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Safety of intranasal corticosteroid sprays during pregnancy: an updated review

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Abstract

Introduction

Rhinitis and rhinosinusitis are commonly encountered in pregnant women. Intranasal corticosteroid (INCS) sprays are generally safe and effective in the treatment of these conditions in the general population. However, the use of some of these INCS sprays during pregnancy is still controversial.

Objective

To review the current literature about the safety of intranasal corticosteroid sprays during pregnancy.

Methodology

Using different search engines, each type of INCS was reviewed separately (triamcinolone, beclomethasone, budesonide, fluticasone propionate, fluticasone furoate, mometasone, and ciclesonide). A total of 51 full-length articles were examined for eligibility. After applying inclusion and exclusion criteria, a total of three articles were reviewed.

Results

No significant association with congenital organ malformations has been linked to intranasal use of beclomethasone, budesonide, fluticasone propionate, fluticasone furoate, or mometasone. Intranasal triamcinolone, however, has been found to have a significant association with respiratory tract defects. Data about the safety of intranasal ciclesonide during pregnancy are not available.

Conclusion

Lacking sufficient clinical trials on the use of intranasal corticosteroid sprays in pregnancy, we suggest that the intranasal use of fluticasone furoate, mometasone, and budesonide is safe if they are used at the recommended therapeutic dose after a proper medical evaluation. Intranasal fluticasone propionate might be a safe option in the absence of other INCS options due to its questionable efficacy during pregnancy. Risk-benefit ratio should always be considered before prescribing any intranasal corticosteroid sprays during pregnancy.

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References

  1. Bende M, Gredmark T (1999) Nasal stuffiness during pregnancy. Laryngoscope 109:1108–1110. doi:10.1097/00005537-199907000-00018

    Article  CAS  PubMed  Google Scholar 

  2. Hamano N (1998) Effect of sex hormones on eosinophilic inflammation in nasal mucosa. Allergy Asthma Proc 19:263–269

    Article  CAS  PubMed  Google Scholar 

  3. Schatz M, Zeiger RS (1988). Diagnosis and management of rhinitis during pregnancy. Allergy Asthma Proc 9(5):545–554

    Article  CAS  Google Scholar 

  4. Wei W, Liu H, Kang D et al (2015) Non-surgical interventions for nasal congestion during pregnancy. Cochrane Database Syst Rev. doi:10.1002/14651858.CD011653

    PubMed Central  Google Scholar 

  5. Yawn B, Knudtson M (2007) Treating asthma and comorbid allergic rhinitis in pregnancy. J Am Board Fam Med 20:289–298. doi:10.3122/jabfm.2007.03.060144

    Article  PubMed  Google Scholar 

  6. Ellegård EK (2006) Pregnancy rhinitis. Immunol Allergy Clin North Am 26:119–135. doi:10.1016/j.iac.2005.10.007

    Article  PubMed  Google Scholar 

  7. Incaudo GA (2004) Diagnosis and treatment of allergic rhinitis and sinusitis during pregnancy and lactation. Clin Rev Allergy Immunol 27:159–177. doi:10.1385/criai:27:2:159

    Article  PubMed  Google Scholar 

  8. Gilbey P, McGruthers L, Morency A-M, Shrim A (2012) Rhinosinusitis-related quality of life during pregnancy. Am J Rhinol Allergy 26:283–286. doi:10.2500/ajra.2012.26.3776

    Article  PubMed  Google Scholar 

  9. Caparroz FA, Gregorio LL, Bongiovanni G et al (2016) Rhinitis and pregnancy: literature review. Braz J Otorhinolaryngol 82:105–111. doi:10.1016/j.bjorl.2015.04.011

    Article  PubMed  Google Scholar 

  10. Pien GW, Schwab RJ (2004) Sleep disorders during pregnancy. Sleep 27:1405–1417

    Article  PubMed  Google Scholar 

  11. Kaiser HB, Liao Y, Diener P et al (2004) Triamcinolone acetonide and fluticasone propionate nasal sprays provide comparable relief of seasonal allergic rhinitis symptoms regardless of disease severity. Allergy Asthma Proc 25:423–428

    CAS  PubMed  Google Scholar 

  12. Mak KK, Ku MS, Lu KH et al (2013) Comparison of mometasone furoate monohydrate (Nasonex) and fluticasone propionate (Flixonase) nasal sprays in the treatment of dust mite-sensitive children with perennial allergic rhinitis. Pediatr Neonatol 54:239–245. doi:10.1016/j.pedneo.2013.01.007

    Article  PubMed  Google Scholar 

  13. Newson-Smith G, Powell M, Baehre M et al (1997) A placebo controlled study comparing the efficacy of intranasal azelastine and beclomethasone in the treatment of seasonal allergic rhinitis. Eur Arch Otorhinolaryngol 254:236–241

    Article  CAS  PubMed  Google Scholar 

  14. Trangsrud AJ, Whitaker AL, Small RE (2002) Intranasal corticosteroids for allergic rhinitis. Pharmacotherapy 22:1458–1467. doi:10.1592/phco.22.16.1458.33692

    Article  CAS  PubMed  Google Scholar 

  15. Weiner JM, Abramson MJ, Puy RM (1998) Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ 317:1624–1629. doi:10.1136/bmj.317.7173.1624

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Sheikh A, Panesar SS, Salvilla S (2009) Ear, nose, and throat disorders Hay fever in adolescents and adults Ear, nose, and throat disorders Hay fever in adolescents and adults. BMJ clinical evidence

  17. Day J, Carrillo T (1998) Comparison of the efficacy of budesonide and fluticasone propionate aqueous nasal spray for once daily treatment of perennial allergic rhinitis. J Allergy Clin Immunol 102:902–908

    Article  CAS  PubMed  Google Scholar 

  18. Fokkens W, Lund V, Mullol J (2012) European position paper on rhinosinusitis and nasal polyps. Rhinology 1–136. doi:10.4193/Rhino50E2

  19. Allen DB (2000) Systemic effects of intranasal steroids: an endocrinologist’s perspective. J Allergy Clin Immunol 106:S179-90. doi:10.1067/mai.2000.110038

    Article  PubMed  Google Scholar 

  20. Corren J (1999) Intranasal corticosteroids for allergic rhinitis: how do different agents compare? J Allergy Clin Immunol 104:S144-9. doi:10.1016/S0091-6749(99)70310-6

    Article  PubMed  Google Scholar 

  21. Boner AL (2001) Effects of intranasal corticosteroids on the hypothalamic-pituitary-adrenal axis in children. J Allergy Clin Immunol 108:32–39. doi:10.1067/mai.2001.115564

    Article  Google Scholar 

  22. Kim KT, Rabinovitch N, Uryniak T et al (2004) Effect of budesonide aqueous nasal spray on hypothalamic-pituitary-adrenal axis function in children with allergic rhinitis. Ann Allergy Asthma Immunol 93:61–67. doi:10.1016/S1081-1206(10)61448-2

    Article  CAS  PubMed  Google Scholar 

  23. Wilson a M, McFarlane LC, Lipworth BJ (1998) Effects of repeated once daily dosing of three intranasal corticosteroids on basal and dynamic measures of hypothalamic-pituitary-adrenal-axis activity. J Allergy Clin Immunol 101:470–474. doi:10.1016/S0091-6749(98)70354-9

    Article  PubMed  Google Scholar 

  24. Sastre J, Mosges R (2012) Local and systemic safety of intranasal corticosteroids. J Investig Allergol Clin Immunol 22:1–12

    CAS  PubMed  Google Scholar 

  25. Wihl J-Å, Andersson K-E, Johansson S-Å (1997) Systemic effects of two nasally administered glucocorticosteroids. Allergy 52:620–626. doi:10.1111/j.1398-9995.1997.tb01040.x

    Article  CAS  PubMed  Google Scholar 

  26. Ramoz LL, Patel-Shori NM (2014) Recent changes in pregnancy and lactation labeling: retirement of risk categories. Pharmacotherapy 34:389–395. doi:10.1002/phar.1385

    Article  PubMed  Google Scholar 

  27. Broek JL, Bousquet J, Baena-Cagnani CE et al (2010) Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 126:466–476. doi:10.1016/j.jaci.2010.06.047

    Article  Google Scholar 

  28. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions : explanation and elaboration. doi:10.1371/journal.pmed.1000100

  29. Bérard A, Sheehy O, Kurzinger M-L, Juhaeri J (2016) Intranasal triamcinolone use during pregnancy and the risk of adverse pregnancy outcomes. J Allergy Clin Immunol 138:97–104.e7. doi:10.1016/j.jaci.2016.01.021

    Article  PubMed  Google Scholar 

  30. Källén BAJ, Otterblad Olausson P (2003) Maternal drug use in early pregnancy and infant cardiovascular defect. Reprod Toxicol 17:255–261. doi:10.1016/S0890-6238(03)00012-1

    Article  PubMed  Google Scholar 

  31. Ellegård EK, Hellgren M, Karlsson NG (2001) Fluticasone propionate aqueous nasal spray in pregnancy rhinitis. Clin Otolaryngol Allied Sci 26:394–400. doi:10.1046/j.1365-2273.2001.00491.x

    Article  PubMed  Google Scholar 

  32. Pelucchi Foresi a, Gherson A G, et al (1996) Once daily intranasal fluticasone propionate (200 micrograms) reduces nasal symptoms and inflammation but also attenuates the increase in bronchial responsiveness during the pollen season in allergic rhinitis. J Allergy Clin Immunol 98:274–282

    Article  PubMed  Google Scholar 

  33. Daley-Yates PT, Price AC, Sisson JR et al (2001) Beclomethasone dipropionate: Absolute bioavailability, pharmacokinetics and metabolism following intravenous, oral, intranasal and inhaled administration in man. Br J Clin Pharmacol 51:400–409. doi:10.1046/j.0306-5251.2001.01374.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Dawes M, Chowienczyk PJ (2001) Pharmacokinetics in pregnancy. Best Pract Res Clin Obstet Gynaecol 15:819–826. doi:10.1053/beog.2001.0231

    Article  CAS  PubMed  Google Scholar 

  35. Kallen B, Rydhstroem H, Aberg A (1999) Congenital malformations after the use of inhaled budesonide in early pregnancy. Am J Obstet Gynecol 93:392–395

    CAS  Google Scholar 

  36. Norjavaara E, De Verdier MG (2003) Normal pregnancy outcomes in a population-based study including 2968 pregnant women exposed to budesonide. J Allergy Clin Immunol 111:736–742. doi:10.1067/mai.2003.1340

    Article  CAS  PubMed  Google Scholar 

  37. Renu Lal Pharm.D (2015) Drugs in pregnancy and lactation: improved benefit-risk information. Food and Drug Administration (FDA) https://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/SmallBusinessAssistance/UCM431132.pdf. Accessed 24 Jan 2017

  38. Noordzij M, Dekker FW, Zoccali C, Jager KJ (2009) Study designs in clinical research. Nephron Clin Pract. doi:10.1159/000235610

    PubMed  Google Scholar 

  39. Carlson MDA, Ph D, Morrison RS (2009) A user’ s guide to research in palliative care study design, precision, and validity in observational studies. J Palliat Med 12(1):77–82. doi:10.1089/jpm.2008.9690

    Article  PubMed  PubMed Central  Google Scholar 

  40. Daley-Yates PT, Kunka RL, Yin Y et al (2004) Bioavailability of fluticasone propionate and mometasone furoate aqueous nasal sprays. Eur J Clin Pharmacol 60:265–268. doi:10.1007/s00228-004-0763-y

    Article  CAS  PubMed  Google Scholar 

  41. Daley-yates PT, Price AC, Sisson JR et al (2001) Beclomethasone dipropionate : absolute bioavailability, pharmacokinetics and metabolism following intravenous, oral, intranasal and inhaled administration in man. Br J Clin Pharmacol 51(5):400–409

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Thorsson L, Borga O, Edsbacker S (1999) Systemic availability of budesonide after nasal administration of three different formulations; pressurized aerosol, aqueous spray pump and powder. Br J Clin Pharmacol 47:619–624. doi:10.1046/j.1365-2125.1999.00956.xf

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Allen A, Down G, Newland A et al (2007) Absolute bioavailability of intranasal fluticasone furoate in healthy subjects. Clin Ther 29:1415–1420. doi:10.1016/j.clinthera.2007.07.028

    Article  CAS  PubMed  Google Scholar 

  44. Nave R, Herzog R, Laurent A, Wingertzahn MA (2009) Pharmacokinetics of ciclesonide and desisobutyryl ciclesonide after administration via aqueous nasal spray or hydrofluoroalkane nasal aerosol compared with orally inhaled ciclesonide: an open-label, single-dose, three-period crossover study in healthy vol. Clin Ther 31:2988–2999. doi:10.1016/j.clinthera.2009.12.002

    Article  CAS  PubMed  Google Scholar 

  45. Shekelle PG, Woolf SH, Eccles M, Grimshaw J (1999) Developing clinical guidelines. West J Med 170:348–351

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Lal D, Jategaonkar AA, Borish L et al (2016) Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations. Rhinology 54:99–104. doi:10.4193/Rhino15.228

    PubMed  Google Scholar 

  47. Wallace DV, Dykewicz MS, Bernstein DI et al (2008) The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol 122:1–84. doi:10.1016/j.jaci.2008.06.003

    Article  Google Scholar 

  48. Walker SM, Durham SR, Till SJ et al (2011) Immunotherapy for allergic rhinitis. Clin Exp Allergy 41:1177–1200. doi:10.1111/j.1365-2222.2011.03794.x

    Article  CAS  PubMed  Google Scholar 

  49. Seidman MD, Gurgel RK, Lin SY et al (2015) Clinical practice guideline: allergic rhinitis. Otolaryngol Head Neck Surg 152:S1–S43. doi:10.1177/0194599814561600

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Ahmed H. Alhussien

  2. Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426, Saudi Arabia

    Riyadh A. Alhedaithy

  3. Rhinology and Endoscopic Skull Base Surgery Unit, Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, Saudi Arabia

    Saad A. Alsaleh

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  1. Ahmed H. Alhussien
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Correspondence to Riyadh A. Alhedaithy.

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Alhussien, A.H., Alhedaithy, R.A. & Alsaleh, S.A. Safety of intranasal corticosteroid sprays during pregnancy: an updated review. Eur Arch Otorhinolaryngol 275, 325–333 (2018). https://doi.org/10.1007/s00405-017-4785-3

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