Systemic absorption may occur from any nasal steroid particularly if the doses are high and prolonged.

The CSM recommends that on the rare occasion that children are receiving prolonged treatment with nasal corticosteroids the height of the child should be monitored. If growth is slowed, then paediatric referral should be considered.

NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). These conditions include mild to moderate hay fever/seasonal allergic rhinitis.

Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Beclometasone dipropionate

• Nasal spray 50micrograms/dose (£3.62 = 200 doses)

Indications

• Allergic rhinitis

Dose

• Use one or two sprays each nostril twice daily

Notes

1. Beclometasone nasal spray should be prescribed in 200 dose containers as other sizes cost considerably more per dose.
2. Beclometasone is licensed for both allergic and vasomotor rhinitis.

Mometasone

• Nasal spray 50micrograms/dose (£4.78 = 140 doses)

Indications

• Allergic rhinitis (following treatment failure of first line agent)

Dose

• Initially 2 sprays each nostril once daily. Dose can be titrated, maintenance treatment should be with the lowest effective dose which can include 1 spray once daily.

Fluticasone furoate

• Nasal spray 27.5micrograms/dose (£6.44 = 120 doses)

Indications

• Allergic rhinitis

Dose

• Initially two sprays into each nostril once daily

Fluticasone propionate

• Nasal drops 400microgram/unit dose (£15.99 = 30 unit dose)

Indications

• Nasal polyps

Dose

• Use one container once or twice daily

Azelastine hydrochloride and fluticasone propionate (Dymista)

The routine commissioning of Azelastine hydrochloride and fluticasone propionate (Dymista) is not accepted in Devon for allergic rhinitis (see Commissioning Policy for more details). The policy indicates that in exceptional circumstances the Trust-Managed Individual Patient Treatments process can be used for this indication.