These recommendations are based on published expert opinion [Schenkel et al, 2000; Yawn, 2006; London New Drugs Group, 2008], and the British National Formulary [BNF 59, 2010].

• The BNF states that the risk of systemic adverse effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays [BNF 59, 2010].
• Choice of intranasal corticosteroid for children
• Experts recommend budesonide, fluticasone, and mometasone for children [Schenkel et al, 2000; Yawn, 2006]. The BNF also recommend these intranasal corticosteroids in children, as well as triamcinolone.
• Intranasal beclometasone affects growth in children [BNF 59, 2010].
• CKS found several small studies comparing intranasal corticosteroids with placebo in children with allergic rhinitis.
•  A year-long randomized controlled trial (RCT), in 100 children 6–9 years of age, compared intranasal beclometasone (168 micrograms twice daily) with placebo. Rate of growth was significantly slower in the beclometasone group than the placebo group, (0.013 cm/day compared with 0.017 cm/day). After 12 months, the children in the beclometasone group had grown 5 cm and those in the placebo group 5.9 cm [Skoner et al, 2000].
• A year-long RCT, in 98 children 3–9 years of age, compared intranasal mometasone with placebo. After 12 months, the mean increase in height was 6.95 cm in the mometasone group, compared with 6.35 cm in the placebo group (p = 0.02) [Schenkel et al, 2000].
• A year-long RCT, in 150 children 3.5–9 years of age, which compared intranasal fluticasone (200 micrograms daily) with placebo, found a 6.4-cm height increase in both groups [Allen et al, 2002].
• A year-long RCT compared intranasal budesonide (64 micrograms once daily) with placebo in 229 children 4–8 years of age. After 1 year, the mean growth velocity was 5.91 cm/year in the budesonide group and 6.19 cm/year in the placebo group. However, the mean difference (0.27 cm) was not statistically significant [Murphy et al, 2006].
• In a small study of 24 children (6–14 years of age) using intranasal triamcinolone, the children followed their age-appropriate growth velocities [Ober et al, 2004].
• In conclusion, these studies show that twice daily beclometasone can slow growth velocity in children, whilst once daily mometasone, triamcinolone, fluticasone, and budesonide do not affect growth. However, it is not known whether once daily beclometasone also affects growth [London New Drugs Group, 2008].
• It is questionable whether the effect seen in these small studies for beclometasone will result in reduced adult height [London New Drugs Group, 2008].