Contemporary developments in pharmacotherapeutic agents have amended doctors' capacity to offer the best treatment alternatives with the greatest degree of comfort and convenience, particularly for the pediatric population. In order to reduce the possibility of systemic side effects, intra-nasal corticosteroids are preferable and offer topical drug administration that targets the actions of the drug molecules to the nasal mucosa.

Nasal corticosteroids have been a first-line treatment for rhinitis since they address the chronic mucosal inflammation. Combination therapies, such as antihistamine and a topical corticosteroid, are quite effective for many patients. The use of these drugs as first-line therapy has expanded since the release of newer formulations that only require once- or twice-daily dosing.

Intranasal corticosteroids are the most effective treatment for controlling a variety of allergies, including allergic rhinitis, according to a recent paper by the American College of Allergy, Asthma, and Immunology. Nasal polyps are another common complaint treated by intranasal corticosteroids in children. Intranasal corticosteroids (INCS) are commonly used to treat allergic rhinitis (AR), snoring, polyps, congestion, and a number of other conditions. The systemic use of corticosteroids is associated with a number of undesirable side effects. Even though the INCS differs in some of these aspects, it was designed to enhance topical effects and minimise systemic side effects. The likelihood and severity of side effects with INCS are influenced by a variety of variables, including the drug's characteristics (lipophilicity, pharmacokinetics, and pharmacodynamics), dosage, and the patient's sensitivity. Adult patients are typically unaffected by systemic side effects of INCS. Therefore, INCS poses a lower risk of systemic adverse effects than inhaled corticosteroids since the dosage for intranasal usage is lower than that normally advised for treating asthma. However, there may be an increased risk for people who are using intranasal and inhaled corticosteroids simultaneously for the treatment of rhinitis and asthma. Long-term corticosteroid medication may have a systemic impact of greatly suppressing the hypothalamic-pituitary-adrenal (HPA) axis. Corticosteroid derivatives mimic the actions of cortisol by predominantly interacting with the glucocorticoid receptor, they may interfere with the activity of the HPA axis, which heavily influences the rate of cortisol production. There has been a notable growth in the use of nonstandard means of INCS delivery, such as irrigations and intranasal injections, in recent years. Intranasal corticosteroid drops are still utilized in addition to these treatments. These gadgets are linked to nonstandard dosages, the safety of which has not been well examined. There is worry that non-FDA-approved dosages and treatments may increase the risk of systemic absorption, which could lead to adrenal suppression, decreased growth velocity, or ocular side effects. The comparison of intranasal corticosteroid spray with intranasal corticosteroid drops has been evaluated in many studies, indicating relatively higher efficacy of INCS spray due to more absorbance, lower wastage of medicine and easier application. INCSs administered via FDA-approved ways appear to be generally safe for usage in the pediatric population.

The aim of this systematic review is to assess the efficacy of intranasal corticosteroid spray versus drops in pediatric population.