The use of intranasal corticosteroids has revolutionised the management of allergic rhinitis and rhinosinusitis and there is now significant evidence of their safety. The problem with side-effects is that clinical studies are designed to demonstrate efficacy, but are underpowered to show evidence of side-effects. None of the studies pooled in this meta-analysis has shown a significant effect of intranasal corticosteroids on growth, however they all showed a consistent trend towards reduced growth velocity. This meta analysis pooling their results showing the effect to be real and consistent, albeit small, as measured by knemometry growth velocity, even after use as limited as for a few weeks. What is not clear is the long-term effect, and whether the children can later catch up. In any case, it is a study that certainly calls for exercising caution in their use and always use the lowest effective dose.

Topical intranasal corticosteroids and growth velocity in children: a meta-analysis.
Mener DJ, Shargorodsky J, Varadhan R, Lin SY.
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Christos Georgalas

Academic Medical Center, The Netherlands.

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