Nasal Sprays for Allergies: The 10 Most Important Things to Know

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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The most effective single therapy for people with nasal congestion and runny nose from allergies is a steroid (glucocorticoid) nasal spray. There are many options out there, new and old, but here are 10 things that may surprise you:

1.  Do they work?  Intranasal glucocorticoids are currently the most effective single maintenance therapy for allergic rhinitis and cause few side effects at the recommended doses. They work better than oral antihistamines (Claritin, Zyrtec, Allegra) for nasal congestion, sneezing and post-nasal drip.

2.  Does the steroid get absorbed into my system?  There are first generation and second generation nasal sprays and this is important for you to know because first generation nasal steroids are absorbed into the bloodstream more than the newer agents. First generation intranasal steroids have a 10 – 50% systemic bioavailability, which means a higher chance of systemic side effects.

3.  Fewer side effects.  Second generation intranasal steroids have LESS systemic absorption of steroid. These are Flonase (fluticasone propionate), Veramyst (fluticasone furoate), Nasonex (mometasone furoate), Omnaris (ciclesonide) and Zetonna (ciclesonide).

4.  First generation sprays,  which offer MORE systemic absorption of steroid, include Rhinocort (budesonide), Nasacort AQ (triamcinolone), Beconase AQ (beclomethasone dipropionate) and Qnasl (beclomethasone dipropionate).

5.  Are any of them over the counter?  Yes, in the United States Nasacort became available without a prescription in 2014 (as Nasacort Allergy 24HR).

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6.  Is one better than the others?  Studies comparing different intranasal steroid preparations have not demonstrated significant differences in effectiveness. While they all work the same, side effect profile and taste are different.

7.  How fast do they work?  Intranasal steroids will start to work in a few hours but may take days to weeks for maximal effect.

8.  How do they work?  These nasal sprays work in a couple of ways: they tone down the inflammatory response by activating anti-inflammatory proteins, and they suppress many cytokines that promote inflammation.

9.  Are there any scary side effects?  Nosebleeds can be a problem with all the intranasal steroid sprays, often from the trauma of the spray. Talk to your doctor if your nasal steroid gives you nosebleeds.

10.  I hate the spray, are there any other options?  Yes, there are now dry powder formulation nasal sprays. Patients who don’t like the wet run-off or taste side effects of some of the nasal steroids may like these new dry powder formulations. Qnasl and Zetonna are the two nasal sprays available that use a “dry” aerosol delivery system.

What has your experience been?

Dr O.

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