Rynacrom (Nasalcrom) vs. Beconase

Written by on December 1, 2005 in antihistamines with 3 Comments

Following are some thoughts from a great bit of digging by Aurelia. The topic of seasonal allergies and nasal sprays emerges every now and then on the list. The whole thread is available at Google Groups Archive.

Thanks for your effort in finding some excellent messages on this topic Aurelia.

I used steroid anti-rhinitis and hay fever sprays such as Beconase for years until a pal said she wouldn’t try them because several of her friends had wound up with noses that were permanently swollen, sore and inflamed, thanks to the steroids! I’d had those problems for about as long as I’d used the sprays and never thought that there might be a link. It is possible that there was NO connection, but I strongly suspect that there was. That’s why I wish I’d never used them.

To be fair, there are rosaceans who’ve used steroid nasal sprays for up to 20 years and have not had any problems with them. Every rosacean is different and nothing works the same with all of us.

But how is the steroid supposed to reach the outside of the nose? Two ways: mist settling onto the face, or the drug working its way through the tissue. I was always careful to release the spray deep into the nostrils so no spray touched my face, but several RS posters attributed their rosacea to steroids working back through the skin.

In RSG Message 63047 Dr Nase wrote about a different steroid nasal spray: “The steroid is absorbed into the nasal blood vessels and transported underneath and around the entire nose, up through the cheeks and even into the eye. There are many documented cases and warnings by rosacea specialists.”

He cited a study titled “Rosacea induced by beclomethasone dipropionate nasal spray”, which was published in 1999, and Beth Adams kindly gave us the main findings in this post: RSG Message 74772

To summarise it very briefly, the doctors felt that the two cases of rosacea they examined were caused by “backspray” or leakage where the liquid actually got on the skin around the nose and mouth. They also stated:

“Beclomethasone dipropionate is a potent halogenated steroid, and in this form represents a surreptitious means of causing or worsening pre-existing rosacea. The means by which halogenated corticosteroids exacerbate rosacea is not well understood. Halogenated topical steroids can cause cutaneous atrophy, leading to erythema and increased telangiectasia.”

In RSG Message 8150 Rachel Priebee told the group about “a nasal spray which has been very effective in the past (Beconase) I was told by my dermatologist causes visible veins around my nostrils”. Horrors! That is SO not what we want to hear!

“The actual reason why sodium cromoglycate spray is better than a cortisone based spray” – well, that’s subjective. Not everyone agrees, but it looks like the scientific facts mostly line up that way. Personally, I switched to Rynacrom (sodium cromoglycate) aka Nasalcrom (cromolyn sodium) and it really did help my chronic allergic rhinitis, but mainly by stopping chronic severe throat inflammation caused by allergies. It’s a mast cell inhibitor.

If you want to read up on mast cell inhibitors, particularly Nasalcrom, here is a very good post from Steve Malone (“paulsmalone”) reproducing one of Geoffrey Nase’s posts from 1999: RSG Message 57650

Here is part of the explanation about mast cells:

“We are now learning that part of the problem with rosacea skin and vessels may be due to altered function and reactivity of mast cells. Mast cells are located in facial skin and are in close proximity to blood vessels. Mast cells are also in great abundance in the nasal passages. When activated, these mast cells open up (degranulation) and release substances that cause the nearby vessels to open up (increased blood flow) and leak (swelling). Mast cells release histamine, cytokines, prostaglandins and inflammatory enzymes that can cause intense bouts of inflammation. It has been speculated that these mast cells are hyperactive or hypersensitive to stimuli such that they release these inflammatory substances quite often and in great concentration.””The reason why antihistamines sometimes help alleviate the redness, flushing, burning and itching associated with rosacea is because it blocks the actions of mast cell released histamine on blood vessels But …
mast cells release many other potent inflammatory substances. So the goal should be to stop the mast cell from releasing any of its contents. This can be done by stabilizing the cell membrane of mast cells — with certain drugs. The active ingredient in nasalcrom (cromolyn sodium) is one such drug — but it takes some time to stabilize the membrane of mast cells within your nasal cavity (so be patient). So yes, I highly recommend it.”

But you do have to start using it several weeks before your allergies are expected to kick in.

In RSG Message 70505 Logan, who used to post us a lot of excellent scientific stuff and is very much missed, turned up a research study that explained that the drug could only work when applied directly to the nasal lining, meaning that it wouldn’t work as well if the patient already had “nasal congestion and secretions”. It was also ineffective “in vasomotor rhinitis, exercise-induced rhinitis, or in the management of nasal polyps”.

In RSG Message 19352 dermatologist Dr Linda Sy posted that it could even be used as a topical, eg for infants with eczema, is sometimes used as an inhaler for asthmatics, and “Some doctors advise patients to use it for preventative purposes when they expect to be exposed – say, someone allergic to cats visiting a place with cats.”

It is a very gentle drug, however, someone I once recommended it to got back to say “the stuff really burns inside my nose”. Again, we’re all different!

Quite a few rosaceans are fighting allergies and chronic rhinitis by using antihistamines such as Astelin, and some swear by Singulair, and they say it actually helps their rosacea. Here are several interesting messages you might like to look at, with regard to allergies:

RSG Message 70379

RSG Message 63066

But again, there are rosaceans who’ve tried just about all the antihistimines and never found one that helps with their rosacea.

I hope this will be of help to you, Jasper. Do please let us know what you decide, and how you get on.

Kind regards,

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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3 Reader Comments

  1. Erik says:

    What about Nasonex? I’ve using it for the last six months and I really can’t tell it has aggravated my redness but it might in the long run.

  2. Heather says:

    I have only flushed 2 times in 28 years…as soon as I started using Nasocort and Astelin my nose flushed daily and intensely until I stopped (for 1 week). Now my nose seems to flush easily. I wish I had read this earlier!

  3. Marcin_pl says:

    I am pretty sure my rosacea is far worse than it would be without inhaled corticosteroids (budesonide – rhinocort, buderhin) – OR MAYBE it is solely steroid induced (i’ve never used them topical)…

    I’ve symptoms since 14-15 yo (telangiectasia), I was using corticosterois several weeks/months a year (for allergy of course). Around 20 I was having mild permanent erythema. Now I’m 30 and my nose is something like rosacea stage 2-3, with moderatly-severe permament erythema – definitely not good looking 🙁

    I tried (intranasal) Avamys recently (fluticasone) and it worsens my symptoms too – I never had erythema on the cheeks, but with this drug I became within 1 month swollen and rose cheeks and had two pimples (or pustules, don’t know the right name) on them. So I believe dr Nase is right here… ; / For those who wonder why I even try some new nasal sprays – I’ve stuffed nose all year round (mites allergy) and would like to breathe like a normal human sometimes ;).

    Wrote this to WARN everyone that the danger from inhaled corticosteroids (budesonide, fluticasone = fluorinated corticosterodis) is real.

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