Side Effects Caused by Nasal Steroid Sprays

Most occur with prolonged use

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Short-term and long-term use of nasal steroid sprays is generally considered safe for children and adults, but you may experience some side effects if you use them. Side effects may only affect the superficial skin of the nasal passages or involve the sinuses, but they may be systemic, causing symptoms and complications that affect other areas of the body.

Nasal steroid sprays are often used for treating allergies, and they are different than steroid irrigation and steroid injections.

If you have just started using nasal steroids for allergies, it may be difficult to know whether some of your symptoms are side effects of the spray or if they are related to your allergies. Topical side effects are generally the most obvious and the most easily confused with allergies, while the systemic side effects are not as easily recognizable.

Localized Side Effects

The topical side effects of nasal steroids generally occur near the opening of the nasal passage, where you insert the nasal applicator, and rarely higher in your nostrils. They can occur right after you use the nasal spray or days afterward.

Topical side effects commonly include:

  • Irritation
  • Itching
  • Dryness
  • Redness
  • Nosebleeds
  • Crusting
  • Burning
  • Infection
  • Nasal polyps

Often, improper technique is the reason they occur. If you are starting to use nasal steroids, it helps to become familiar with the appropriate way to administer a nasal spray. While technique is important, it is possible to experience these side effects even when you use steroid nasal sprays as directed.

Sometimes the side effects decrease as your body adjusts to the steroid spray, and sometimes the side effects persist or worsen.

If you experience these symptoms, you talk to your doctor, who may suggest that you stop using your nasal steroid for a few days, and then re-start the medication using the proper technique to reduce your chances of having these side effects. This is especially important if bleeding and irritation of your nasal passages continue, as you may be at risk of more serious complications such as ulceration or septal perforation.

Though not as common as the above, side effects related to the eyes and sinuses can result from nasal spray use as well. These may occur immediately after or days after use.

Such side effects include:

  • Sneezing
  • Watery eyes
  • A runny nose or stuffiness
  • Headaches
  • Aftertaste
  • A cough

Systemic Side Effects

There are several side effects of steroid nasal sprays that can involve other areas, but they are not common. These occur as the result of the steroid's effect on the body. For example, the drug can suppress your immune system, alter your hormone levels, or increase pressure in your eyes.

It can take days or weeks for systemic side effects to appear, and you may not develop them unless you regularly use steroid nasal sprays for months.

Systemic side effects include:

  • Nausea or vomiting
  • Upper respiratory tract infections
  • Abnormal menstrual cycles
  • Cataracts
  • Glaucoma
  • Systemic infection

Growth and Behavior in Children

There have been concerns about the prolonged use of nasal steroid sprays in children, specifically with regard to growth and behavior. So far, research suggests that nasal steroids are safe for children, but there is a chance of these side effects.

  • Growth: Nasal steroids may have a small effect on a child’s vertical growth, particularly when used consistently and for a long period of time. The evidence is not consistent, and there may be a mild slowing of growth, but it is unclear whether a child's final height will be affected by the use of nasal steroid sprays.
  • Behavior: There has been some concern about hyperactivity, irritability, or behavioral problems in children who regularly use nasal steroid sprays. The studies show mixed results, so it is best to be aware of the potential problem and to observe your child closely for behavioral changes if he or she is using a nasal steroid spray.

Contraindications

If you have cataracts or glaucoma, or a family history of these diseases, using nasal steroids can put you at risk of exacerbation of these conditions. If you will use nasal steroids, it is recommended that you have routine annual eye exams by a qualified optometrist or ophthalmologist.

If you have adrenal disease, it is possible that using nasal steroids could exacerbate your disease, particularly if you use them frequently and for a long period of time.

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