The benefits of steroids clearly outweigh the side effects. We like to try a trial of steroids in allergy patients, because we are more optimistic about the success of immunotherapy in patients who get good relief from steroids. Immunotherapy typically provides the benefits of steroids without the ominous side effects.
All of the the nasal steroid sprays are about equal in effectiveness, but some patients prefer one over the other for various reasons such as fragrance, taste, or delivery system. We typically have patients administer the sprays one to two times a day after a nasal saline rinse. Compliance is critical as the dose given several days ago is the one that is helping you today. You cannot take these medications on an as-needed basis.The same is true of oral-inhaled steroids. If you use a nasal steroid spray such as Flonase, Vancenase, Beconase or Nasacort, always use the salt-water mixture first, then use your nasal steroid spray. The steroid reaches deeper into the nose and sinuses when it is sprayed onto clean, decongested nasal tissues. Always aim your steroids up and out, actually pointing them towards the top of the same side ear.
Typical doses of systemic steroids range from a Medrol dose pack to a three to four-week Prednisone taper. Some patients find Methylprednisolone more tolerable than Prednisone. We generally have patients take the majority of the dose in the morning since that parallels our own corticosteroid production , and sleep cycles are less disrupted.
Direct injection of steroids has been helpful to many of our patients as well. We will often inject up to 80 mg of Kenalog into the inferior nasal turbinates. We also use this method to reduce tip edema after rhinoplasty .