Do intranasal corticosteroids affect childhood growth?

Topical intranasal corticosteroids (INS) are the most effective treatment for allergic rhinitis and are being increasingly prescribed to children. Due to the potent inhibition of childhood growth seen with oral corticosteroids, it is important to examine whether INS could have similar effects. The evidence available suggests that some INS, such as beclomethasone dipropionate (BDP), may slow growth when used regularly for prolonged periods. However, newer INS such as fluticasone propionate (FP) and mometasone furoate, which have substantially reduced bioavailability via gastrointestinal absorption, are unlikely to do so. Well-designed prospective studies are needed to distinguish those INS with reduced or absent effects on growth. In practice, choosing an INS which optimises the ratio of therapeutic effect to systemic bioavailability will probably reduce the risk of growth suppression to a negligible level.