Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Triamcinolone acetonide is a synthetic glucocorticoid which has been formulated as both an aerosol and an aqueous mete red-dose pump spray for nasal inhalation in the treatment of allergic rhinitis. Nasally administered triamcinolone acetonide is not significantly absorbed into the systemic circulation and does not suppress hypothalamic-pituitary-adrenal (HPA) axis function at therapeutic dosages.
Clinical trials with either formulation have shown that once-daily triamcinolone acetonide 110 to 220µg reduces symptoms of allergic rhinitis within the first day of administration. Once symptoms are under control, the dosage of aqueous triamcinolone acetonide may be reduced from 220 to 110 µg/day without loss of effect.
Both aqueous and aerosol formulations of triamcinolone acetonide are significantly more effective in relieving symptoms and reducing nasal eosinophil influx than placebo.
Once-daily intranasal triamcinolone acetonide 220 µg/day produced similar reductions from baseline in nasal symptoms of allergic rhinitis, when measured both subjectively (visual analogue scales) and objectively (anterior rhinomanometry), to those seen with beclomethasone 84 to 168µg twice daily, fluticasone 200µg once daily or flunisolide 100∥ twice daily for 3 to 12 weeks.
Furthermore, triamcinolone acetonide aerosol 220 µg/day was significantly more effective at reducing the nasal symptoms of allergic rhinitis than the oral antihistamines loratadine and astemizole (both 10mg daily) and was equally as effective in reducing the associated ocular symptoms. The use of intranasal triamcinolone acetonide and oral loratadine in combination did not confer any additional advantage over triamcinolone acetonide alone.
Triamcinolone acetonide [110 to either 220 µg/day (aqueous) or 440 µg/day (aerosol)] was well tolerated in clinical trials; headache and epistaxis were the only adverse events considered possibly or probably related to aerosol therapy in a 1-year study (110 to 440 µg/day).
Therefore, in accordance with the recommendations from the International Rhinitis Management Working Group regarding the use of nasal glucocorticoids, triamcinolone acetonide may be considered a first-line therapy option in adults with moderately severe seasonal allergic rhinitis with predominantly nasal symptoms and also in children and adult patients with perennial allergic rhinitis.
In patients with allergic rhinitis, intranasal triamcinolone acetonide aerosol 220 µg/day, compared with placebo, had no effect on histamine or tryptase levels in nasal exudate, but attenuated albumin levels and significantly reduced nasal eosinophil infiltration. Response of both upper and lower airways to controlled allergen exposure was also reduced in patients who received triamcinolone acetonide aerosol 440 µg/day. In addition, triamcinolone acetonide aerosol 440 µg/day compared with placebo reduced nasal ragweed-specific IgE and attenuated the seasonal increase in specific serum IgE in patients with ragweed allergy.
The symptoms of allergic rhinitis, including those associated with the early phase inflammatory response, were reduced by intranasal triamcinolone acetonide (440 µg/day) within 1 day of starting therapy.
Unlike prednisone 10 mg/day, aqueous (220 µg/day) and aerosol (440 µg/day) formulations of triamcinolone acetonide once daily for 6 weeks had no effect on adrenocortical function in adults with rhinitis. Similarly, no effect was seen with the aqueous formulation 220 to 440 µg/day in a noncomparative trial in children.
After a single dose of intranasal triamcinolone acetonide aerosol 440µg, pharmacokinetic parameters were similar in patients with allergy and nonallergic volunteers. This suggests that nasal inflammation does not enhance the minimal systemic absorption of triamcinolone acetonide aerosol. After 440 µg/day for 6 weeks, maximum plasma drug concentration (Cmax) was 0.40 µg/L, time to Cmax (tmax) was 4.0 hours, area under the plasma concentration-time curve from 0 to 12 hours (AUC12) was 2.0 µg/L · h and elimination half-life (t1/2p) was 3.3 hours in 4 patients with allergy. Accumulation was not apparent with continuous use of triamcinolone acetonide aerosol for up to 6 weeks.
In 24 patients and 24 volunteers, Cmax values were dose-dependent and greater at all 3 dose levels (110, 220 and 440µg; 0.25 to 0.82 µg/L) with the aqueous than with the aerosol (440µg; 0.14 to 0.16 µg/L) formulation; again, there was little difference between values recorded in patients and volunteers. The AUC∞ values were also dose-dependent and, with the exception of the AUC after a dose of 110µg in volunteers, were greater after the administration of the aqueous formulation (1.45 to 4.68 jug/L · h) than after the aerosol formulation (1.31 to 1.70 µg/L · h). Mean tmax values after aqueous administration were 1.3 to 1.8 hours for all recipients, and after aerosol administration were 2.9 and 4.5 hours for patients and volunteers, respectively (no statistical analysis reported). Mean t1/2β values of 4.9 hours (patients) and 5.3 hours (volunteers) were observed after aerosol administration, in comparison with 3.1 to 3.3 hours for all recipients after the administration of the aqueous formulation (no statistical analysis reported).
Positron emission tomography and magnetic resonance imaging scans demonstrated that 11C-triamcinolone acetonide migrated further into the nasal passages after initial deposition in the anterior of the nose. About 4% of a 110µg dose of the aqueous thixotropic formulation of 11C-triamcinolone acetonide was distributed to the maxillary and frontal sinuses within 30 seconds of administration. Most of the agent (maximum 64%) was distributed to the turbinate region. Target tissues (frontal cavity, sinuses and turbinates) retained up to 16% of the dose after 2 hours. Up to 83% of the total dose was directly deposited on the target tissues.
Once-daily administration of intranasal triamcinolone acetonide (either aqueous or aerosol formulation) provides effective relief of allergic rhinitis symptoms (congestion, rhinorrhoea and sneezing).
Aqueous or aerosol intranasal triamcinolone acetonide 220 µg/day, compared with placebo, significantly improved the symptoms of allergic rhinitis within 1 day of initial administration. Efficacy was generally maintained for the duration of therapy (up to 1 year). Moreover, reductions in symptom scores from baseline after 1 week of therapy were maintained for up to 2 weeks after halving the daily aqueous triamcinolone acetonide dose from 220 to 110µg. Ocular symptoms were also significantly reduced from baseline assessments in triamcinolone acetonide recipients compared with those receiving placebo.
In general, patient and physician global efficacy assessments favoured triamcinolone acetonide over placebo.
Beneficial effects of intranasal triamcinolone acetonide on symptoms of allergic rhinitis were also observed in adolescents (aged 11 to 17 years) and children (aged 4 to 12 years) who received either formulation of the agent at dosages of 82.5 to 220 µg/day for 2 to 12 weeks.
Comparison of oral (275 µg/day) and intranasal (220 µg/day; aqueous) triamcinolone acetonide suggests that the efficacy of the drug in the treatment of rhinitis is achieved primarily by topical contact, since neither placebo nor oral triamcinolone acetonide improved nasal symptoms.
Symptoms were significantly suppressed in patients with seasonal allergic rhinitis who received triamcinolone acetonide aerosol 220µg once daily compared with those who received placebo for at least 1 week before the onset of the pollen season.
When compared with other nasally administered corticosteroids, once-daily intranasal triamcinolone acetonide aerosol 220µg produced similar reductions from baseline evaluations of allergic rhinitis symptoms to those seen with beclomethasone aqueous formulation 84, 166 or 168 µg/day twice daily for up to 12 weeks, fluticasone 200µg once daily for 3 weeks or flunisolide `00µg twice daily for 4 weeks.
In addition, intranasal triamcinolone acetonide aerosol 220µg provided relief from both nasal and ocular symptoms of rhinitis which was greater than or equal to that obtained with loratadine or astemizole (both 10 mg/day). The reduction in overall nasal index (sum of individual rhinitis scores) was greater (p < 0.01) in patients receiving triamcinolone acetonide (50% reduction in score) than astemizole (37%), but ocular symptoms were similarly reduced by about 40% from baseline in patients receiving triamcinolone acetonide, loratadine or astemizole.
Physician global assessment favoured triamcinolone acetonide over oral antihistamine therapy.
In one double-blind study (n=229), the combined use of intranasal triamcinolone acetonide and oral loratadine did not confer additional therapeutic benefits compared with triamcinolone acetonide alone.
Adverse events considered possibly or probably related to therapy in clinical trials included nasal irritation, sneezing, dry mucous membranes, nasosinus discomfort, throat discomfort, headache and epistaxis. However, in a 1 -year study of the aerosol formulation 110 to 440 µg/day, only headache (n=1) and epistaxis (n=5) were considered possibly or probably related to the medication in a study population of 93 patients. In a second study, an oral fungal infection (no further details given) was reported in 1 patient receiving nasally inhaled triamcinolone acetonide aqueous formulation 220 µg/day for 15 days.
The concentration, formulation and frequency of application of intranasal triamcinolone acetonide did not appear to affect the incidence or type of adverse events reported.
Dosage and Administration
Triamcinolone acetonide for intranasal administration is available in aerosol and aqueous formulations; both supply 55µg of active compound per actuation. The recommended initial triamcinolone acetonide dosage for adults and children ≥6 years of age is 220 µg/day given as 2 actuations per nostril once daily. Efficacy should be assessed after 4 to 7 days.
If necessary, in adults and children ≥ 12 years of age the dosage of the aerosol formulation may be increased to 440µg once daily or as a divided dose up to 4 times daily. In children 6 to 11 years of age the recommended initial (and maximum) once-daily dosage of the aerosol formulation is 220µg. The maximum recommended dosage for the aqueous formulation (adults only) is also 220µg once daily. With both formulations, dosage should be gradually reduced to 110 µg/day once symptoms are satisfactorily controlled.
Patients changing from systemic to topical corticosteroids should be monitored, especially those who have received long term systemic corticosteroid therapy. The FDA advises that caution is required with use of triamcinolone acetonide (as with all other inhaled steroids) in patients with untreated infections (including quiescent tuberculosis), and those who have recently had nasal surgery and/or nasal septal ulcers.
- Pavord, I, Knox, A (1993) Pharmacokinetic optimisation of inhaled steroid therapy in asthma. Clin Pharmacokinet 25: pp. 126-35 CrossRef
- Argenti, D, Colligon, I, Heald, D (1994) Nasal mucosal inflammation has no effect on the absorption of intranasal triamcinolone acetonide. J Clin Pharmacol 34: pp. 854-8
- Golub, JR (1980) Long-term triamcinolone acetonide aerosol treatment in adult patients with chronic bronchial asthma. Ann Allergy 44: pp. 131-7
- Falliers, CJ, Petraco, AJ (1982) Control of asthma with triamcinolone acetonide aerosol inhalations at 12-hour intervals. J Asthma 19: pp. 241-7 CrossRef
- Nasacort nasal inhaler (triamcinolone acetonide) product monograph (Rhone-Poulenc Rorer Phermaceuticals Inc.; Pennsylvania).
- Summary of product characterisics Nasacort AQ. Rhone-Poulenc Rorer, 1996. (Data on file).
- Mygind, N (1993) Glucocorticosteroids and rhinitis. Allergy 48: pp. 476-90 CrossRef
- Naclerio, RM, Proud, D, Togias, AG (1985) Inflammatory mediators in late antigen-induced rhinitis. N Engl J Med 313: pp. 65-70 CrossRef
- Tinkelman, D, Falliers, C, Gross, G (1990) Multicenter evaluation of triamcinolone acetonide nasal aerosol in the treatment of adult patients with seasonal allergic rhinitis. Ann Allergy 64: pp. 234-40
- Spector, S, Bronsky, E, Chervinsky, P (1990) Multicenter, double-blind, placebo-controlled trial of triamcinolone acetonide nasal aerosol in the treatment of perennial allergic rhinitis. Ann Allergy 64: pp. 300-5
- Findlay, S, Huber, F, Garcia, J (1992) Efficacy of once-a-day intranasal administration of triamcinolone acetonide in patients with seasonal allergic rhinitis. Ann Allergy 68: pp. 228-32
- Storms, W, Bronsky, E, Findlay, S (1991) Once daily triamcinolone acetonide nasal spray is effective for the treatment of perennial allergic rhinitis. Ann Allergy 66: pp. 329-34
- Storms, W, Bernstein, D, LaForce, C (1996) Prophylactic use of topical triamcinolone acetonide nasal inhaler in patients with seasonal allergic rhinitis [abstract no. 999]. J Allergy Clin Immunol 97: pp. 432 CrossRef
- Creticos, PS, Bernstein, DI, Proud, D (1994) Triamcinolone acetonide nasal aerosol versus astemizole in patients with seasonal ragweed allergic rhinitis [abstract]. J Allergy Clin Immunol 93: pp. 177
- Wood, RA, Eggleston, PA (1995) The effects of intranasal steroids on nasal and pulmonary responses to cat exposure. Am J Respir Crit Care Med 151: pp. 315-20
- Munk, Z, Gross, G, Hampel, F (1995) Prophylactic use of triamcinolone acetonide nasal inhaler in patients with seasonal ragweed induced allergic rhinitis, [abstract no. 224]. J Allergy Clin Immunol 95: pp. 198
- Data on file. Rhône-Poulenc Rorer, 1996
- Amos, WMG (1981) Antibody function. Basic immunology. Butterworths & Co. Ltd, Bodmin, pp. 44-8
- Naclerio, RM, Adkinson, NF, Creticos, PS (1993) Intranasal steroids inhibit seasonal increases in ragweed-specific immunoglobulin E antibodies. J Allergy Clin Immunol 92: pp. 717-21 CrossRef
- Kobayashi, RH, Beaucher, WN, Koepke, JW (1995) Triamcinolone acetonide aqueous nasal spray for the treatment of patients with perennial allergic rhinitis: a multicenter, randomized, double-blind, placebo-controlled study. Clin Ther 17: pp. 503-13 CrossRef
- Settipane, G, Korenblat, PE, Winder, J (1995) Triamcinolone acetonide aqueous nasal spray in patients with seasonal ragweed allergic rhinitis: a placebo-controlled, double-blind study. Clin Ther 17: pp. 252-63 CrossRef
- Day, JH, Buckeridge, DL, Clark, RH (1996) A randomized, double-blind, placebo-controlled, controlled antigen delivery study of the onset of action of aerosolized triamcinolone acetonide nasal spray in subjects with ragweed-induced allergic rhinitis. J Allergy Clin Immunol 97: pp. 1050-7 CrossRef
- Spector, SL, English, G, Jones, L (1980) Clinical and nasal biopsy response to treatment of perennial rhinitis. J Allergy Clin Immunol 66: pp. 129-37 CrossRef
- Jones, LM, Spector, SL, English, GM (1979) Treatment of perennial rhinitis with flunisolide corticosteroid spray. Ann Allergy 42: pp. 139-44
- Law, CM, Marchant, JL, Honour, JW (1986) Nocturnal adrenal supression in asthmatic children taking inhaled beclometha-sone diproprionate. Lancet 1: pp. 942-4 CrossRef
- Pedersen, S, Fuglsang, G (1988) Urine cortisol excretion in children treated with high doses of inhaled corticosteroids: a comparison of budesonide and beclomethasone. Eur Respir J 1: pp. 433-5
- Springer, C, Avital, A, Maayan, CH (1987) Comparison of budesonide and beclomethasone dipropionate fir treatment of asthma. Arch Dis Child 62: pp. 815-9 CrossRef
- Sherman, B, Weinberger, M, Chen-Walden, H (1982) Further studies of the effects of inhaled glucocorticoids on pituitary-adrenal function in healthy adults. J Allergy Clin Immunol 69: pp. 208-12 CrossRef
- Feiss, G, Morris, R, Rom, D (1992) A comparative study of the effects of intranasal triamcinolone acetonide aerosol (ITAA) and prednisone on adrenocortical function. J Allergy Clin Immunol 89: pp. 1151-6 CrossRef
- Schenkel, EJ, Ellis, MH, Gross, G (1996) Triamcinolone acetonide aqueous nasal spray does not alter adrenocortical function in children with allergic rhinitis, (abstract 61]. J Allergy Clin Immunol 97: pp. 198 CrossRef
- Howland, WC, Dockhorn, R, Gillman, S (1996) A comparison of effects of triamcinolone acetonide aqueous nasal spray, oral prednisone, and placebo on adrenocortical function in male patients with allergic rhinitis. J Allergy Clin Immunol 98: pp. 32-8 CrossRef
- Pauli, B, Ziemniak, J, Smith, JA (1991) A pharmacokinetic comparison of triamcinolone acetonide (Kenalog R-40 vs Nasacort TM) in patients with allergic rhinitis [abstract]. Ann Allergy 66: pp. 92
- Derendorf, H, Mollmann, H, Gruner, A (1986) Pharmacokinetics and pharmacodynamics of glucocorticoid suspensions after intra-articular administration. Clin Pharmacol Ther 39: pp. 313-7 CrossRef
- Hensel R, Mullen ME. Pharmacokinetic report: An open label pharmacokinetic study of RG5029Y (triamcinolone aceto-nide) aqueous nasal spray and Nasacort nasal inhaler. RhÔne-Poulenc Rorer, 1993. Protocol number RG 5029Y-101 (Data on file)
- Heald DL, Bednarczyk EM, Bordeaux K, et al. Regional distribution of 11C-labeled triamcinolone acetonide following intranasal administration in healthy volunteers [abstract] (95th Annual Meeting American Society for Clinical Pharmacology and Therapeutics; 183).
- Heald D, Berridge M, Muswick G, et al. Nasal biodistribution and pharmacokinetics of an aqueous formulation of triamcinolone acetonide utilizing positron emission tomography (PET). Rhône-Poulenc Rorer, 1996. (Data on file).
- Mackay, IS (1994) Classification and differential diagnosis of rhinitis. Eur Resp Rev 4: pp. 245-7
- Munk, ZM, LaForce, C, Furst, JA (1996) Efficacy and safety of triamcinolone acetonide aqueous nasal spray in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 77: pp. 277-81 CrossRef
- Smith, JA, Schenkel, EJ, Gross, G (1996) Efficacy and safety of once-daily triamcinolone acetonide aqueous nasal spray in pediatric patients with spring grass seasonal allergic rhinitis [abstract no. 601. J Allergy Clin Immunol 97: pp. 57
- Goldberg P, Simpson B. Safety and eficacy of triamcinolone acetonide aqueous nasal spray in children with perennial allergic rhinitis (abstract). Rhône-Poulenc Rorer, 1996. Study number 314 (Data on file).
- Banov, CH, Silvers, WS, Green, AW (1996) Placebo-controlled, double-blind study of the efficacy and safety of triamcinolone acetonide aerosol nasal inhaler in pediatric patients with seasonal allergic rhinitis. Clin Ther 18: pp. 265-72 CrossRef
- Storms, WW, Southern, L, Feiss, G (1996) Efficacy of triamcinolone acetonide aerosol nasal inhaler in children with perennial allergic rhinitis. Pediatr Asthma Allergy Immunol 10: pp. 59-64 CrossRef
- Welch, MJ, Bronsky, EA, Grossman, J (1991) Clinical evaluation of triamcinolone acetonide nasal aerosol in children with perennial allergic rhinitis. Ann Allergy 67: pp. 493-8
- Storms, B, Procaccini, RL, Smith, JA (1995) Evaluation of the topical versus systemic effects of triamcinolone acetonide aqueous nasal spray in allergic rhinitis [abstract]. J Allergy Clin Immunol 95: pp. 196
- Gross, G, Boggs, P, Ginchansky, E (1996) The efficacy of triamcinolone acetonide aqueous nasal spray for seasonal allergic rhinitis is due to topical effects [abstract]. Ann Allergy Asthma Immunol 76: pp. 95
- Gross G, Boggs P, Ginchansky E, et al. A placebo-controlled, double-blind comparison of topical versus systemic triamcinolone acetonide aqueous nasal spray in seasonal allergic rhinitis. Rhône-Poulenc Rorer, 1995. Study number 308. (Data on file)
- Scadding GK, Lund VJ, Holmstrom M, et al. Clinical and physionogical effect of fluticasone propionate aqueous nasal spray in the treatment of perennial rhinitis. Rhinology 1991 Suppl. 11: 37–43
- Lebowitz, RA, Jacobs, JB (1993) Rhinomanometric and clinical evaluation of triamcinolone acetonide and beclomethasone dipropionate in rhinitis. Am J Rhinol 7: pp. 121-4 CrossRef
- Grossman, J, Ball, R, Shulan, D (1991) A comparison of the systemic availability of triamcinolone acetonide aerosol (Nasacort (Rm)) in men with and without active rhinitis [abstract]. J Allergy Clin Immunol 87: pp. 154 CrossRef
- Welch, MJ, Bronsky, E, Findlay, S (1994) Long-term safety of triamcinolone acetonide nasal aerosol for the treatment of perennial allergic rhinitis. Clin Ther 16: pp. 253-62
- Smith, JA, Kobayashi, RH, Beaucher, WN (1996) Triamcinoline acetonide aqueous nasal spray for the long-term treatment of perennial allergic rhinitis [abstract]. Ann Allergy Asthma Immunol 76: pp. 96
- Winder, J, Bell, T, Brodsky, L (1993) A comparative study of intranasal triamcinalone acetonide aerosol and intranasal beclomethasone dipropionate aqueous spray in perennial allergic rhinitis. Immunology and Allergy Practice 15: pp. 8-14
- Nsouli, SM, Nsouli, TM, Bellanti, JA (1994) Treatment of allergic rhinitis beclomethasone dipropionate (BD) versus triamcinolone acetonide (TA) [abstract]. Ann Allergy 72: pp. 83
- Grubbe R, Adelglass J, Casale T, et al. Triamcinolone acetonide nasal inhaler vs beclomethasone diproprionate nasal spray in patients with perennial allergic rhinitis [abstract]. 1994 (1994 Annual Meeting — American College of Allergy and Immunology; 3)
- LaForce, C, Hampel, F, Kiechel, F (1996) Comparison of once-daily triamcinolone acetonide aqueous nasal spray and twice-daily Beconase AQ for the treatment of seasonal allergic rhinitis due to ragweed, [abstract no. 1002]. J Allergy Clin Immunol 97: pp. 433 CrossRef
- Small, P, Houle, PA, Day, J (1996) Triamcinolone acetonide nasal spray (T) vs fluticasone propionate aqueous nasal spray (F) in patients with seasonal allergic rhinitis, [abstract no. 1003]. J Allergy Clin Immunol 97: pp. 433 CrossRef
- Bavel, J, Blumenfeld, R, Huang, S (1992) Intranasal triamcinolone acetonide aerosol vs flunisolide spray (FS) in perennial allergic rhinitis (PAR), [abstract no. P55]. Ann Allergy 68: pp. 107
- Bernstein, DI, Creticos, PS, Busse, WW (1996) Comparison of triamcinolone acetonide nasal inhaler with astemizole in the treatment of ragweed-induced allergic rhinitis. J Allergy Clin Immunol 97: pp. 749-55 CrossRef
- Schoenwetter, W, Lim, J (1995) Comparison of intranasal triamcinolone acetonide with oral loratidine for the treatment of patients with seasonal allergic rhinitis. Clin Ther 17: pp. 479-92 CrossRef
- Gold, M, Small, P, Patel, P (1996) Triamcinolone acetonide nasal spray (T) vs loratadine tablets (L) vs T + L in patients with spring pollen allergic rhinoconjunctivitis (RC). [abstract no. 1000]. J Allergy Clin Immunol 97: pp. 432 CrossRef
- Brown, DC, Savacool, AM, Letizia, CM (1989) A retrospective review of the effects of one year of triamcinolone acetonide aerosol treatment on the growth patterns of asthmatic children. Ann Allergy 63: pp. 47-51
- Welch, MJ (1994) Inhaled steroids and severe viral infections. J Asthma 31: pp. 43-50 CrossRef
- Naclerio, RM (1991) Allergic rhinitis. N Engl J Med 325: pp. 860-9 CrossRef
- Noble, S, McTavish, D (1995) Levocabastine: an update of its pharmacology, clinical efficacy and tolerability in the topical treatmant of allergic rhinitis and conjunctivitis. Drugs 50: pp. 1032-49 CrossRef
- Mabry, RL (1992) Topical pharmacotherapy for allergic rhinitis: new agents. South Med J 85: pp. 149-54 CrossRef
- Welch, MJ (1993) Topical nasal steroids for allergic rhinitis. West J Med 158: pp. 616-7
- Mabry, RL (1992) Corticosteroids in the management of upper respiratory allergy: the emerging role of steroid nasal sprays. Otolaryngol Head Neck Surg 107: pp. 855-60
- Mygind, N, Lund, V (1996) Topical corticosteroid therapy of rhinitis: a review. Clin Immunother 5: pp. 122-36 CrossRef
- Krause, HF (1995) Pharmacotherapy or perennial and seasonal allergic rhinitis. Clin Immunother 3: pp. 308-24 CrossRef
- Dolovich, J, Wong, AG, Chodirker, WB (1994) Multicenter trial of fluticasone propionate aqueous nasal spray in ragweed allergic rhinitis. Ann Allergy 73: pp. 147-53
- Lund, VJ (1995) Practical application of the International Consensus on the management of rhinitis. Clin Immunother 4: pp. 270-8 CrossRef
- Banov, CH, Woehler, TR, LaForce, CF (1994) Once daily intranasal fluticasone propionate is effective for perennial allergic rhinitis. Ann Allergy 73: pp. 240-6
- Knutsson, U, Stierna, P, Marcus, C (1995) Effects of intranasal glucocorticoids on endogenous glucocorticoid peripheral and central function. J Endocrinol 144: pp. 301-10 CrossRef
- Triamcinolone Acetonide
Volume 53, Issue 2 , pp 257-280
- Cover Date
- Print ISSN
- Online ISSN
- Springer International Publishing
- Additional Links
- Industry Sectors