for allergies range from common antihistamine medications and decongestants to prescription medications aimed at reducing allergy-related inflammation. The symptoms of allergic rhinitis (sometimes misleadingly termed “hay fever”) include itchy nose, mouth, eyes, or throat, runny nose, sneezing, and tearing eyes. After these initial symptoms, nasal congestion and other symptoms, such as dark circles under the eyes and puffiness around the eyes, may also occur.

Inhaled/Intranasal Corticosteroids

Corticosteroids are potent anti-inflammatory compounds. Inhaled “intranasal” corticosteroids are prescription drugs that are delivered as a spray in measured doses, directly into the nasal cavities, to relieve allergy-related inflammation. They are considered the most effective, first-line treatment for the symptoms of allergic rhinitis. Examples include ciclesonide, fluticasone furoate, mometasone furoate, triamcinolone acetonide, fluticasone propionate, budesonide, and beclomethasone dipropionate. They may be used long term or as needed.

Although the use of oral corticosteroids is generally associated with fairly significant side effects, intranasal corticosteroids largely avoid this problem because they are not absorbed directly into the bloodstream. Rather, they help control local nasal inflammation by blanketing nasal tissues to help mediate the allergic response. Their “negligible systemic absorption” is credited with their excellent safety profile. In other words, by not entering the general circulation, their side effects are limited to relatively minor complaints, such as dry, burning or stinging nasal passages.

Intranasal corticosteroids can help relieve nasal congestion and stuffiness, alleviate runny nose, and reduce sneezing and itchiness. Patients with related conditions, such as asthma, may be prescribed inhaled corticosteroids. Like intranasal corticosteroids, inhaled corticosteroids have a fairly benign side effect profile—they are well tolerated with few significant side effects. These drugs are inhaled directly into the bronchi of the lungs, usually through the mouth. When taken for the control of bronchial inflammation, they are usually prescribed for regular, daily use.

Like intranasal corticosteroids for allergic rhinitis, inhaled corticosteroids target inflammation of the immediate tissues lining the airways where they are sprayed, with little absorption of active ingredients into the blood stream. Examples of inhaled corticosteroids include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex Twisthaler), beclomethasone (Qvar) and ciclesonide (Alvesco).

Oral Corticosteroids

Corticosteroids in pill form are used to relieve serious allergic symptoms that may result from any number of allergic reactions. They (and injectable steroids) are reserved for only the most serious, intractable forms of allergic reaction. Although powerful, these drugs have potentially serious side effects, which limit their usefulness. One common example is prednisone.

Possible side effects of prednisone include cataracts, osteoporosis, muscle weakness, stomach ulcers, and delayed growth in children.

Oral corticosteroids can also make high blood pressure problems worse. Edema (retention of fluid that may result in swollen limbs) is not uncommon. Oral corticosteroids may also affect mood and have been associated with weight gain. Oral corticosteroids (also known as systemic corticosteroids) mimic the action of certain adrenal hormones to limit systemic inflammation. As such, they affect immunity, and may render a user more susceptible to certain infections.

If you are prescribed oral corticosteroids, there are certain steps that may be taken to minimize your risk of suffering certain side effects. Taking supplemental calcium and vitamin D, for example, may help offset the risk of bone mineral loss (osteoporosis), which can result in brittle bones that are more likely to suffer breaks. Careful control of diet may help prevent drug-related weight gain, while exercise may prevent muscle weakness. When stopping oral corticosteroids, especially after long-term use, it may be necessary to slowly reduce your intake, rather than stopping abruptly. Prescription corticosteroids suppress the production of natural hormones by the adrenal glands; slow withdrawal allows the adrenals time to respond and resume normal hormone production.

Corticosteroid Eye Drops

It’s been estimated that 40 to 80 percent of people with allergies experience symptoms of inflammation in the eyes. A form of severe eye inflammation linked to seasonal allergies, called vernal keratoconjunctivitis, often occurs in the summer, especially in hot, humid climates. Symptoms include burning and itching of the conjunctiva of the eyes. The conjunctiva consists of the outermost layer of the eyeball and the inner lining of the eyelid.

Corticosteroids in the form of eye drops are occasionally prescribed for the treatment of severe eye irritation associated with allergies. Examples include dexamethasone, fluorometholone, and prednisolone. Use of these medications may cause blurred vision and has been associated with an increased risk of eye infections, glaucoma and cataracts.