Nasal steroid sprays are highly efficacious in treating allergic rhinitis. They control the 4 major symptoms of rhinitis (ie, sneezing, itching, rhinorrhea, congestion). They are effective as monotherapy, although they do not significantly affect ocular symptoms. Studies have shown nasal steroids to be more effective than monotherapy with nasal cromolyn or antihistamines. Greater benefit may occur when nasal steroids are used with other classes of medication. They are safe to use and not associated with significant systemic adverse effects in adults . Glucocorticoids inhibit allergic inflammation in the nose at many levels. These agents downregulate inflammatory responses by binding to intracellular glucocorticoid receptors in the cytoplasm of inflammatory cells. The receptors undergo conformational changes upon activation, entering the cell nucleus where they bind with glucocorticoid response elements located on antiinflammatory genes. These activated genes transcribe messenger RNA for antiinflammatory proteins. At the same time, activated glucocorticoid receptors suppress the transcription of most cytokine and chemokine genes