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Recent guidelines recommend intranasal corticosteroids as first-line treatment for managing persistent symptoms of moderate to severe allergic rhinitis (AR). However, in children, long-term continual treatment with corticosteroids has raised concerns about potential growth suppression.To evaluate the effects of the recommended once-daily dose of budesonide aqueous nasal spray on growth velocity, as measured with stadiometry, in children with perennial AR.In this double-blind, placebo-controlled, multicenter study, 229 prepubertal children (mean age, 5.9 years; age range, 4–8 years) with perennial AR were randomized (2:1) to receive budesonide aqueous nasal spray, 64 μg (32 μg per nostril) once daily, or placebo for 1 year. The change from baseline in growth velocity, height after treatment, and the percentage of patients whose percentile for height decreased from baseline to the end of treatment were evaluated.Growth velocity was not significantly different between the 2 groups. The least-squares mean ± SE growth velocity during treatment was 5.91 ± 0.11 cm per year for children receiving budesonide and 6.19 ± 0.16 cm per year for those receiving placebo. The mean difference in growth velocity between the 2 groups was 0.27 ± 0.18 cm per year (95% confidence interval, −0.07 to 0.62 cm per year). After treatment, the mean ± SD height was 128.8 ± 8.7 cm for children receiving budesonide and 128.2 ± 8.8 for those receiving placebo. The percentage of children whose percentile for height decreased during treatment was not significantly different between the 2 groups (budesonide, 59%, placebo, 54%; P = .64). The incidence and types of adverse events and the mean 24-hour urinary cortisol-creatinine ratio were similar for the 2 groups.Treatment with budesonide aqueous nasal spray, 64 μg once daily, for 1 year did not suppress growth velocity compared with placebo and was well tolerated in prepubertal children with perennial AR.