Generic Triacet

TRIAMCINOLONE
Inhaler: 55 mcg triamcinolone acetonide/actuation (Rx) Nasacort (Aventis)
Spray: 55 mcg triamcinolone acetonide/actuation (Rx) Nasacort AQ (Aventis)
50 mcg trimacinolone acetonide/spray (Rx) Tri-Nasal (Muro)

Indications
Treatment of seasonal and perennial allergic rhinitis symptoms in adults and children > 6 years of age (Nasacort and Nasacort AQ) or > 12 years of age (Tri-Nasal).

Administration and Dosage
Adults and children > 12 years of age -
Nasacort: The recommended starting dose is 220 mcg/day given as 2 sprays (55 mcg/spray) in each nostril once a day. The dose may be increased to 440 mcg/ day (55 mcg/spray) either as once-a-day dosage or divided up to 4 times/day (i.e., twice a day [2 sprays/nostril] or 4 times/day [1 spray/nostril]). After desired effect is obtained, some patients («= 50%) may be maintained on as little as 1 spray in each nostril once a day. The degree of relief does not seem to be significantly different when comparing 2 or 4 times/day dosing with once-a-day dosing.
A dose response between 110 and 440 mcg/day is not clearly discernible. In general, the highest dose tends to provide relief sooner. This suggests an alternative approach to starting therapy: Start treatment with 440 mcg (4 sprays/nostril/ day), and then, depending on response, decrease the dose by 1 spray/day every 4 to 7 days.
Nasacort AQ: The recommended starting and maximum dose is 220 mcg/day as 2 sprays in each nostril once daily. When the maximum benefit has been achieved and symptoms have been controlled in patients initially controlled at 220 mcg/ day, decreasing the dose to 110 mcg/day (1 spray in each nostril/day) has been demonstrated to be effective in allergic rhinitis symptoms.
Tri-Nasal: The recommended starting dose for most patients is 200 mcg (2 sprays/nostril) once daily. The dose may be increased to a maximum of 400 mcg (4 sprays/nostril) once daily. An alternative 400 mcg/day dosing regimen may be given as 200 mcg twice daily (two 50 mcg sprays in each nostril twice daily). Do not exceed the maximum daily dose of 400 mcg. After symptoms have been brought under control, the patient should be titrated to the minimum effective dose.
Children 6 to 12 years of age -
Nasacort: The recommended starting dose is 220 mcg/day given as 2 sprays (55 mcg/spray) in each nostril once a day. Once the maximal effect has been achieved, titrate the patient to the minimum effective dose.
Nasacort AQ: The recommended starting dose is 110 mcg/day given as 1 spray in each nostril once daily. The maximum recommended dose is 220 mcg/day as 2 sprays/nostril once daily. Once symptoms are controlled, pediatric patients may be maintained on 110 mcg/day (1 spray in each nostril per day).
Nasacort and Nasacort AQ are not recommended for children ANTI-ALLERGIC/ASTHMA

PERENNIAL ALLERGIC RHINITIS
This form of nasal allergy is caused by becoming allergic either to a single agent to which one is exposed on a year-around basis or to multiple agents whose collective exposure results in perennial, or year-around, symptoms. The symptoms of perennial allergic rhinitis are similar to those of seasonal allergic rhinitis, except that they persist throughout the year and tend not to be as explosive.
Both seasonal and non-seasonal allergens contribute to the symptoms of perennial allergic rhinitis.

Causes of Perennial Allergic Rhinitis
Environmental allergens - house dust; house dust mites; mold spores; dogs, cats, feather pillows Seasonal allergens - tree pollens; grass pollens; weed pollens
Animals – dogs; cats; feather pillows
Occupational agents
Foods

Most textbooks list the primary causes of perennial allergic rhinitis to be the environmental or household allergens: dust, mites, mold spores, animals. These are substances to which we are exposed year-around. In reality, however, most people who suffer with allergic rhinitis all year are not only reactive to one or more of these agents, but also are allergic to multiple pollens as well. It is this collective assault of multiple agents on an allergic nose that results in the presence of symptoms all year round.
Also assaulting the nose and causing nasal symptoms are a group of agents that allergists refer to as non-allergic irritants. They cause symptoms by their irritant quality rather than by their ability to stimulate allergic reactions, and they can cause symptoms in almost anyone who is sufficiently exposed. The common non-allergic irritants-: cigarette smoke, aerosol sprays, inert particles in the air, winds, cold air, bright lights, scented cosmetics, an almost limitless variety of chemicals, and more.

Chronic Rhinitis Example 1.
Anne is twenty-eight years old and never had any trouble with her nose until six months ago. She first noticed some stuffiness of the nose at night. Then it progressed to daily symptoms, alternating between congestion, sneezing, and runny nose and intermittent itching of the nose and eyes. A detailed allergy history revealed that a year ago she had been given a Siamese cat, Ginger, whom she kept inside and who slept on her bed each night and much of the day while Anne worked. She admitted with some reluctance that petting the cat would sometimes make her nose and eyes run and cause her to sneeze, "but, never this bad!" The cat was the only agent definitely suggested by her history as a cause of symptoms.
Allergy skin tests confirmed that her only positive reaction was to cats. Ginger became an outside cat, and Anne's symptoms completely cleared over the course of about three months. Diagnosis: perennial allergic rhinitis, cat.

Chronic Rhinitis Example 2.
Paul is twenty-six years old and has had an "allergic nose" since he was twelve years old. Prior to last year his symptoms occurred only in the spring, from March through May. However, since last March his symptoms have been continuous. No medicine helped, so he consulted an allergist. A detailed history strongly suggested that house dust, the family dog, ragweed pollen, elm pollen, and grass pollen all triggered his symptoms. Additionally, non-allergic irritant triggers of symptoms included cigarette smoke and strong perfumes.
Allergy skin testing confirmed Paul's history and further pinpointed the problem with house dust to be the house dust mite. Paul's allergy problems had increased over time. He no longer just had seasonal allergic rhinitis but chronic allergic rhinitis. He was placed on a treatment program encompassing avoidance, symptomatic medication, and allergy desensitization injections. Diagnosis: perennial allergic rhinitis, environmental and pollens.
*3/322/5*
ANTI-ALLERGIC/ASTHMA

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