Topical Nasal Steroids for allergic rhinitis in children. Is one better than the others? A systematic review and network meta-analysis

Background: Allergic rhinitis (AR) is a prevalent chronic condition in children, impacting quality of life (QoL) and exacerbating conditions like asthma. Topical nasal steroids (TNS) are first-line treatments, but comparative efficacy and safety data among different TNS in children remain limited. This study aimed to evaluate the relative efficacy, safety, and impact on growth of various TNS in pediatric AR through a systematic review and network meta-analysis (NMA). Methods: The study included 53 randomized controlled trials (RCTs) involving 12,959 children with moderate-to-severe AR. Outcomes assessed included symptom reduction (primary), QoL, adverse events (AEs), epistaxis, and growth velocity (measured by stadiometry or knemometry). Risk of bias was evaluated using Cochrane ROB2, and evidence certainty was graded using GRADE. Results: - Efficacy: Triamcinolone obtained a symptom scale reduction of -1.62 SMD (95% CI: -2.32, -0.91, and mometasone showed a reduction of -0.90 SMD (95% CI: -1.62, -0.17), both with low certainty in the evidence. Budesonide was not superior to placebo. - Safety: Budesonide had the lowest odds of AEs (OR: 0.51, 95% CI: 0.29, 0.91). Epistaxis risk was similar across all TNS and placebo. - Growth: Mometasone was associated with superior growth velocity versus placebo (MD: 0.61 cm/year, 95% CI: 0.04, 1.18), while triamcinolone showed reduced growth (MD: -0.4 cm/year, 95% CI: -0.74, -0.05). - QoL: Limited data suggested fluticasone propionate and mometasone improved QoL, but evidence was sparse. Conclusions: Second-generation TNS (e.g., fluticasone, mometasone) demonstrated favorable efficacy and safety profiles, with mometasone showing the best performance in growth. First-generation TNS (e.g., triamcinolone) may impair growth. Evidence gaps persist in long-term growth effects and QoL outcomes. The findings support guideline recommendations favoring second-generation TNS but highlight the need for standardized outcome measures and further research in pediatric populations. Keywords: Allergic rhinitis, children, topical nasal steroids, efficacy, safety, growth.

• Autores: Osorno-Ortiz, Santiago; Areti-Angeliki, Veroniki; Villatoro-Rodriquez, Silvia; Goldfeder-De-Gracia, Sydney; Mercado-Lara, Maria Fernanda; Yepes-Núñez, Juan J.; Florez Gomez, Ivan D. Florez
• Fecha de publicación: 2025
• Institución: Universidad de Antioquia
• Repositorio: Repositorio UdeA
• Idioma: eng
• OAI Identifier: oai:bibliotecadigital.udea.edu.co:10495/47792
• Acceso en línea: https://hdl.handle.net/10495/47792
• Palabra clave: Rinitis alérgica; Rhinitis, Allergic; Población pediátrica; Esteroides nasales tópicos; https://id.nlm.nih.gov/mesh/D065631; ODS 3: Salud y bienestar. Garantizar una vida sana y promover el bienestar de todos a todas las edades
• Rights: embargoedAccess
• License: http://creativecommons.org/licenses/by-nc-sa/4.0/