Nasal Sprays

Nasal Sprays Overview

If seasonal changes bring sneezing, a runny nose or congestion, you have plenty of company: about one in four U.S. adults (25.7%) have a diagnosed seasonal allergy (CDC). Nasal sprays are among the most effective ways to treat these symptoms; intranasal steroid sprays are the single most effective drug class for allergic rhinitis (ACAAI).

How Do Nasal Sprays Work?

Nasal sprays deliver medicine directly to the lining of the nose, where allergy symptoms happen. Because the medicine acts mainly where it is sprayed, nasal sprays can work with lower doses and fewer whole-body side effects than many pills.

You can easily have access to these sprays from your nearby pharmacy, but first, you should know the different types of sprays available for various symptoms.  

Types of Nasal Sprays

Several types of sprays are available, each working in a different way.

Decongestion

The medicine from these sprays are injected directly into the nostrils for the relief of congestion that may be caused by different conditions that may include common cold, hay fever, sinusitis and allergies. It reduces swelling and congestion in the nose by constricting the blood vessels there. Some over the counter decongestion spray medicines are:

• Oxymetazoline hydrochloride  
• Phenylephrine hydrochloride  

Pseudoephedrine is a decongestant pill, not a spray. Decongestants are sometimes combined with antihistamines in oral products (ACAAI).

Don’t use decongestant sprays for more than 3 days, because longer use can cause rebound congestion (MedlinePlus). Check with your doctor before using decongestants if you have:

• Glaucoma
• Uncontrolled blood pressure
• Heart disease 
• Diabetes
• Unbalanced thyroid 
• Enlarged prostate

Oral decongestants can cause nervousness or trouble sleeping (ACAAI). See our decongestants page for more.

Antihistamine

Antihistamine nasal sprays work well for allergic rhinitis and act quickly enough to be used as needed (MedlinePlus; ACAAI). Examples include:

• Azelastine
• Olopatadine

Some people feel sleepy with antihistamine sprays, and azelastine may have an unpleasant taste (ACAAI).

Anticholinergic

Ipratropium bromide (Atrovent) nasal spray helps reduce nasal drainage (runny nose) from allergic rhinitis or some forms of nonallergic rhinitis. It doesn’t relieve congestion or sneezing (ACAAI).

Tell your doctor if you have glaucoma or an enlarged prostate before using it.

Some side effects may includeheadache, sore throat, bleeding, or irritation in the nose. 

Steroid

Steroid sprays reduce swelling and inflammation in the nose and can significantly relieve congestion, sneezing, itching and a runny nose (ACAAI). They work best when used every day, but can help even when used intermittently (MedlinePlus). Many are available over the counter, including:

• Triamcinolone
• Budesonide
• Fluticasone

Other steroid sprays are available too; ask your pharmacist which ones are sold without a prescription (MedlinePlus).

The most common side effects are nasal irritation and nosebleeds. Avoid spraying toward the center of the nose (the septum) (ACAAI).

Cromolyn Sodium

Cromolyn sodium (NasalCrom) blocks the release of allergy-causing substances from mast cells. It can help prevent symptoms if used before allergen exposure, but it doesn’t work for everyone (ACAAI).

The full dose is four times a day, and it may take several weeks for symptoms to improve (ACAAI). Saline sprays are another option: they help with dry nasal passages or thick mucus and can be used as often as needed.

The use of sodium cromolyn sprays has reported some side effects like nasal congestion, sneezing, coughing, nosebleeds and burning.

How Effective Are Nasal Sprays For Seasonal Allergies?

Nasal sprays are very effective for allergy symptoms, especially steroid sprays, which treat congestion, sneezing, itching and runny nose (ACAAI).

If your symptoms are mostly in your nose, a nasal spray alone may be enough; otherwise it can be combined with other medicines under your doctor’s guidance.

Most people tolerate nasal sprays well when used as directed. If you have nasal injuries, frequent nosebleeds or recent nasal surgery, check with your doctor first.

Conclusion

Steroid sprays are the most effective option for ongoing allergy symptoms, antihistamine sprays work quickly as needed, cromolyn is best started before exposure, and decongestant sprays should be limited to 3 days. See also corticosteroids, antihistamines and spring allergies.

Check out for the elements of allergies and let your doctor know about any of the mentioned issues or if using any other over the counter drugs before using these medications to avoid side effects altogether. 

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Written by: Madiha Ather Hashmi (September 22, 2020)

This article is for general education and is not medical advice. Talk with your doctor or pharmacist about your symptoms and before starting, stopping, or combining any medicine.

What actually helps

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HEPA air purifier & filters

A portable HEPA purifier sized to the room can lower airborne particles such as pollen and dust; it only works if you replace filters on schedule. (EPA: Guide to Air Cleaners in the Home)

See the Levoit Core 300 on Amazon

Saline nasal rinse kit

Rinsing with saline can clear pollen from the nose; use distilled, sterile or boiled-then-cooled water, never plain tap water. (FDA: Is rinsing your sinuses with neti pots safe?)

See the NeilMed Sinus Rinse kit on Amazon

Dust-mite pillow & mattress covers

Allergists recommend zippered, allergen-proof encasings for pillows, mattresses and box springs, plus hot-water washing of bedding. (ACAAI: Dust Allergy)

See Hospitology zippered pillow encasements on Amazon

Nasal Spray FAQs

Which nasal spray is best for allergies?

Intranasal steroid sprays are the single most effective drug class for allergic rhinitis (ACAAI).

Can I use a decongestant spray every day?

No. Limit decongestant sprays to 3 days to avoid rebound congestion (MedlinePlus).

Can I use saline spray as often as I want?

Yes. Unlike decongestant sprays, saline sprays can be used as often as needed (ACAAI).

Why do steroid sprays sometimes cause nosebleeds?

Local irritation is the most common side effect. Aim away from the nasal septum (ACAAI).

Sources

Looking to learn more about allergy lifestyles? Find a full list of living with allergies resources here.