Dawaa Reference

acute

Disturbance of Smell or Taste

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Egyptian National Drug Formulary - respiratory-2026.pdf, Fluticasone monograph (chapter PDF p77) · Li X, Lui F. Anosmia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last update July 3, 2023.

Verified against1 document
  • Egyptian National Drug Formulary - respiratory-2026.pdf, Fluticasone monograph (chapter PDF p77)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (8)

  • Loss that came on suddenly usually follows a head injury or a viral illness
  • Loss that has crept up slowly points to allergic rhinitis, nasal polyps or a growth [allergic rhinitis · nasal polyps]
  • Smell that comes and goes fits allergic rhinitis or regular use of nose sprays and drops [allergic rhinitis]
  • The two commonest causes are long-standing rhinitis and head injury, so ask about both
  • Headache or a change in behaviour alongside it suggests a cause inside the skull [headache]
  • Loss of smell is a symptom, never a diagnosis in its own right [loss of smell]
  • Ask about work exposures to fumes, toxins or allergens
  • Ask about medicines; sometimes only stopping the suspect drug proves the link

Signs — what you find (6)

  • In a very young patient with other features, think congenital causes such as Kallmann syndrome
  • Where that is suspected, examine the gonads and the nervous system carefully
  • In an older patient, weigh normal ageing against an early neurodegenerative illness such as Parkinson disease
  • Examine the nasal cavity and the sinuses closely
  • A neurological examination may uncover other deficits pointing to a wider brain problem
  • Look at the fundi for raised pressure inside the skull, which would justify imaging

Tests (8)

  • A rough bedside test with chocolate or coffee is easy but subjective
  • Formal testing gives a measured threshold that can be set against the patient's age group
  • The UPSIT odour identification test is the most widely used and takes about ten minutes
  • Suspected head injury, sinus disease or a tumour warrants an MRI or a CT
  • If allergic rhinitis is likely, allergy skin testing may give the answer
  • An ESR helps when the wider picture suggests inflammation
  • Depending on the suspected cause, consider blood count, creatinine, liver and thyroid tests, ANA and heavy metal levels
  • When no cause is apparent, MRI seldom explains it: across 839 patients it gave the answer 0.8% of the time

If not this — what else fits (8)

  • Hyposmia means a blunted sense of smell rather than a complete loss
  • Parosmia means a real smell is perceived wrongly
  • Phantosmia means smelling something when nothing is there
  • Chronic rhinitis and head injury together account for most cases
  • Nasal polyps and tumours produce the slow-onset picture
  • Kallmann syndrome is the congenital cause to consider in the very young
  • In older people, ordinary ageing or early Parkinson disease
  • A medicine can be the cause, and only withdrawal proves it

SourceStatPearls "Anosmia" - disease-level clinical article

Presentation findings are traced to the source above.

1

FLUTICASONE

1st line

Formspray

Adult dose and duration

Two spray actuations in each nostril once daily (110 mcg/day total for fluticasone furoate, or 200 mcg/day total for the fluticasone propionate product) to treat the underlying nasal cause. - Trial for at least several weeks; full benefit may take longer than 48 hours to appear.

Paediatric dose

(A different, lower intranasal dose applies to children 4-12 years (one spray per nostril once daily); not the focus here as this is being used for a nasal cause of smell disturbance in an adult.)

Dose by age
4 to 12 years:One spray per nostril once daily - a lower dose than the adult one.
Dose source

Egyptian National Drug Formulary - respiratory-2026.pdf, Fluticasone monograph (chapter PDF p77)

Why

When smell or taste disturbance is due to nasal congestion, allergic rhinitis, or sinus inflammation, an intranasal corticosteroid treats the underlying nasal cause; it is not itself a licensed anosmia treatment and does not replace referral when red flags are present.

Cautions
  • Given as a nasal spray, not swallowed: the dose is two actuations per nostril.
  • This treats nasal congestion/allergic rhinitis as a likely underlying cause of smell or taste disturbance - it is not a direct treatment for anosmia itself, and evidence for post-viral (including post-COVID) smell loss is limited.
  • Unilateral smell loss with headache or a visual change needs urgent referral to exclude an intracranial mass, not empirical nasal steroid.
  • Onset after head trauma needs referral rather than routine treatment.
  • Loss persisting beyond several months without an obvious cause warrants ENT referral.
  • Local irritation or epistaxis can occur - correct spray technique (angled away from the septum) reduces this.
Egyptian brands
Egyptian brandManufacturerIndicative price
RHINORELIEF NASAL SUSP. 50 MCG/METERED SPRAY DOSEARAB DRUG COMPANY (ADCO)32.00 EGP
TICANASE 0.05% NASAL SPRAY 12 GMEUROPEAN EGYPTIAN PHARM. IND.70.00 EGP
FLIX NASAL SPRAY 50 MCG/METERED SPRAY DOSEEVA PHARMA76.00 EGP
FLIXONASE 50 MCG/METERED NASAL SPRAY 120 DOSEGLAXO SMITHKLINE133.00 EGP
FLOHALE HFA 250MCG/DOSE AEROSOL 120 DOSESCIPLA LTD. - INDIA > STAR INTERNATIONAL COMPANY95.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.