Swallowed Nasal Fluticasone Spray for Eosinophilic Esophagitis: An Affordable and Off-Label Path to Histologic Remission

Swallowed topical corticosteroids are among the first-line therapies for eosinophilic esophagitis, with budesonide oral suspension recently approved by the Food and Drug Administration. However, off-label options such as fluticasone from metered-dose inhalers remain widely used due to cost and access barriers. We report a case of histologic remission achieved using over-the-counter fluticasone nasal spray administered orally with honey-an approach not previously described in the literature. This patient-led, low-cost method followed incomplete response to both proton pump inhibitors and fluticasone metered-dose inhaler. The case may illustrate a potential alternative steroid delivery method in eosinophilic esophagitis for resource-conscious, individualized care.