The huge advantage nasal sprays have when treating basal problems is that they are sprayed directly into the nose to relieve nasal allergy symptoms with extremely minimal amounts being absorbed into the body. This results in lesser side effects together with better efficacy. There are many types of nasal sprays available in the market with most of them available over the counter without a prescription. It is best to have an ENT specialist examine your nose at least once before attempting to use nasal sprays without a prescription. It is also advisable to immediately seek ENT help if symptoms are not relieved after having used nasal sprays with or without the prescription. Nasal sprays can cause nose bleeds and even septal perforation in the long run if not used correctly. The following is a quick guide about the different types of nasal sprays.
Corticosteroid Nasal Spray
The product is usually one of the first-line therapies for allergies. They work by decreasing inflammation within the nasal passages. These sprays offer relief from all four of the cardinal symptoms of allergic rhinitis ie nasal congestion, sneezing, nasal itchiness and runny nose.
It is important to use them daily or twice daily for a few weeks to get the full benefit of the treatment. Sometimes people only try them for a week or do not use them on a regular basis and then claim that the steroid nasal sprays do not work for them.
Steroids have many side effects (such as cataracts), which is why it is best to use steroid spray as the risks are much lower than the oral form. It is contraindicated in those <2 years of age, and in patients who have had an allergic reaction to any of the ingredients. Secondly, patients who are pregnant or breastfeeding should speak to their doctor.
- Generic names – Budesonide, Triamcinolone, Fluticasone, Mometasone, Beclomethasone
- Brand names – Rhinocort, Nasacort, Avamys, Flixonase, Nasonex, Beconase,
Nasal Decongestant Sprays
Nasal decongestants provide temporary relief of nasal congestion by constricting the blood vessels in the nose which reduces nasal swelling and congestion so the patient can breathe more freely. The product provides temporary relief of nasal congestion due to the common cold, hay fever, or upper respiratory allergies. Patients with nasal congestion may choose either oral or topical nasal decongestants. Nasal decongestant sprays contain such ingredients as oxymetazoline (e.g., Afrin), phenylephrine (e.g., Neo-Synephrine), or naphazoline (limited availability).
Nasal decongestant sprays should not be used if the patient has heart disease, diabetes mellitus, hypertension, thyroid disease, or trouble urinating due to an enlarged prostate gland. Patients who are pregnant or breastfeeding should speak to their physician before use.
These should not be used for more than three days as they can become addictive by causing a rebound nasal congestion effect. This is called Rhinitis medicamentosa.
- Generic – Oxymetazoline, phenylephrine, xylometazoline
- Brand – Afrin
Saline Nasal Sprays or Irrigations
These sprays contain saline. The sprays are good to keep the nose moist, but they are unlikely to help with nasal congestion. They may be of benefit in certain cases: 1) relieving or reducing nasal dryness 2) thinning mucus 3) reducing the incidence nosebleeds caused by dryness 4) moisturizing and irrigating nasal membranes after nasal surgery; 5) relieving dryness associated with oxygen treatments and continuous positive airway pressure (CPAP) equipment used for sleep apnea; 6) providing nasal moisture in cold and dry climates; and 7) moisturizing the nasal passages when the patient must spend time in enclosed spaces such as airplanes..
- Generic – Salt water spray
- Brand – Sterimar, Neilmed, Flo SalinePlus
Nasal irrigation is a procedure whereby sterile water that is mixed with salt and often baking soda is flushed into the nose. The idea is to rinse out the mucus out of the nose. This is mainly used after nasal surgery and also in cases where there is thick nasal discharge which tends to remain in the nasal cavities. Water from the tap or well cannot be used as it is not adequately filtered.
- Generic – Bulb syringe
- Brand- Nettipot, Neilmed,
Cromolyn Nasal Spray
Cromolyn nasal spray (e.g., NasalCrom) helps with relief of nasal allergy symptoms, including rhinorrhea, nasal pruritus, sneezing, and allergic stuffy nose. It works by inhibiting mast cells. It helps prevent and relieve symptoms of hay fever and other nasal allergies, specifically runny nose, itching of the nose, sneezing, and stuffy nose due to allergies. For prevention, the patient can initiate pretreatment 1 to 2 weeks before exposure to the cause of allergies (e.g., pollen, mold, pets, dust mites). The most common side-effect is nasal burning and bad taste.
- Generic – Cromolyn nasal
- Brand- Allegrocrom, Nasalcrom
Nasal Antihistamine Sprays
Nasal antihistamine sprays are similar to oral antihistamines by blocking histamine. These medications are good at treating the runny nose aspect of allergies. The most common reaction is bitter taste.
- Generic – Azelastine, olopatadine
- Brand – Astelin, Astepro, Patanase
Combination Nasal Steroid And Antihistamine Sprays
This nasal spray contains both a nasal steroid and antihistamine (azelastine and fluticasone).
Brand – Dymista
Nasal Anticholinergic Sprays
Anticholinergic nasal sprays are good for treating runny nose in patients with both allergic and nonallergic rhinitis. These work by blocking acetylcholine which decreases secretions from the glands in the nasal passage. Common reactions include dry mouth and bad taste.
- Generic – Ipratropium Bromide
- Brand – Atrovent
As always, if you are unsure, please ask your doctor. Also, if you have tried one or more of the above, and you continue to have allergy symptoms, perhaps it’s time to visit your ENT specialist or allergist and discuss other options.