The risk of having epistaxis is higher in rhinitis patients using Intranasal corticosteroids (INCSs) such as beclomethasone hydrofluoroalkane, fluticasone furoate, mometasone furoate, and fluticasone propionate, pointed out a review article published in Otolaryngology head and neck surgery.
Epistaxis, also known as the nose bleeding, is a common occurrence of bleeding from the nose and also a known side-effect of INCSs. A nasal corticosteroid spray reduces swelling and mucus in the nasal passageway. Intranasal corticosteroid (INCSs) is widely used for allergic rhinitis and their extensive use with few reported adverse events supports the safety of these medications.
To understand whether the risk of epistaxis differs among INSCSs, scientists from the Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Tulane University, did a systematic review of primary studies conducted on INCSs. This Systematic review was conducted according to the PRISMA standard. English-language studies were queried through February 1, 2018. The search identified randomized controlled trials of INCSs for treatment of allergic rhinitis that reported the incidence of epistaxis. An itemized assessment of the risk of bias was conducted for each included study, and meta-analysis was performed of the relative risk of epistaxis for each INCS.
The researchers found that out of 949 identified studies, 72 met the criteria for analysis. Meta-analysis demonstrated an overall relative risk of epistaxis of 1.48 for all INCSs. The INCSs associated with the highest risk of epistaxis were beclomethasone hydrofluoroalkane, fluticasone furoate, mometasone furoate, and fluticasone propionate. Beclomethasone aqueous, ciclesonide hydrofluoroalkane, and ciclesonide aqueous were associated with the lowest risk of epistaxis.
This systemic review confirmed an increased risk of epistaxis for patients using INCSs as compared with placebo for the treatment of allergic rhinitis.
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