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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><\/jats:sec><jats:sec><jats:title>Review Methods<\/jats:title><jats:p>A structured literature search was conducted. Each study was graded for level of evidence using the Oxford Centre for Evidence\u2010Based Medicine. Extracted data included population size, study design, drug (dosage, route, and frequency), presence of hypothalamus pituitary axis suppression, ocular symptoms, and treatment\u2010related adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 60 studies met inclusion criteria. The studies included use of INCS as metered nasal sprays, drops, injections, aerosols, and irrigations. There were no persistent abnormalities in cortisol level or intraocular pressure change. Meta\u2010analysis of epistaxis showed a significantly increased risk in the FDA\u2010approved treatment group in comparison with control (risk ratio 1.56; 95% confidence interval, 1.13\u20102.14; <jats:italic>P<\/jats:italic> =. 007).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Overall, it appears that the use of both FDA and published non\u2010FDA application of INCS are safe in the adult population. Meta\u2010analysis demonstrated an increased risk of epistaxis in patients using INCS compared with placebo. Otherwise, there was no significant difference between in adults in the treatment group and placebo group. As an important caveat, the interpretation of safety of nonstandard INCS is restricted to delivery methods and dosages published in the literature.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599820931455","type":"journal-article","created":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T04:01:26Z","timestamp":1592280086000},"page":"1097-1108","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Intranasal Corticosteroid Therapy: Systematic Review and Meta\u2010analysis of Reported Safety and Adverse Effects in Adults"],"prefix":"10.1002","volume":"163","author":[{"given":"Angela M.","family":"Donaldson","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Mayo Clinic in Florida Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garret","family":"Choby","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Mayo Clinic in Rochester Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California Irvine Irvine California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa A.","family":"Marks","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery Mayo Clinic in Arizona Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devyani","family":"Lal","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head &amp; Neck Surgery Mayo Clinic in Arizona Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,16]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"HowickJ ChalmersI GlasziouP et al.The Oxford levels of evidence 2.May 1 2016. 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