A sneezy, stuffy, runny nose makes it hard to concentrate and get a good night’s sleep. Nasal sprays, which are sprayed directly into the nose, can provide relief for your nasal allergy symptoms by targeting the mechanisms leading to them.
To make an appointment with Anthony G. Del Signore, MD, PharmD, call 212-844-8450
Many prescription and over-the-counter nasal spray options are available that reduce or eliminate nasal allergy symptoms, but each contains different medications that target different symptoms. In this Q&A, Anthony G. Del Signore, MD, PharmD, Director, Rhinology and Endoscopic Skull Base Surgery, Mount Sinai Beth Israel, and Assistant Professor of Otolaryngology, Icahn School of Medicine at Mount Sinai, explains what nasal sprays are available and how to choose the best one for you.
What nasal sprays are available to treat my allergy symptoms?
The following is a guide to some of the most popular nasal spray options. It provides details on how these sprays work, what they treat, and their potential side effects. However, you should consult your physician or otolaryngologist before using them.
Saline Spray or Gel:
These sprays help to lubricate dry nasal passages, and are often recommended for patients with epistaxis, or nosebleeds. However, they may not relieve nasal congestion.
Examples: Simply Saline™, Xlear®, A&H, Ayr®
Saline Irrigations:
These treatments, which mix purified, distilled or boiled tap water with salt and baking soda, help flush mucus from the nasal passages, thins nasal secretions and thus pair well with nasal sprays for relieving congestion. These are often first line and the backbone of nasal regimens when treating allergies to viral and bacterial infections.
Tips: It is important to regularly clean your irrigation device and to use purified water. Depending on your symptoms, your physician or otolaryngologist may recommend using steroids or antibiotic ointments to achieve the best outcomes.
Examples: Neti Pot, NeilMed®, Ayr
Steroid Sprays
Nasal steroids are typically recommended as a firstline treatment of nasal allergy symptoms. These sprays help decrease inflammation in the nasal passages, which reduces symptoms such as congestion, runny nose, and sneezing.
Tips: To achieve the full benefit of these sprays, you should use them as recommended—once or twice each day for several weeks. The benefit is not immediate and must be used consistently to see adequate relief of symptoms. To minimize the risk of nasal bleeding be sure to aim away from the nasal septum and towards the side of the nose (think of pointing the bottle towards the eye).
Side effects: Although oral steroid use has associated risks, including cataracts, elevated blood sugar levels, mood changes, and disturbances of sleep, these risks are considerably lower when steroids are taken in nasal form. The more common risks include nosebleeds and nasal perforations when improperly used.
Over-the-counter examples: triamcinolone acetonide (Nasacort®), fluticasone propionate (Flonase®), mometasone (Nasonex®)
Prescription spray examples: beclomethasone (Beconase®), ciclesonide (Zetonna®)
Antihistamine Sprays
Much like oral antihistamines, these sprays block the effects of histamine, a chemical in cells responsible for many allergy symptoms, including a runny nose and sneezing.
Tips: To achieve the full benefits of these sprays, it is important to use them once or twice daily. For an additive benefit, be sure to use in conjunction with the nasal steroid spray.
Side effects: Some patients have reported drowsiness when taking these sprays. If you experience drowsiness, consider taking them before bed. Other patients have reported a bitter taste, dry mouth, and dizziness.
Examples: Azelastine (Astelin®, Astepro®), olopatadine (Patanase®)
Steroid and Antihistamine Sprays
This combination spray (azelastine and fluticasone) is only available by prescription. It can provide relief from nasal allergies in cases where using a steroid spray is not fully effective.
Tips: Use consistently to see maximum benefits. Often prescribed up to two times in each nostril once or twice daily. To minimize the risk of nasal bleeding, be sure to aim away from the nasal septum and towards the side of the nose (think of pointing the bottle towards the eye).
Example: The only branded combination spray currently available is Dymista®.
Anticholinergic Sprays
Available only by prescription, these sprays help to block a neurochemical that increases mucus secretions in the nose. They mainly provide relief from nasal drip .
Tips: This spray can be added to other nasal spray regimens to control nasal drip. The spray can be used up to four times a day. Best results seen when a known trigger is identified, i.e., cold weather, eating, consuming hot beverages, and typically can be pre-treated prior to the inciting factor.
Side effects: Some patients have reported dryness, nosebleeds, bitter taste, headaches, and irritation when using these sprays.
Example: The only spray currently available is ipratropium bromide (Atrovent®)
Cromolyn Sodium Sprays
These over-the-counter sprays work by blocking mast cell release, which induce inflammation and lead to nasal congestion, runny nose, and sneezing.
Tips: To achieve the best possible results, you should use them one to two times a day, starting at least several weeks before allergy season begins.
Side effects: Some patients have reported a burning sensation in their nose and a bitter taste in their mouth when using this spray.
Example: There is only one branded cromolyn nasal spray: NasalCrom®.
Decongestant Sprays
These over-the-counter treatments work by reducing swelling of blood vessels in the nose, which helps to relieve nasal swelling and congestion.
Tips: Although decongestants are effective for short-term relief, prolonged use—seven or more days—can result in rebound nasal congestion, also known as rhinitis medicamentosa, with inflammation of the nasal passages. They are also not recommended if you have glaucoma or high blood pressure as they can make these conditions worse.
Side effects: In addition to rebound nasal congestion, some patients have reported dryness, stinging, rapid heartbeat, and higher blood pressure when using these sprays, particularly during prolonged use.
Examples: Oxymetazoline hydrochloride (Afrin®, Sinex™, Dristan®), phenylephrine hydrochloride (Sudafed®)
Remember, nasal sprays can provide effective relief from the allergy symptoms you experience. If you have tried one and it did not work, there are other options you can try. The key is to see an otolaryngologist and discuss your symptoms. Based on that, they will be able to recommend one that does work for you.
