Gawchik S M, Saccar C L
Asthma and Allergy Research Associates, Upland, Pennsylvania 19013, USA.
Drug Saf. 2000 Oct;23(4):309-22. doi: 10.2165/00002018-200023040-00004.
The efficacy of intranasal triamcinolone acetonide in seasonal and allergic rhinitis has been evaluated in clinical trials and has been compared with antihistamines and other intranasal corticosteroids. Intranasal corticosteroids are either as equally effective as or more effective than comparative drugs. Intranasal corticosteroids are particularly useful as they decrease membrane permeability and inhibit both early and late phase reactions to allergens. They minimise the nasal secretory response and reduce the sensitivity of local nasal irritant receptors. A potential benefit of topical application is the flushing action of the nasal mucosa, which may reduce allergens and secretions. In addition to seasonal and perennial rhinitis, intranasal corticosteroids have additional benefits when used to reduce inflammation in the treatment of sinusitis and may help in decreasing secondary rhinovirus infections. Furthermore, suboptimal control of asthma can be avoided by treatment of allergic rhinitis with intranasal corticosteroids. In clinical trials, common adverse effects for triamcinolone acetonide include sneezing, dry, mucosa, nasal irritation, sinus discomfort, throat discomfort, epistaxis and headache. Posterior subcapsular cataract formation has not been seen with triamcinolone acetonide. Recent literature evaluating systemic absorption of intranasal corticosteroids have shown surprising results where significant absorption has occurred with intranasal budesonide and fluticasone propionate. Growth and hypothalamic pituitary axis (HPA) function studies have been reviewed, with some intranasal corticosteroids showing changes with continual use. A retrospective study in children receiving daily triamcinolone acetonide for 12 months showed no effect on height and bodyweight. Triamcinolone acetonide at standard dosages (110 or 220microg once or twice a day) does not appear to suppress adrenal gland function and is effective in relieving most symptoms of allergic rhinitis. The International Consensus Conference Proceedings on Rhinitis now currently recommends the use of intranasal corticosteroids as first line therapy, since they have been found to be well tolerated and effective with minimal adverse effects and, specifically, no cognitive impairment. The recommended maximum dose of aqueous triamcinolone acetonide in adults and children is 220microg once a day. The aerosol form may be recommended in children between 7 and 12 years old, up to 440microg once a day or in divided doses. Duration of allergy treatment is generally for the length of each allergy season. If symptoms are perennial, then a reduction of dosage is made to the lowest effective dose with monitoring every 3 months for risk and benefit assessment. Complications to watch for include bleeding, and possible septal perforation and nasal candidiasis, although these are rare.
在临床试验中已对鼻内用曲安奈德治疗季节性和变应性鼻炎的疗效进行了评估，并与抗组胺药及其他鼻内用皮质类固醇进行了比较。鼻内用皮质类固醇与对照药物的疗效相当或更佳。鼻内用皮质类固醇特别有用，因为它们可降低膜通透性，并抑制对变应原的早期和晚期反应。它们可使鼻分泌反应降至最低，并降低局部鼻刺激感受器的敏感性。局部应用的一个潜在益处是鼻黏膜的冲洗作用，这可能减少变应原和分泌物。除季节性和常年性鼻炎外，鼻内用皮质类固醇在用于减轻鼻窦炎治疗中的炎症时还有额外益处，且可能有助于减少继发的鼻病毒感染。此外，用鼻内用皮质类固醇治疗变应性鼻炎可避免哮喘控制不佳的情况。在临床试验中，曲安奈德的常见不良反应包括打喷嚏、鼻黏膜干燥、鼻刺激、鼻窦不适、咽喉不适、鼻出血和头痛。未观察到曲安奈德导致后囊下白内障形成。近期评估鼻内用皮质类固醇全身吸收情况的文献显示了令人惊讶的结果，即鼻内用布地奈德和丙酸氟替卡松发生了显著吸收。已对生长及下丘脑 - 垂体轴（HPA）功能研究进行了综述，一些鼻内用皮质类固醇持续使用时显示出有变化。一项对接受每日曲安奈德治疗12个月的儿童进行的回顾性研究表明，对身高和体重无影响。标准剂量（110或220微克，每日一次或两次）的曲安奈德似乎不会抑制肾上腺功能，且可有效缓解变应性鼻炎的大多数症状。鼻炎国际共识会议论文集目前推荐使用鼻内用皮质类固醇作为一线治疗，因为已发现它们耐受性良好且有效，不良反应极少，特别是无认知损害。成人和儿童水性曲安奈德的推荐最大剂量为每日一次220微克。对于7至12岁的儿童，可推荐使用气雾剂剂型，每日一次最多440微克或分剂量使用。变应性疾病的治疗持续时间一般为每个变应性季节的时长。如果症状为常年性的，则将剂量减至最低有效剂量，并每3个月监测一次以进行风险和获益评估。需要注意的并发症包括出血，以及可能的鼻中隔穿孔和鼻念珠菌病，尽管这些情况很少见。
