Benefit versus risk for oral, inhaled, and nasal glucocorticosteroids

Immunol Allergy Clin North Am. 2005 Aug;25(3):523-39. doi: 10.1016/j.iac.2005.05.002.


Many factors affect the benefit-to-risk analysis of the use of the glucocorticosteroids in the treatment of allergic inflammation. For most patients the benefit-to-risk ratio favors topical over oral administration, but in severe disease oral administration may be required. It is clear from pharmacokinetic and pharmacodynamic studies that inhaled glucocorticosteroids in particular are absorbed into the systemic circulation and that they can have clinical adverse effects when given in high doses. Therefore, with inhaled and nasal glucocorticosteroids, the dose that will achieve the optimal benefit/risk ratio is the lowest dose that controls symptoms and prevents exacerbations requiring treatment with oral glucocorticosteroids. This optimal dose needs to be determined on an individual basis and is likely to vary as disease severity changes over time.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Administration, Inhalation
  • Administration, Intranasal
  • Administration, Oral
  • Anti-Inflammatory Agents / administration & dosage*
  • Anti-Inflammatory Agents / adverse effects*
  • Anti-Inflammatory Agents / pharmacokinetics
  • Asthma / drug therapy
  • Drug Administration Schedule
  • Glucocorticoids / administration & dosage*
  • Glucocorticoids / adverse effects*
  • Glucocorticoids / pharmacokinetics
  • Humans
  • Rhinitis, Allergic, Perennial / drug therapy
  • Rhinitis, Allergic, Seasonal / drug therapy
  • Risk Factors


  • Anti-Inflammatory Agents
  • Glucocorticoids