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The effects of topical corticosteroids is not immediate and requires regular use and at least a few days to start experiencing noticeable symptom relief. As-needed use has been shown to be not as effective as regular recommended use. Flunisolide should not be used in the presence of nasal infection. It should not be continued if there is no relief of symptoms after regular use over two to three weeks. Corticosteroid nasal sprays may affect the hypothalamic-pituitary-adrenal (HPA) axis function in humans. Recommended amounts of intranasal corticosteroids are generally not associated with systemic side effects. In pregnancy, recommended doses of intranasal corticosteroids are safe and efficatious.