Effectiveness and safety of beclomethasone dipropionate, an intranasal corticosteroid, in the treatment of patients with allergic rhinitis

There is an increasing trend toward topical intranasal corticosteroids as the preferred treatment for seasonal or perennial allergic rhinitis. This trend is based on the fact that the chronic, mucosal inflammation that accompanies allergic rhinitis responds to anti-inflammatory drugs such as topical corticosteroids. Intranasal corticosteroids, given before the natural antigen challenge, reverse preexisting inflammation and prevent nasal priming by antigens. One intranasal corticosteroid, beclomethasone dipropionate, has been available by prescription in the United States for more than a decade and has an established efficacy and safety profile in patients with allergic rhinitis. Beclomethasone dipropionate has become the standard to which other intranasal corticosteroid preparations are compared. In comparison with earlier corticosteroids (eg, hydrocortisone, prednisolone, dexamethasone, betamethasone) that caused adrenal suppression and other systemic adverse reactions, the actions of newer corticosteroids, including beclomethasone dipropionate, are confined to the site of application. These drugs are also more rapidly metabolized, less irritating to the nasal mucosa, and have a longer duration of action. When given intranasally to relieve the sneezing, congestion, and rhinorrhea associated with seasonal and perennial allergic rhinitis, the newer corticosteroids have proved safe and effective. Despite the fact that topical nasal corticosteroids such as beclomethasone dipropionate are responsible for important improvements in the treatment of both allergic and nonallergic rhinitis as well as nasal polyposis and chronic sinusitis, these drugs may be underused, particularly in the pediatric population. Because of the concern of systemic side effects in younger children, less effective therapies are sometimes used.