鼻内镜手术联合经鼻雾化吸入布地奈德混悬液治疗嗜酸粒细胞性鼻窦炎伴鼻息肉145例疗效观察

目的：分析探讨鼻内镜手术联合经鼻雾化吸入布地奈德混悬液治疗嗜酸粒细胞性鼻窦炎伴鼻息肉的临床疗效。方法：选取290例嗜酸粒细胞性鼻窦炎伴鼻息肉患者随机分为观察组和对照组各145例,对照组患者行鼻内镜手术治疗,观察组患者行鼻内镜手术联合经鼻雾化吸入布地奈德混悬液治疗。分析比较两组患者的临床疗效、主观症状改善时间和治疗前后的VAS评分及Lund-Kennedy评分变化。结果：观察组患者的主观症状改善时间明显小于对照组（P＜0.05）;治疗前,两组患者的VAS和Lund-Kennedy评分比较无统计学意义,治疗后,观察组患者的上述评分均低于对照组（P＜0.05）;观察组患者的临床疗效明显优于对照组（P＜0.05）。结论：鼻内镜手术联合经鼻雾化吸入布地奈德混悬液治疗嗜酸粒细胞性鼻窦炎伴鼻息肉疗效显著。     

慢性鼻窦炎伴鼻息肉术后应用布地奈德的作用观察

目的探讨布地奈德对慢性鼻窦炎伴鼻息肉鼻内窥镜术后黏膜转归过程的干预作用。方法随机将174例Ⅱ型3期、Ⅲ型慢性鼻窦炎伴鼻息肉患者分成观察组（94例）及对照组（80例）,先行鼻内窥镜鼻窦手术,观察组术后给予布地奈德喷鼻（128峭／每侧,每天一次）,对照组为空白对照,分别对两组术后4周、12周鼻黏膜水肿情况、分泌物数量、窦口开放程度及术腔上皮化程度进行比较。结果术后4周达到临床治愈或临床好转（Ⅰ级）观察组44例（46．8％）,对照组24例（30．0％）（P〈0．05）;术后4—12周完成延期治愈或迁延炎症（Ⅱ级）向Ⅰ级转变观察组45例（90．0％）,对照组32例（57．1％）（P〈0．01）;术后12周总体达到Ⅰ级观察组89例（94．7％）,对照组56例（70．0％）（P〈0．01）。结论对慢性鼻窦炎伴鼻息肉行鼻内窥镜鼻窦手术是可行的,布地奈德术后持续应用能明显减轻鼻腔黏膜水肿,减少术腔粘连,加快上皮化进程,防止息肉复发。     

鼻内镜手术联合糖皮质激素治疗鼻息肉的效果探讨

目的观察鼻内镜手术联合糖皮质激素(吸入用布地奈德混悬液联合甲泼尼龙片)治疗鼻息肉的效果。方法42例鼻息肉患者,随机分为对照组和观察组,每组21例。两组患者均行鼻内镜手术,对照组患者围手术期给予息斯敏药物治疗干预;观察组患者围手术期给予吸入用布地奈德混悬液联合甲泼尼龙片治疗。比较两组患者的治疗效果。结果观察组患者中痊愈9例、显效8例、一般3例、无效1例,总有效率为80.95%(17/21);对照组患者中痊愈4例、显效6例、一般9例、无效2例,总有效率为47.62%(10/21);观察组患者的总有效率高于对照组,差异有统计学意义(P<0.05)。结论采用鼻内镜手术治疗鼻息肉患者时,围手术期给予吸入用布地奈德混悬液联合甲泼尼龙片治疗,能够取得较为理想的效果,值得临床推广。     

Short-term outcomes of five heroin detoxification methods in the Australian NEPOD Project

This study included 380 participants in five heroin detoxification trials whose data were pooled to enable direct comparison of five detoxification methods in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD). Rapid detoxification achieved similar initial abstinence rates with either anaesthesia or sedation (average 59%), which were higher than was achieved by inpatient detoxification using clonidine plus other symptomatic medications (24%), which in turn was higher than outpatient detoxification using either buprenorphine (12%) or clonidine plus other symptomatic medications (4%). Older participants and those using more illicit drugs were more likely to achieve abstinence. Entry rates into ongoing postdetoxification treatment were as follows: buprenorphine outpatient (65%), sedation (63%), anaesthesia (42%), symptomatic outpatient (27%), and symptomatic inpatient (12%). Postdetoxification treatment with buprenorphine or methadone was preferred over naltrexone. Participants with more previous detoxification attempts were more likely to enter postdetoxification treatment. Given that outpatient detoxification was more effective with buprenorphine than with symptomatic medications and that rapid detoxification was more effective than the symptomatic inpatient method, the roles of the symptomatic methods should be reconsidered.     

鼻内镜下鼻中隔偏曲矫正术临床疗效研究

目的探讨鼻内镜下鼻中隔偏曲矫正术的手术方式及临床疗效。方法对我院行鼻内镜下鼻中隔偏曲矫正术的116例鼻中隔偏曲患者的一般资料、临床治疗过程及疗效进行回顾性分析。结果116例鼻中隔偏曲患者中,39例单纯鼻中隔偏曲患者均治愈。77例合并慢性鼻窦炎、鼻息肉及下鼻甲肥大患者61例治愈,9例显效。总有效率为94．0％。全部患者术中及术后未发生严重并发症。结论鼻内镜下术野清晰,使鼻中隔偏曲矫正术中操作精确,矫正完全,从而避免了术中发生穿孔及黏膜受损,使鼻腔生理功能的恢复得到促进,并维持了鼻中隔的稳定性。     

Systemic availability of budesonide after nasal administration of three different formulations: pressurized aerosol, aqueous pump spray, and powder

AIMS: The present study was undertaken to determine the absolute systemic availability of budesonide from three different devices for nasal administration: pressurized aerosol, aqueous pump spray, and powder. METHODS: Sixteen healthy, non-smoking, volunteers participated in this open, randomized, and crossover study. All subjects received budesonide as an intravenous dose of 400 microg, and as three, single-dose, intranasal administrations: pressurized aerosol 800 microg, aqueous pump spray 400 microg, and powder 800 microg. Blood was sampled for 10 h after each administration and budesonide was assayed in plasma by liquid chromatography plus mass spectrometry. RESULTS: The mean [95% CI] systemic availability of budesonide with reference to the metered dose was: 13 [10; 15]%, 29 [23; 37]%, and 20 [16; 23]%, and the maximum plasma concentration (Cmax) was attained at (tmax) 2.0, 0.7, and 0.4 h after administration for the pressurized aerosol, aqueous pump spray, and powder, respectively. CONCLUSIONS: The uptake of budesonide was more rapid and more complete, and the systemic availability of the drug was significantly higher from the aqueous pump spray and powder than from the pressurized aerosol.     

慢性鼻 -鼻窦炎伴鼻息肉病人鼻内镜手术围手术期处理对嗅功能的影响

目的 研究慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)伴鼻息肉病人鼻内镜手术(endoscopic sinus surgery,ESS)围手术期处理对嗅功能的影响.方法 选取2017年1月至2019年2月青岛大学附属青岛市市立医院行ESS治疗的CRS伴有鼻息肉及嗅觉障碍病人122例,采用随机数字表法分为四组,ESS围手术期给予不同方式处理,A组术后给予甲泼尼龙联合银杏叶提取物治疗(n=31);B组术后给予纳吸棉联合布地奈德混悬液填塞鼻腔治疗(n=31);C组术后给予甲泼尼龙治疗(n=30);D组术后给予布地奈德喷鼻剂喷鼻治疗(n=30).所有病人于术前、术后1个月、术后3个月行T&T嗅觉检测.结果 四组嗅觉评分术前[A组4.2(3.8,4.6)分,B组4.2(3.8,4.6)分,C组4.0(3.6,4.4)分,D组4.2(3.8,4.65)分]、术后1个月[A组3.6(3.2,4.0)分,B组3.0(2.6,3.6)分,C组3.5(3.2,4.0)分,D组3.4(3.2,4.0)分]、术后3个月[A组3.2(2.8,3.6)分,B组2.6(2.2,2.8)分,C组3.2(2.75,3.6)分,D组3.2(2.6,3.65)分]比较,差异有统计学意义(P<0.05);术后1个月、3个月A、C、D组评分结果组间比较差异无统计学意义(P>0.05);B组术后1个月、3个月评分结果低于其他三组,差异有统计学意义(P<0.05);B组术后3个月总改善率为83.9％,高于其他三组,差异有统计学意义(P<0.05).结论 CRS伴鼻息肉病人行ESS及术后辅以糖皮质激素治疗可以提高自身嗅觉功能,术后纳吸棉联合布地奈德混悬液填塞鼻腔对嗅觉功能改善最为显著.     

醋酸泼尼松与布地奈德结合鼻内镜手术治疗鼻息肉的临床疗效观察

目的观察醋酸泼尼松与布地奈德结合鼻内镜手术对鼻息肉的治疗作用。方法随机将在笔者所在医院接受治疗的74例鼻息肉患者分为对照组和联合治疗组,每组各37例。对照组采用单纯鼻内镜手术治疗,联合治疗组在对照组的治疗基础上加用醋酸泼尼松与布地奈德进行联合治疗,以两组患者的术中出血量、术后复发率及总有效率作为临床药效的评价指标。结果联合治疗组术中出血量、术后复发率及临床总有效率分别为(41.5±6.9)mL、21.4%及88.9%,对照组分别为(69.2±7.1)mL、32.5%及75.9%,两组比较差异有统计学意义(P<0.05或P<0.01)。结论使用糖皮质激素联合鼻内镜手术对于鼻息肉具有显著的临床疗效,其效果优于单纯手术治疗,此法值得在临床进行推广。     

A randomized controlled assessment of the effects of different dosing regimens of budesonide on the HPA-axis in healthy subjects

AIMS: To investigate the effect on the hypothalamo-pituitary-adrenal (HPA) axis of treatment with budesonide, 400 microg once daily, morning or evening, or 200 microg twice daily, and 800 microg twice daily via Turbuhaler in a randomized, placebo-controlled, double-blind, double-dummy crossover study. METHODS: Healthy men received budesonide, 400 microg in the morning (08.00-09.00 h) or evening (20.00-21.00 h), budesonide, 200 microg twice daily, 800 microg twice daily, and placebo twice daily, for 1 week each. Plasma and urine samples were obtained over 24 h on day 7 for cortisol determination. Twenty-five subjects completed all treatments, and 27 were included in the analysis. RESULTS: The 24 h plasma cortisol concentrations vs placebo (95% CI) were 98% (89, 108) for 400 microg in the morning, 92% (83, 100) for 400 microg in the evening, 95% (86, 104) for 200 microg twice daily, and 76% (70, 84) for 800 microg twice daily. CONCLUSIONS: Budesonide at a dose of 400 microg day-1 via Turbuhaler had no statistically significant effect on 24 h cortisol production, irrespective of whether treatment is given once or twice daily, whereas a dose of 800 microg twice daily resulted in a statistically significant suppression vs placebo. Neither could a significant difference be found between morning and evening dosing.     

Efficacy and safety of budesonide and formoterol in one pressurised metered-dose inhaler in adults and adolescents with moderate to severe asthma: a randomised clinical trial

BACKGROUND: Inhaled corticosteroids (ICSs) are the preferred maintenance therapy for adults and children with mild, moderate and severe persistent asthma, with the addition of a long-acting beta(2)-adrenoceptor agonist to ICS therapy recommended for patients with moderate or severe persistent asthma. The efficacy and safety of the combination of budesonide and formoterol delivered via dry powder inhaler (DPI) is well documented. OBJECTIVE: To compare the efficacy and safety of budesonide/formoterol pressurised metered-dose inhaler (budesonide/formoterol pMDI; Symbicort pMDI, AstraZeneca LP, Wilmington, DE, USA) with budesonide pMDI (Pulmicort pMDI, Astra [corrected] Zeneca, Lund, Sweden), formoterol DPI (Oxis Turbuhaler, AstraZeneca, Lund, Sweden), budesonide plus formoterol in separate inhalers (budesonide pMDI + formoterol DPI) and placebo. STUDY DESIGN: This was a 12-week randomised, double-blind, double-dummy, placebo-controlled study. SETTING: This multicentre study was conducted in the respiratory specialty clinical practice setting. PATIENTS: The study included 596 patients > or =12 years of age with moderate to severe persistent asthma previously receiving ICSs. INTERVENTIONS: After 2 weeks on budesonide pMDI 80 microg x two inhalations (160 microg) twice daily, patients received budesonide/formoterol pMDI 160 microg/4.5 microg x two inhalations (320 microg/9 microg); budesonide pMDI 160 microg x two inhalations (320 microg) + formoterol DPI 4.5 microg x two inhalations (9 microg); budesonide pMDI 160 microg x two inhalations (320 microg); formoterol DPI 4.5 microg x two inhalations (9 microg); or placebo twice daily. MAIN OUTCOME MEASURES: There were two prespecified primary efficacy variables: mean change from baseline in morning predose forced expiratory volume in 1 second (FEV(1)), obtained approximately 12 hours after the most recent administration of study medication at home and immediately before the next administration of study medication at the clinic; and mean change from baseline in 12-hour FEV(1), assessed as the average change in FEV(1) from serial spirometry over the 12-hour period after administration of the morning dose of study medication at the clinic. RESULTS: Mean changes from baseline in morning predose FEV(1) at end of treatment were greater (p < or = 0.049) with budesonide/formoterol pMDI (0.19L) versus budesonide pMDI (0.10L), formoterol DPI (-0.12L) and placebo (-0.17L). Mean changes from baseline in 12-hour FEV(1) were greater (p < or = 0.001) with budesonide/formoterol pMDI after 1 day (0.37L), 2 weeks (0.34L) and at end of treatment (0.37L) versus budesonide pMDI (0.11, 0.15 and 0.15L) and placebo (0.09, -0.03 and -0.03L), and after 2 weeks and at end of treatment versus formoterol DPI (0.19 and 0.17L). Fewer (p < or = 0.025) patients receiving budesonide/formoterol pMDI versus monoproducts or placebo met worsening asthma criteria. Results were similar in the budesonide/formoterol pMDI group and the budesonide pMDI + formoterol DPI group on all measures. All treatments were well tolerated with similar safety profiles. CONCLUSIONS: In this population, twice-daily budesonide/formoterol pMDI provides asthma control significantly greater than the monocomponents or placebo and comparable with budesonide pMDI + formoterol DPI. Safety profiles were similar for all treatments.     

Topical corticosteroids in nasal polyposis

Nasal polyps are the common end-point of a number of conditions characterised by inflammation and are rarely 'curable' in its true sense. After consideration of the underlying aetiology and confirmation of the diagnosis, they are normally managed by a combination of medical and surgical interventions. Of these, topical corticosteroids have proved to be the medical treatment of choice. The objectives of the medical management are to eliminate or reduce the size of polyps, re-establish nasal airway and nasal breathing, improve or restore the sense of smell, and prevent recurrence of nasal polyps. The mechanism of action of corticosteroids may be by a multifactorial effect on various aspects of the inflammatory reaction, the effect being initiated by their binding to a specific cytoplasmic glucocorticoid receptor. At a cellular level, there is a reduction in the number of antigen-presenting cells, in the number and activation of T cells, in the number of mast cells, and in the number and activation of eosinophils. When polyps are large (grade 3) topical medication is difficult to instil in a very blocked nose and surgery or short term systemic corticosteroids may be required. Topical corticosteroids are of use in the primary treatment of nasal polyps when they are of a small or medium size (grades 1 and 2) and in the maintenance of any therapeutic improvement. The efficacy of topical corticosteroids such as betamethasone sodium phosphate nose drops, beclomethasone dipropionate, fluticasone propionate and budesonide nasal sprays in reducing polyp size and rhinitis symptoms has been demonstrated in several randomised, placebo-controlled trials. Beclomethasone dipropionate, flunisolide and budesonide sprays have also been shown to delay the recurrence of polyps after surgery. Placebo-controlled studies of agents that have shown a significant clinical effect in the management of nasal polyposis are reviewed.     

A cost-effectiveness analysis of heroin detoxification methods in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD)

This economic evaluation was part of the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD) project. Data from four trials of heroin detoxification methods, involving 365 participants, were pooled to enable a comprehensive comparison of the cost-effectiveness of five inpatient and outpatient detoxification methods. This study took the perspective of the treatment provider in assessing resource use and costs. Two short-term outcome measures were used-achievement of an initial 7-day period of abstinence, and entry into ongoing post-detoxification treatment. The mean costs of the various detoxification methods ranged widely, from AUD 491 dollars(buprenorphine-based outpatient); to AUD 605 dollars for conventional outpatient; AUD 1404 dollars for conventional inpatient; AUD 1990 dollars for rapid detoxification under sedation; and to AUD 2689 dollars for anaesthesia per episode. An incremental cost-effectiveness analysis was carried out using conventional outpatient detoxification as the base comparator. The buprenorphine-based outpatient detoxification method was found to be the most cost-effective method overall, and rapid opioid detoxification under sedation was the most cost-effective inpatient method.     

Cetirizine/pseudoephedrine.

Cetirizine is the carboxylated metabolite of hydroxyzine, and has high specific affinity for histamine H(1) receptors. Pseudoephedrine is a sympathomimetic drug that acts directly on alpha-adrenergic receptors. black triangle Cetirizine/pseudoephedrine 5/120 mg twice daily was significantly more effective than intranasal budesonide 100 microg or placebo at improving nasal obstruction, nasal patency and reducing the volume of nasal secretion, and was significantly more effective than intranasal xylometazoline 0.1% with respect to nasal secretion, during house dust mite faeces challenge in three randomised, cross- over studies among volunteers with seasonal or perennial rhinitis. The onset of action of cetirizine/pseudoephedrine was reported to be approximately 30 minutes. black triangle The bioavailability of cetirizine and pseudoephedrine is similar after administration of cetirizine/pseudoephedrine 5/120 mg bilayer tablets or coadministration of cetirizine 5 mg tablets plus pseudoephedrine sustained-release (SR) 120 mg caplets. black triangle Cetirizine 5mg plus pseudoephedrine SR 120 mg twice daily for 2 to 3 weeks was significantly more effective than each drug given alone at reducing mean total symptom scores for seasonal or perennial allergic rhinitis in two randomised, double-blind, multicentre trials. In both studies, the mean proportion of days during which the five measured symptoms (nasal obstruction, sneezing, rhinorrhoea, nasal pruritus and ocular pruritus) were absent or mild was significantly greater in recipients of the cetirizine plus pseudoephedrine SR. black triangle In one study, cetirizine 5 mg plus pseudoephedrine SR 120 mg was significantly more effective at reducing nasal obstruction than either drug alone. black triangle Cetirizine 5mg plus pseudoephedrine SR 120 mg twice daily for 2 to 3 weeks was well tolerated in patients with seasonal or perennial allergic rhinitis. The most common adverse events were dry mouth, insomnia, headache, somnolence, asthenia and nervousness.     

Intranasal budesonide once daily in seasonal allergic rhinitis

A double-blind, parallel-group, multi-centre study was carried out in 248 patients with symptomatic seasonal allergic rhinitis to assess the effectiveness and tolerability of intranasal aqueous budesonide given as a single daily dose each morning of 400 micrograms compared with the conventional dosage regimen of 200 micrograms twice daily. After a 1-week run-in period during which only oral terfenadine was allowed for intolerable symptom relief, symptomatic patients were allocated at random to receive budesonide in one or other dosage regimen for 3 weeks. The results of assessments made by the physician at clinic visits and by patients recording daily data on diary record cards showed that specific nasal symptom incidence and severity were significantly (p less than 0.001) reduced in both treatment groups. The proportions of patients symptom-free at 3 weeks were 40% in the 400 micrograms once daily and 45% in the 200 micrograms twice daily group; in addition, mean nasal symptom scores from the daily diary cards were significantly (p less than 0.001) reduced in both groups, with a reduction in total symptom scores of 53% and 60%, respectively. The differences between the groups were not statistically significant. Total symptom scores were significantly (p less than 0.01) reduced in both dosage groups at all levels of pollen exposure. Patients rated treatment overall as being highly effective, mean scores being very similar in both groups, and tolerability was similar and good whether budesonide was given as a 400 micrograms once daily dose or as 200 micrograms twice daily. Assuming equal symptom control, 74% of patients stated they would prefer once daily to twice daily treatment.     

鼻内镜修正术治疗复发性鼻窦炎鼻息肉疗效观察

目的探讨鼻内镜修正术治疗复发性鼻窦炎鼻息肉的疗效及手术方法。方法对42例复发性鼻窦炎鼻息肉患者采用鼻内镜修正术治疗。结果经0.5～1年随访,42例患者中治愈27例(64.3%),好转10例(23.8%),无效5例(11.9%),总有效率为88.1%。结论鼻内镜修正术是治疗复发性鼻窦炎鼻息肉的有效方法。     

Ciclesonide nasal spray: in allergic rhinitis

Ciclesonide nasal spray delivers the corticosteroid ciclesonide as a hypotonic spray via a metered-dose manual pump. Systemic exposure to ciclesonide and its active metabolite desisobutyryl-ciclesonide is low after intranasal administration. High protein binding (approximately 99%) and rapid first-pass clearance further reduce systemic exposure to the drug. In well designed trials, intranasal ciclesonide 200 microg once daily for 2-4 weeks was more effective than placebo in terms of improving nasal symptoms in adolescents and adults with moderate to severe seasonal allergic rhinitis. Quality of life measures were statistically significantly improved in ciclesonide relative to placebo recipients during the first 2 weeks of therapy. Similarly, in adolescents and adults with moderately severe perennial allergic rhinitis, ciclesonide 200 microg once daily was more effective than placebo in terms of reducing nasal symptoms in well designed trials of 6 weeks' and 1 year's duration. Improvements relative to placebo in quality of life measures were not considered clinically relevant. Ciclesonide nasal spray was generally well tolerated in these clinical trials; most adverse events were mild to moderate in intensity.     

支撑喉镜联合鼻内镜下声带息肉切除术68例临床分析

目的:探讨支撑喉镜联合鼻内镜下声带息肉摘除术的疗效及优越性。方法:对68例声带息肉患者采用了支撑喉镜联合鼻内镜下声带息肉摘除术。结果:随访3～18个月,60例治愈(88.2%),6例有效(8.8%),无效2例(2.9%)。结论:支撑喉镜联合鼻内镜下声带息肉手术视野清晰,精准度高,副损伤小。     

鼻内镜下鼻窦炎、鼻息肉手术78例疗效评价

目的：观察鼻内窥镜下鼻窦炎、鼻息肉手术疗效评价。方法：分析78例内镜鼻窦手术患者术后随访及手术1年后的治疗效果。结果：78例患者治愈63例,好转10例,无效5例,总有效率为93.6%。结论：鼻内窥镜下鼻窦炎、鼻息肉手术具有良好的疗效,建立术后严格的鼻内镜随访换药制度是防止术后并发症、提高手术疗效的关键。     

济生乌梅片预防胃及十二指肠息肉术后复发的疗效研究

目的 探讨济生乌梅片对预防胃及十二指肠息肉内镜下切除术后复发的疗效。方法 按照纳入标准以2020年1月— 2022年3月在重庆市中医院消化科门诊或住院部就诊，并在本院行胃镜检查及手术治疗的胃和（或）十二指肠息肉患者共83例为研究对象，根据治疗方案不同分为对照组（n＝42）和试验组（n＝41）。对照组采取胃镜下息肉切除术［息肉切除方式包括息肉冷切除、息肉的氩气刀治疗术及黏膜切除术（EMR术）］治疗，试验组在胃镜下息肉切除后，继续给予济生乌梅片治疗，每次3片，每日3次，连续服用3个月。比较两组患者术后1年胃及十二指肠息肉的复发率、临床症状缓解情况及肿瘤标志物的变化情况。结果 两组治疗1年后患者临床症状（腹胀、嗳气及腹痛）均有改善（P<0.05）。肿瘤标志物CA72-4水平在两组中治疗后均有降低（P<0.05）。试验组术后息肉复发率（26.83%）明显低于对照组（64.29%，P< 0.05）。结论 内镜下息肉切除术联合术后济生乌梅片治疗可改善患者的主要临床症状，降低CA72-4的表达。术后联用济生乌梅片对预防胃及十二指肠息肉术后复发疗效佳。     

A risk-benefit assessment of intranasal triamcinolone acetonide in allergic rhinitis.

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.