Using Nasal Sprays to Treat Allergies

Allergy nasal sprays are the most effective medications for the treatment of nasal allergy symptoms. In fact, you may be surprised to learn that they are even better than oral antihistamines.

Blonde woman using nasal spray
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Nasal sprays do, however, have a downside—they need to be used routinely to get the best results, and many people do not like the idea of putting medication in their nose.

How to Correctly Use a Nasal Spray

It seems pretty obvious. Still, most people do not use a nasal spray correctly. Incorrect use leads to an increased chance you'll suffer side effects and a decreased chance that the medication will work as well as it could.

To correctly use a nasal spray:

  • Remove any mucus in the nasal passages by blowing your nose.
  • Shake the bottle of nose spray and remove the cap.
  • Tilt your head down (look towards the floor).
  • Hold the spray bottle in the palm of one hand and place the tip of the nozzle in the opposite nostril. (The nozzle will then point to the outer part of the nostril.)
  • As you spray the medication, sniff gently as if smelling food or a flower. Snorting the spray can cause the medication to go into the throat.
  • Repeat sprays as needed until the prescribed amount is delivered into each nostril.

Should nasal bleeding, irritation, or other unpleasant side effects occur, stop using the nasal spray for three to five days and try again. If the side effects continue to occur, stop using the nasal spray entirely and contact your doctor.

Types of Nasal Sprays

Available nasal sprays include topical nasal steroids, topical nasal antihistamines, topical nasal anticholinergics, and topical nasal mast cell stabilizers. Many previously prescribed nasal sprays, including Flonase, Rhinocort, Nasacort, and NasalCrom, are now available over the counter, and it is likely that more once-prescription-only sprays will become available in the future.  

Many patients find that using a corticosteroid nasal spray can at least partially alleviate eye allergy symptoms in addition to nasal allergy symptoms. This is thought to be at least partly due to the medication acting on the nasolacrimal duct, the passageway between the nose and eyes.

Topical Nasal Steroids

This class of allergy medications is probably the most effective at treating nasal allergies, as well as non-allergic rhinitis. Most topical corticosteroid nasal sprays are now available over the counter.

Some people note that one smells or tastes better than another, but they all work about the same.

This group of medications includes the following.

  • Mometasone (Nasonex)
  • Budesonide (Rhinocort Aqua)
  • Flunisolide (Nasarel)
  • Triamcinolone (Nasacort AQ)
  • Beclomethasone (Beconase AQ)
  • Fluticasone furcate (Flonase Sensimist)
  • Fluticasone furoate (Veramyst)
  • Fluticasone propionate (Flonase)
  • Dymista: a combination of azelastine (antihistamine) and fluticasone (intranasal corticosteroid)
  • Xhance: a new nasal spray that uses an exhalation delivery system, Xhance is used in the treatment of nasal polyps, which can occur in some patients with nasal allergy symptoms.

Topical Nasal Antihistamines

At the present time, there is only one medication in this category: Azelastine (Astelin). Astelin is effective in treating allergic and non-allergic rhinitis. It at least partly treats all nasal allergy symptoms, including nasal congestion (which oral antihistamines often do not improve); it has a quick onset of action and can be used as needed.

Side effects are generally mild and include nasal irritation.

Topical Nasal Anticholinergics

Nasal ipratropium (Atrovent Nasal) works to dry up nasal secretions and is recommended for the treatment of allergic rhinitis, non-allergic rhinitis, and symptoms of the common cold. It works great at treating a “drippy nose,” but will not treat nasal itching or nasal congestion symptoms.

Side effects are mild and typically include nasal irritation and dryness.

Topical Nasal Mast Cell Stabilizers

Cromolyn (NasalCrom) is a medication that can prevent symptoms of nasal allergies when used before exposure to allergens. This medication prevents mast cells from releasing chemicals that cause allergy symptoms. The medication does not treat allergy symptoms once they have occurred, however. Therefore, it has only limited usefulness for most people.

NasalCrom is now also available over the counter without a prescription.

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  1. Juel-berg N, Darling P, Bolvig J, et al. Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis: A systematic review and meta-analysis. Am J Rhinol Allergy. 2017;31(1):19-28. doi:10.2500/ajra.2016.30.4397

  2. Tran NP, Vickery J, Blaiss MS. Management of rhinitis: allergic and non-allergic. Allergy Asthma Immunol Res. 2011;3(3):148-56. doi:10.4168/aair.2011.3.3.148

  3. Edwards AM, Hagberg H. Oral and inhaled sodium cromoglicate in the management of systemic mastocytosis: a case report. J Med Case Rep. 2010;4:193. doi:10.1186/1752-1947-4-193

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