xRead - September 2022

Wise et al.

Page 98

effect of INCS on growth in children has been investigated in controlled studies using both knemometry in short-term studies (2 to 4 weeks) and stadiometry in long-term (12 months) studies. A meta-analysis of 8 randomized controlled trials with appropriate controls showed that, compared to children using placebo, mean growth was significantly lower among children using INCS in trials using knemometry (n = 4) and that there was no significant growth difference in studies using stadiometry (n = 4). 1320 The data suggests that INCS might have deleterious effects on short-term growth in children, but the heterogeneity in the stadiometry studies makes the effects on long-term growth suppression unclear (Table IX.B.2.c-4). INCSs are first-line therapy for the treatment of AR due to their superior efficacy in controlling nasal congestion and other symptoms of this inflammatory condition. Subjects with known SAR should start prophylactic treatment with INCS several days before the pollen season with an evaluation of the patient’s response in 2 weeks. In addition to making changes to the treatment regimen according to the patient’s response, a nasal exam evaluates for signs of local irritation due to the drug or mechanical trauma from the applicator itself. Aiming the spray away from the nasal septum may also reduce irritation in this area. Children receiving INCS should be on the lowest effective dose to avoid negative growth effects. • Aggregate Grade of Evidence: A (Level 1a: 15 studies; Level 1b: 33 studies; Level 2a: 3 studies; Level 2b: 1 study; Level 5: 1 study; Tables IX.B.2.c-1, IX.B.2.c-2, IX.B.2.c-3, and IX.B.2.c-4). • Benefit: INCSs are effective in reducing nasal and ocular symptoms of AR. They have superior efficacy compared to oral antihistamines and LTRAs. • Harm: INCS have known undesirable local adverse effects such as epistaxis with some increased frequency compared to placebo in prolonged administration studies. There are no apparent negative effects on the hypothalamic-pituitary axis. There might be some negative effects on short-term growth in children, but it is unclear whether these effects translate into long-term growth suppression. • Cost: Low. • Benefits-Harm Assessment: The benefits of using INCS outweigh the risks when used to treat SAR and PAR. • Value Judgments: None. • Policy Level: Strong recommendation for the use of INCS to treat AR. • Intervention: The well-proven efficacy of INCSs, as well as their superiority over other agents, make them first-line therapy in the treatment of AR. IX.B.3. Decongestants IX.B.3.a. Oral decongestants.: Oral decongestants, such as pseudoephedrine, act on adrenergic receptors and lead to vasoconstriction, which can relieve nasal congestion in patients with AR. With extended-release oral decongestants nasal decongestion can last up to 24 hours. Oral decongestants are available for use alone or in combination with oral

Author Manuscript Author Manuscript Author Manuscript Author Manuscript

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.