TRIAMCINOLONE ACETONIDE NASAL SPRAY 

What is triamcinolone?

Triamcinolone is available as an over-the-counter nasal corticosteroid spray (Nasacort) used to relieve symptoms of seasonal and year-long allergies such as sneezing, nasal congestion, and a runny nose. It can be applied as two sprays (or 110 mcg) in each nostril once daily and then one spray once daily in each nostril once symptoms are more controlled. Triamcinolone should not be used if there is no relief after three weeks.

How can triamcinolone nasal spray help alleviate certain long COVID symptoms?

The SARS-CoV-2 virus is known to enter ACE2 receptors in the nasal mucosa, activating 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.¹ Nasal corticosteroids like triamcinolone may be used to improve loss of smell post-COVID. The mechanism behind this is not fully known, but it may be due to reduced inflammatory swelling of the nasal passage that allows for the increased penetration of odors.²

What evidence supports the use of triamcinolone nasal spray 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.¹ In a study of 120 patients that looked at the use of fluticasone propionate nasal spray with a triamcinolone paste for loss of smell, there was significant improvement in the ability to smell five tested odors and taste four different flavors within a week of use.³  However, the effects of triamcinolone paste may not be the same as those of a triamcinolone nasal spray due to differences in how the drug is absorbed through different routes of administration. 

A systematic review of 21 studies found that the use of an intranasal corticosteroid such as triamcinolone or fluticasone was able to help COVID patients regain their sense of smell 23 days earlier than with an oral corticosteroid or another intranasal corticosteroid called mometasone furoate.⁴ It is also recommended to be combined 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 using triamcinolone nasal spray?

Triamcinolone can have some local effects, such as a burning or stinging sensation in the nose. It can also cause nosebleeds and may have a bitter aftertaste for some people. If you are experiencing mucous crusting around your nostrils, you can consider rinsing with a nasal saline spray before applying triamcinolone.

When using triamcinolone, consider applying it contralaterally by spraying it in your left nostril with your right hand 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 triamcinolone is a steroid nasal spray, it should not be used chronically. It should also be used with caution in people with cataracts and/or glaucoma.

References:

1)      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

2)     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

3)     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

4)     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