類固醇鼻噴劑對兒童發育的影響：最新研究與建議-兒科

裴仁生 醫師回覆-兒科

醫事人員經歷： 衛生福利部桃園醫院 兒科 主治醫師

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您好:

2020/11/14 am 搜尋　ｕｐｔｏｄａｔｅ 的資訊:
Older children and adults — For children ≥2 years of age, the approach to pharmacotherapy is essentially the same as that in adults and depends upon the severity and persistence of symptoms.

Mild or episodic symptoms — Patients with mild or episodic symptoms that are related to predictable allergen exposures (visiting a relative's house with a pet) can be managed with one of the following options:

●A second-generation oral antihistamine: This can be administered regularly or as needed (ideally two to five hours before an exposure for cetirizine and fexofenadine, while loratadine peaks eight hours after administration). Cetirizine (approved for children ≥6 months), loratadine, and fexofenadine (both approved for children ≥2 years) are similarly efficacious and are available in syrups. (See 'Minimally-sedating agents' below.)

●An antihistamine nasal spray (eg, azelastine or olopatadine): The FDA has approved the use of intranasal azelastine in children >5 years of age and the use of intranasal olopatadine in children >12 years of age (its safety and efficacy have not been evaluated in younger children). (See 'Antihistamine nasal sprays' below.)

●A glucocorticoid nasal spray (more effective than antihistamines) administered regularly or as needed (table 1). For predictable exposures, we suggest initiating therapy two days before, continuing through, and for two days after the end of exposure [16,17]. Mometasone furoate, fluticasone furoate, and triamcinolone acetonide are approved by the FDA for use in children ≥2 years of age [14,15].

●Cromolyn nasal spray administered regularly or as needed (ideally 30 minutes before an exposure). Taken in this manner, cromolyn is helpful for brief exposures (minutes to hours). For prolonged exposures, administration should ideally begin four to seven days in advance. Some parents and clinicians prefer to try cromolyn first in children because of its excellent safety profile. (See 'Cromolyn sodium' below.)

It should be explained to patients that each of these therapies is more effective when taken regularly, although as-needed use may be sufficient for very mild symptoms.

Persistent or moderate-to-severe symptoms

Glucocorticoid nasal sprays are the most effective pharmacologic therapy for allergic rhinitis and are recommended by guidelines as the best single therapy for patients with persistent or moderate-to-severe symptoms, including seasonal symptoms [10,12]. All of the available preparations are similarly effective, although the newer agents (sometimes called second-generation) are more convenient and probably safer for long-term use than the older agents because of lower bioavailability (table 1). Glucocorticoid nasal sprays with low bioavailability and once-daily dosing (all except flunisolide, which is not commonly used) may have a theoretical advantage in children, although this has not been proven. Mometasone and fluticasone furoate are approved by the FDA for use in children ≥2 years of age [14]. Fluticasone propionate is approved for children ≥4 years of age. (See 'Glucocorticoid nasal sprays' below.)

看來仍建議 >2 歲孩童，若有 中重度鼻過敏，鼻內類固醇仍是最好的治療。但文章也提及第二代鼻噴劑雖然全身吸收劑量極低，但仍無法證實沒有任何不良影響。

最佳的原則是：當症狀緩解，宜儘速減量或停藥。

祝 健康快樂平安

衛生福利部桃園醫院
兒科主治醫師　裴仁生 敬復

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回覆日期：2020/11/13
資料來源：台灣e院 - 類固醇噴劑會影響發育嗎