Growth velocity and nasal steroids

Nasal steroids are very effective in the treatment of allergic rhinitis however there is concern regarding the effects of steroids and growth in children.

Data from two double - blind, placebo - controlled multicentre studies that evaluated the effects of intranasal corticosteroids on growth on children with perennial allergic rhinitis are described. These revealed contrasting evidence relating to the use of different nasal steroids in children. Also, these studies do not provide evidence relating to the use of nasal steroids and final height attainment.

• Skoner et al (1) investigated the use of placebo or beclomethasone dipropionate (BDP) in 100 children with perennial allergic rhinitis (mean aged 7.5 years, range 6-9.5 years); the BDP group received conventional dosages of 168 mcg twice daily for one year; in comparison with placebo, the growth of children treated with BDP was significantly slower (mean change in height 5 vs 5.9 cm, p<0.01; mean overall growth rate 0.013 vs 0.017 cm per day, p<0.01)
  
  
• Schenkel et al (2) investigated the use of placebo or mometasone furoate (MF) in 100 children with perennial allergic rhinitis (mean age 6.3 years, range 3-9 years); the MF group received conventional dosages of 100 mcg per day; there was no significant difference in growth rate between MF and recipients of placebo - however the mean increase in height was significantly greater in children taking MF (6.95 cm vs 6.35 cm, p <0.02)

Growth retardation has been seen with some nasal steroids, but not others, based on stadiometric growth studies. Further studies are certainly needed to resolve this issue. Nasal steroids, in general, have an excellent safety record (3)

Reference:

• Skoner DP et al. Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate. Pediatrics 2000; 105: E23.
• Schenkel EJ et al. Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics 2000; 105: E22.
• Mehle ME. Are nasal steroids safe?Curr Opin Otolaryngol Head Neck Surg. 2003 Jun;11(3):201-5.