Seasonal allergic rhinitis - short term treatment, start treatment 2 - 3 weeks before the season starts and continue for several months if necessary.

Perennial rhinitis - long term therapy required, possibly for years.

Corticosteroids

1. Generic beclometasone nasal spray is considered as first line therapy. It is relatively cheap, effective and well tolerated, requiring twice daily administration.

2. Systemic absorption may follow on from any nasal steroid particularly if the doses are high and prolonged. The CSM recommends that when children are receiving prolonged treatment with nasal corticosteroids the height of the child should be monitored. If growth is slowed then paediatric referral should be considered.

3. MHRA Drug Safety Update (Sept 2010) Psychological and behavioural side effects may occur in association with use of inhaled and intranasal formulations of steroids.

4. Nose drops are most effective if applied with the head in a correct position, that is with the nostrils directed superiorly, as illustrated.

Cromoglicate - Sodium cromoglicate may be used as an alternative to topical corticosteroids in children.