FLUTICASONE NASAL SPRAY

What is fluticasone?

Fluticasone is a nasal corticosteroid used for symptoms of seasonal allergies such as sneezing, nasal congestion, a runny nose, and inflamed sinuses. There are two formulations of fluticasone that you can find over the counter: fluticasone propionate (Flonase Allergy Relief) and fluticasone furoate (Flonase Sensimist). Fluticasone propionate can be used twice daily, while fluticasone furoate should be used once daily because of its longer duration of action. The recommended maximum dose can be given as two sprays in each nostril once daily. Fluticasone furoate may be preferred for some because of its aftertaste compared to fluticasone propionate.¹

How can fluticasone help alleviate certain long COVID symptoms? 

The SARS-CoV-2 virus is known to enter ACE2 receptors in the nasal mucosa, which activates an inflammatory response that can lead to olfactory dysfunction. An estimated 19-68% of COVID patients may present with olfactory dysfunction that can linger after the infection has passed.² Nasal corticosteroids like fluticasone may help improve loss of smell and taste from COVID. The mechanism behind this is not fully known, but it may be due to reduced inflammatory swelling of the nasal passage to allow for the increased penetration of odors.³

What evidence supports fluticasone’s use for long COVID?

Several reports have recommended an intranasal corticosteroid such as fluticasone for patients with post-COVID olfactory dysfunction symptoms lasting longer than two weeks.² In a study done with 120 patients that looked at the use of fluticasone propionate nasal spray with a triamcinolone paste for loss of smell, they found significant improvement in the ability to smell five tested odors and taste four different flavors within a week of use.⁴ However, there are some concerns with the study methods used in the trial, such as an unstandardized test of assessing odors and tastes and using the nasal spray at the onset of olfactory symptoms rather than after two weeks of symptoms.⁵

A systematic review of 21 studies found that an intranasal corticosteroid such as triamcinolone or fluticasone helped COVID patients regain their sense of smell 23 days earlier than with an oral corticosteroid or another intranasal corticosteroid called mometasone furoate.⁶ It is also recommended that this be done with olfactory or smell training, which exposes patients to four different odors twice a day for at least 24 weeks.

What should you be aware of when taking fluticasone?

Some side effects of fluticasone include headache, nose bleeds, and throat irritation. When using fluticasone, consider applying it contralaterally by spraying your right hand in your left nostril and vice versa. This directs the medication away from your nasal septum to prevent nasal septal perforations or ulcerations. This product should be avoided after recent nose ulcers, nasal trauma, or nose surgery until the nostril is healed. Because fluticasone is a steroid nasal spray, it should not be used chronically. It should also be used with caution in people with cataracts and glaucoma.

For children 11 years old or younger, fluticasone should not be used more than one spray per nostril daily, as it may suppress their growth if used chronically. Flonase Allergy Relief (fluticasone propionate) should not be used in children under four, and Flonase Sensimist (fluticasone furoate) should not be used in children under two. 

References:

1)      Meltzer EO, Andrews C, Journeay GE, Lim J, Prillaman BA, Garris C, Philpot E. Comparison of patient preference for sensory attributes of fluticasone furoate or fluticasone propionate in adults with seasonal allergic rhinitis: a randomized, placebo-controlled, double-blind study. Ann Allergy Asthma Immunol. 2010 Apr;104(4):331-8. doi: 10.1016/j.anai.2010.02.010

2)     Wu TJ, Yu AC, Lee JT. Management of post-COVID-19 olfactory dysfunction. Curr Treat Options Allergy. 2022;9(1):1-18. doi: 10.1007/s40521-021-00297-9

3)     Blomqvist EH, Lundblad L, Bergstedt H, Stjarne P. Placebo-controlled, randomized, double-blind study evaluating the efficacy of fluticasone propionate nasal spray for the treatment of patients with hyposmia/anosmia. Acta otolaryngol. 2003; 123:862-868. doi: 10.1080/00016480310002140

4)     Singh CV, Jain S, Parveen S. The outcome of fluticasone nasal spray on anosmia and triamcinolone oral paste in dysgeusia in COVID-19 patients. Am J Otolaryngol. 2021 May-Jun;42(3):102892. doi: 10.1016/j.amjoto.2020.102892

5)     Lechien JR, Hoch CC, Vaira LA, Saussez S. The interest of fluticasone nasal spray in COVID-19 related anosmia is still not demonstrated. Am J Otolaryngol. 2021 Jul-Aug;42(4):103008. doi: 10.1016/j.amjoto.2021.103008

6)    Winn PZ, Hlaing T, Tun KM, Lei SL. Effect of any form of steroids in comparison with that of other medications on the duration of olfactory dysfunction in patients with COVID-19: A systematic review of randomized trials and quasi-experimental studies. PLoS One. 2023 Aug 2;18(8):e0288285. doi: 10.1371/journal.pone.0288285