Tammy really hates going to school. She is nine years old. When I first saw her, she was a wreck. Her nose was completely blocked, forcing her to breathe through her mouth. Her throat felt dry and uncomfortable. Her enlarged tonsils caused her to snore. Every night, she would toss and turn in bed, with her stuffed up nose. She would end up not getting enough sleep or rest.
Because of the chronic sleep deprivation, Tammy had difficulty concentrating in class and staying alert at school. Over time, she became anxious and moody, and unable to cope with school work. Life had become a drag. It was no wonder she hated going to school.
Tammy suffered from allergic rhinitis.
Allergic rhinitis is an inflammation of the nose caused most commonly by house dust mite. Untreated, allergic rhinitis can lead to sinusitis, itchy eyes (allergic conjunctivitis), itchy skin (atopic eczema), persistent cough and asthma. It affects general health, learning and performance, which in turn affects perception of well-being, moods, creativity and cognition.
However, with modern medications, we can improve all these parameters.
Steroids improve the quality of life in allergy sufferers. Steroids unwind the frenzied hyper-reactive state of the nose. They reduce the itch, sneezing, sniffing, watery sensation and blocked nose of allergy sufferers.
When I gave Tammy a short course of oral steroids, her symptoms improved drastically. She stopped snoring, her eyes widened and she became more alert, as a result of a restful sleep the night before. With improved moods and higher energy levels, Tammy became a completely different child. Even her mother was amazed.
Unfortunately, oral steroids cannot be given over the long term. They are very effective tools for jumpstarting the treatment, but they extract a high health cost like growth retardation and hormonal problems if used on a long term maintenance therapy.
Many parents worry when their children are given steroid nasal sprays. This fear has arisen because of the bad things they have been hearing about taking long term oral steroids, like growth retardation, hypertension, diabetes, cataracts, osteoporosis, gastritis etc.
But it is important to remember that it not the use of steroids that causes problems, but its absorption into the blood circulation and bodily systems (bioavailability) that produces complications and unwanted side effects.
If we can develop a drug that separates the wanted effect (relief of allergy) from the unwanted side effects (growth retardation), we will be able to optimize the benefits of steroids, without undesirable consequences.
With the help of modern science and technology, this is precisely what has been accomplished!
Steroid nasal sprays are very safe for long term use. They are my first choice treatment for allergy rhinitis. On the benefit side, they are more effective than any other class of nose medications. On the cost side, they do not cause the complications associated with oral steroids.
How is this achieved?
Steroid nasal sprays have three levels of safety and security. Each spray administers only a very small quantity of steroid (50ug). This is possible because the sprayed steroids act directly on the tissues in the nose to reduce allergic inflammation. Even when the spray is swallowed, very small quantities get absorbed from the gut to enter the blood circulation.
Do not worry if you swallow some of it. Most of the absorbed steroid is converted to harmless impotent substances by the liver, thus making the amount of active drug in the blood circulation even lower.
The recommended dosage for steroid sprays (eg Flixonase) in children is a 50ug spray into each nostril per day. This works out to a total of two sprays a day (100ug). Studies show that the bio-availability of steroid sprays range from 0.1% to 1.0% (0.1ug to 1.0ug). This means that when Tammy sprays the steroid into her nose, her body is only exposed to a miniscule 1.0ug of steroid. Her own natural body production of steroids is a whole lot greater than this.
When you compare the 1.0ug of steroid nasal sprays with the 10mg (10,000ug) from oral steroids, it is really very negligible. Because of such negligible bio-availability, steroid nasal sprays can be used for months and years without causing any important untoward effects. Numerous studies have demonstrated its usefulness and safety.
So the next time Tammy uses her bottle of steroid nasal spray, she knows that it is as safe as brushing her teeth, without any nasty side effects even with long term use. She will also want to use it regularly because it is really good at controlling her allergies.