{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:50:57Z","timestamp":1791571857371,"version":"4.3.4"},"reference-count":92,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,2,19]],"date-time":"2019-02-19T00:00:00Z","timestamp":1550534400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Intranasal corticosteroids (INCSs) are widely utilized for the treatment of allergic rhinitis. Epistaxis is a known adverse effect of INCSs, but it is not known if the risk of epistaxis differs among INCSs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p>Systematic review of primary studies identified through Medline, Embase, Web of Science, PubMed Central, and Cochrane databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Review Methods<\/jats:title><jats:p>Systematic review was conducted according to the PRISMA standard. English\u2010language studies were queried through February 1, 2018. The search identified randomized controlled trials of INCSs for treatment of allergic rhinitis that reported incidence of epistaxis. An itemized assessment of the risk of bias was conducted for each included study, and meta\u2010analysis was performed of the relative risk of epistaxis for each INCS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 949 identified studies, 72\u00a0met the criteria for analysis. Meta\u2010analysis demonstrated an overall relative risk of epistaxis of 1.48 (95% CI, 1.32\u20101.67) for all INCSs. The INCSs associated with the highest risk of epistaxis were beclomethasone hydrofluoroalkane, fluticasone furoate, mometasone furoate, and fluticasone propionate. Beclomethasone aqueous, ciclesonide hydrofluoroalkane, and ciclesonide aqueous were associated with the lowest risk of epistaxis. Conclusions about epistaxis with use of budesonide, triamcinolone, and flunisolide are limited due to the low number of studies and high heterogeneity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>While a differential effect on epistaxis among INCS agents is not clearly demonstrated, this meta\u2010analysis does confirm an increased risk of epistaxis for patients using INCSs as compared with placebo for treatment of allergic rhinitis.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599819832277","type":"journal-article","created":{"date-parts":[[2019,2,19]],"date-time":"2019-02-19T14:02:54Z","timestamp":1550584974000},"page":"18-27","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Epistaxis Risk Associated with Intranasal Corticosteroid Sprays: A Systematic Review and Meta\u2010analysis"],"prefix":"10.1002","volume":"161","author":[{"given":"Eric 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