Paper did not include all data on adverse effects

EDITOR—Weiner et al conclude that “results from [their] systematic review, together with data on safety and cost effectiveness, support the use of intranasal corticosteroids over oral antihistamines as first line treatment for allergic rhinitis.”1 They also state that “intranasal corticosteroids are considered safe [and] studies have failed to show significant effects on serum markers of bone metabolism and short term bone growth,” referring to two studies, those by Martinati et al and Wolthers et al. They make no reference to two more recent studies, both of a larger number of subjects over longer periods, which established a significant reduction in paediatric bone growth. 2 3

The issue of adverse effects was also addressed in a report by the Committee on Safety of Medicines and Medicines Control Agency, which concluded that intranasal corticosteroids can cause “clinically important systemic adverse effects at licensed doses.” 4 The United Kingdom datasheet for Beconase aqueous nasal spray (beclomethasone dipropionate) recognises the potential for children to develop growth retardation at licensed doses and the need to refer patients to paediatric specialists while they are being prescribed intranasal corticosteroids (Allen and Hanburys, Sept 1998).

I question the omission of such key data from Weiner et al's systematic review; it …