TABLE 4.
Main findings
| Subject | Main message | |
|---|---|---|
| AR | Global health problem that affects children and adults and influences Q when symptoms are uncontrolled | |
| Treatment options | To control symptoms different pharmacological treatment options are available including INCs, antihistamines, leucotriene antagonists, decongestants, anticholinergics, chromones, saline rinses and immunotherapy | |
| Efficacy of INCs | Compared to other pharmacological treatment options | INCs have been found to be the most effective therapy for moderate to severe AR symptoms |
| Subjective (patient‐reported) outcome measures | INCs have proven to be effective against nasal and ocular symptoms and to improve QoL | |
| Objective outcome measures | PNIF, acoustic rhinometry and rhinomanometry can be used as measure for nasal obstruction. INCs show significant improvement of PNIF | |
| Real‐world effectiveness | The number of studies on real‐world effectiveness is limited, but overall the efficacy of INCs has been confirmed | |
| Regular and as‐needed therapy | INCs may be effective as as‐needed therapy for mild AR symptoms; however, regular use gives greater benefits than as‐needed therapy in total nasal symptoms score and disease‐specific QoL | |
| Safety of INCs | Local adverse events | Local irritation and dryness of the nose and throat, and sneezing after administration are common local side effects of INCs, such as epistaxis and atrophy of the nasal mucosa or septal perforation, which are more severe and rarer adverse events |
| Systemic adverse events | Adequate attention for (serious) systemic adverse events is important, including affecting the hypothalamic–pituitary–adrenal axis; affecting the growth of children; reducing bone mineral density; elevating the intraocular pressure; and developing cataract, glaucoma or chorioretinopathy | |
| MOA | In reaction to allergic stimuli, INCs block the synthesis and release of inflammatory mediators and thereby reduce the influx of inflammatory cells into the nasal mucosa | |
| Desired distribution pattern | No uniform conclusions regarding the desired deposition pattern of INCs could be drawn | |
| Identified deposition pattern | Studies found different deposition patterns including: particles mainly deposit in the inferior and middle turbinates, particles mainly impinge on the non‐ciliated mucosal walls of the vestibule and the narrow valve, particles mainly deposit in the anterior non‐ciliated part of the nose and the head of the inferior turbinate and a small fraction reaches the middle turbinate | |
| Administration technique | Steps of the administration technique | Administration steps include nose blowing, nose rinsing, head positioning, spray positioning, depth of the spray into the nostril, closing of the contralateral nostril, DSD determined by nasal airflow and spray velocity and exhalation |
| The influence on the deposition pattern | No definitive conclusions could be drawn regarding how each step of the administration technique affects INCs particle deposition | |
| Administration instructions | Instructions about the administration technique of INCs in PILs, via healthcare providers and via instruction videos on YouTube are inconsistent and of insufficient quality. Teaching a proper administration technique may reduce the risk of local side effects, which may lead to better treatment adherence | |
| Breath‐actuated powder inhalation devices | The effect of spray velocity caused by the actuation force disappears. It is hypothesized that more and larger droplets deposit deeper into the nose due to the lower airflow rates | |
Abbreviations: AR, allergic rhinitis; DSD, droplet‐size distribution; INCs, intranasal corticosteroids; MOA, mode of action; PIL, patient information leaflet; PNIF, peak nasal inspiration flow; QoL, quality of life.