Intranasal corticosteroids a leading treatment for allergic rhinitis

INCS are administered either intermittently for seasonal AR or continuously for perennial AR. If symptoms persist despite initial treatment, combining INCS with antihistamines may be beneficial to enhance symptom relief. 

INCS work by decreasing the release of inflammatory mediators and cytokines, which provides effective symptomatic relief. They are most beneficial when used continuously or in prolonged treatment blocks, with a noticeable effect occurring within 7 to 12 hours and peak benefit observed after about 2 weeks of regular use. 

INCS are generally well-tolerated, but they can cause local side effects such as nasal dryness, burning sensations, blood-tinged secretions, and epistaxis. To alleviate these issues, using saline to moisturise the nasal passages and ensuring proper spray technique - by aiming away from the nasal septum - can help reduce discomfort. 

The South African Allergic Rhinitis Working Group (SAARWG), in its recent guidelines, has advocated for INCS as a first-line choice in the treatment of AR. This recommendation is based on INCS's superior effectiveness and faster action. These are believed to be due to INCS’s glucocorticoid receptor-binding affinity and anti-inflammatory potency. 

It should be noted that some INCS are more generally potent than others. For example, fluticasone propionate, fluticasone furoate, ciclesonide, and mometasone furoate are known for their high receptor selectivity and retention in nasal tissue, resulting in minimal systemic absorption (less than 1%). This contrasts with other INCS like budesonide, beclomethasone dipropionate, and triamcinolone, which have higher systemic bioavailability and potential for broader effects beyond the nasal passages.