{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:52:17Z","timestamp":1791571937471,"version":"4.3.4"},"reference-count":51,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T00:00:00Z","timestamp":1594684800000},"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":[[2020,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To address concerns related to the safety profile of both Food and Drug Administration (FDA)\u2013approved and non\u2010FDA\u2010approved intranasal corticosteroid (INCS) use in the pediatric population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Source<\/jats:title>\n                    <jats:p>Systematic review of MEDLINE, PubMed, and EMBASE databases using comprehensive search strategy, including all INCS formulations and adverse events. The study design was developed using Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses (PRISMA) guidelines. Additional sources were identified from study references of relevant articles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Review Methods<\/jats:title>\n                    <jats:p>A structured literature search was conducted. Extracted data included age, population size, study design, drug (dosage, route, and frequency), presence of hypothalamic\u2010pituitary\u2010adrenal (HPA) axis suppression, ocular symptoms, and growth velocity adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 33 studies met inclusion criteria. The studies included use of INCS as nasal sprays and drops. There were no persistent abnormalities noted in cortisol level or intraocular pressure change. Growth velocity reduction was reported in 3 of 10 randomized trials. Meta\u2010analysis of epistaxis and headache showed no significant difference in the incidence of headache or epistaxis when FDA\u2010approved INCSs were compared to placebo, with a relative risk of 1.12 (95% CI, 0.77\u20101.63;\n                      <jats:italic>P<\/jats:italic>\n                      =. 56) and 0.84 (95% CI, 0.60\u20101.18;\n                      <jats:italic>P<\/jats:italic>\n                      =. 32), respectively. Meta\u2010analysis was not performed for growth velocity, HPA axis suppression, and ocular change.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>INCSs in FDA\u2010approved routes of administration are generally safe to use in the pediatric population. Use of non\u2010FDA\u2010approved INCS drops may increase risk of iatrogenic Cushing\u2019s syndrome. Growth velocity reduction, HPA axis suppression, and visual changes due to INCS are uncommon.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0194599820931454","type":"journal-article","created":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T04:07:52Z","timestamp":1594699672000},"page":"1087-1096","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Intranasal Corticosteroid Therapy: Systematic Review and Meta\u2010analysis of Reported Safety and Adverse Effects in Children"],"prefix":"10.1002","volume":"163","author":[{"given":"Angela M.","family":"Donaldson","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Mayo Clinic Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garret","family":"Choby","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California Irvine\/Orange County Irvine California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa A.","family":"Marks","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery Mayo Clinic Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devyani","family":"Lal","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Mayo Clinic Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,7,14]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"HowickJ ChalmersI GlasziouP et al. 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