Date - 3 June 2005

Source - Drugs in Context 2005; 1(11): Fluticasone - Allergic rhinitis p591

Author - Dr Rebecca Fox-Spencer

Fluticasone propionate is a topically active corticosteroid, licensed as an intranasal formulation for use in patients with allergic rhinitis. It reduces the nasal, ocular and sinus symptoms associated with the condition by interfering at an early stage with the inflammatory reactions that cause them. Preclinical data indicate a high degree of potency for fluticasone at the glucocorticoid receptor. Intranasal administration of fluticasone results in very low plasma concentrations, which combined with its rapid and extensive hepatic metabolism, leads to a very low systemic availability.This contributes to the good safety and tolerability profile of fluticasone, with side-effects generally restricted to mild, transient events. Furthermore, fluticasone administered intranasally does not appear to have any adverse impact on growth velocity in children, and also effectively reduces nasal symptoms in this age group. In comparison with other corticosteroids in adults and adolescents, fluticasone has been shown to be more effective in reducing symptoms of allergic rhinitis than equivalent doses of beclometasone or triamcinolone, though therapeutic doses of budesonide appear to be at least as effective as fluticasone.As well as demonstrating superior efficacy over montelukast and sodium cromoglicate, fluticasone is clearly more effective than the antihistamines in reducing nasal symptoms, though superiority for ocular symptoms is less apparent.

Keywords: Intermittent allergic rhinitis; persistent allergic rhinitis; nasal congestion; fluticasone propionate; topical corticosteroids