Since the 1970s, corticosteroid use for croup has been debated. A 1989 meta-analysis by Kairys 21 demonstrated benefit in the inpatient setting. More recently, results of a meta-analysis showed that treatment with glucocorticoids is effective in improving symptoms within six hours, for up to 12 hours, with significant improvement in croup scores, shorter hospital stays, and less use of epinephrine. 2 [Evidence level A: meta-analysis of randomized controlled trials (RCTs)] A Cochrane review of 24 studies involving more than 2,000 children concluded that treatment with corticosteroids reduces the Westley croup score at six hours. 22 [Evidence level A: meta-analysis of RCTs] However, most of the included studies took place in emergency departments or on the hospital floor after admission. While it seems clear that steroids provide benefit in the treatment of croup, more recent studies have tried to determine the optimal method of administration and the applicability of the treatment in the office setting.
Short-term palliative treatment of acute episodes or exacerbations and systemic complications of rheumatic disorders (., rheumatoid arthritis, juvenile arthritis, psoriatic arthritis, acute gouty arthritis, posttraumatic osteoarthritis, synovitis of osteoarthritis, epicondylitis, acute nonspecific tenosynovitis, ankylosing spondylitis, Reiter syndrome † , rheumatic fever † [especially with carditis]) and collagen diseases (., acute rheumatic carditis, systemic lupus erythematosus, dematomyositis † [polymyositis], polyarteritis nodosa † , vasculitis † ) refractory to more conservative measures. a c d f
2-Imidazoline derivatives, such as oxymetazoline , may participate in negative feedback on endogenous norepinephrine production. Therefore, after cessation of prolonged use, there will be inadequate sympathetic vasoconstriction in the nasal mucosa , and domination of parasympathetic activity can result in increased secretions and nasal edema .   Evidence suggests that if oxymetazoline is used only nightly for allergic rhinitis (instead of more frequent dosage as may be directed on product label), it may be used longer than one week without high risk of rhinitis medicamentosa especially with use of intranasal steroid like fluticasone furoate.