The trouble with allergies
Allergy season is upon us. And for the more than 50 million Americans who live with seasonal allergies, that means a whole lot of itching, sneezing, and watery eyes.
These symptoms tend to crop up with the onset of tree allergy season, followed by grass and weed season, notes Kevin McGrath, MD, an allergist in private practice in Wethersfield, Connecticut, and spokesperson for the American College of Allergy, Asthma, and Immunology.
“The combination of trees, grasses, weeds, and molds makes for a difficult spring for most allergy patients and leads to sneezing, congestion, postnasal drip, sinus pain and pressure, watery eyes, and fatigue,” he says.
The good news is that there are a myriad of treatments out there that help ease the debilitating symptoms that accompany seasonal allergies. One of the most common and easy-to-use therapies: nasal sprays.
The best part is that you can purchase them over the counter without a prescription, and they work well at alleviating mild to moderate allergy symptoms, according to Sanjeev Jain, MD, allergist and immunologist who works at Columbia Allergy clinics in California, Washington, Oregon, and Idaho.
Nasal sprays are especially useful if most of your allergy symptoms are in your nose.
“If you are experiencing primarily nasal symptoms, you can also take a more localized approach and use nasal sprays to reduce irritation and inflammation, therefore alleviating many of your symptoms,” he says.
The different types of nasal sprays for allergies
There are several different types of nasal sprays on the market, some of which can be purchased over the counter and others that require a prescription. Here’s a look at the most popular.
Steroid nasal sprays
Looking for an accessible yet effective nasal spray? Many people with allergies do very well with steroid sprays like Flonase Sensimist, Nasacort AQ, and Rhinocort AQ, according to Dr. McGrath.
You used to need a prescription for these sprays, but they’re now available over the counter.
“Studies show these medications can all be very effective for nasal congestion, itching, postnasal drip, and even eye allergies when used properly,” he says.
Of course, it may take some trial and error to find the best one for you.
“My personal experience is that most of these are very effective, however many of my patients do find that the regular Flonase nasal spray that you squeeze from the top is not quite as effective as most of the others.”
Come into contact with a foreign substance—say, pollen—and your immune system will raise an alarm. “Attack!” it seems to shout, releasing the inflammatory mediator histamine to protect itself from the invader.
“Histamine causes swelling of the tissues, which, as a result, leads to the classic allergy symptoms,” says Dr. Jain. “So blocking this mediator prevents the symptoms from occurring.”
Antihistamine nasal sprays relieve symptoms by blocking histamine. (See? It’s right there in the name.)
Examples of antihistamine sprays include azelastine (Astelin), and olopatadine (Patanase).
These nasal sprays, which often have oxymetazoline as their main ingredient, shrink the swollen blood vessels and inflamed nasal mucosa that cause congestion, according to Denisa E. Ferastraoaru, MD, an allergist at Montefiore Medical Center in New York City.
These sprays can be great, and you may finally find yourself taking a deep breath (sans sniffles) but they’re not a long-term solution. Or even a medium-term solution. And using them too often can lead to trouble.
“It is important to not use nasal sprays containing oxymetazoline for more than three days because it can result in rebound nasal congestion [also known as rhinitis medicamentosa], and it will make your nasal symptoms worse,” she says.
Some examples of decongestant nasals sprays, or oxymetazoline, include Afrin and Mucinex.
Mast cell stabilizers
“This nasal spray prevents the release of histamine and other inflammatory mediators to prevent swelling of the tissues, therefore alleviating symptoms,” says Dr. Jain.
While these sprays are not effective for immediate relief of symptoms, they can help to prevent symptoms.
To find a mast cell stabilizer spray, look for the active ingredient cromolyn sodium—you’ll find it in Nasalcrom spray.
This nasal spray is essentially saltwater and functions to moisturize irritated nasal passages, explains Dr. Jain.
What type of nasal spray works best?
According to Dr. Jain, the first line of treatment for seasonal allergies is intranasal corticosteroids—that is, steroids you spray up your nose.
“Steroid nasal sprays are considered first-line because they are the most potent agent available, the most effective medication to be used alone, and are especially helpful for relieving nasal congestion,” he says.
“They also have a low side effect profile and can be used long-term and for immediate symptom relief,” he adds.
If those don’t work, the next course of action is to try an antihistamine or nasal decongestant.
“These medications can reduce symptoms but often require treatment with more than one agent [and] have increased side effects,” Dr. Jain says. “And nasal decongestants can only be used for a few days at a time.”
Saline nasal spray are safe for everyone. They come with almost no side effects and can provide comfort to irritated or dry nasal passages.
Prescription vs. over-the-counter allergy nasal sprays
While over-the-counter (OTC) options can be a great starting point for treating seasonal allergies, if symptoms persist, you may benefit from a prescription nasal spray.
“Prescription nasal sprays allow for the nasal spray to reach further into the nasal passage and can also offer a combination of medications,” says Dr. Jain. “One other benefit of prescription nasal sprays is that a provider can specifically select the best medication for you based on your symptoms and what treatments you have tried.”
Allergy nasal sprays vs. oral allergy meds
Oral allergy medications include oral antihistamines and oral nasal decongestants.
Walk the allergy aisle of your local pharmacy and you’ll pass countless antihistamine pills, many of which you’ve probably seen advertised on TV and in magazines.
Some of these can make you sleepy—think diphenhydramine (Benadryl). Others, like cetirizine (Zyrtec) and loratadine (Claritin), use nondrowsy formulations.
“Nonsedating oral antihistamines like Zyrtec and Claritin can be taken once a day to alleviate generalized allergy symptoms,” says Dr. Jain.
The emphasis is on “generalized.” That means these oral meds are targeting overall symptoms of allergies.
But, Dr. Jain warns, they may not target the nasal passages as effectively as their spray counterparts. Symptoms such as congestion, postnasal drip, and runny nose may improve but still linger with the oral medication.
“Oral decongestants can be used for a few days for immediate relief of severe symptoms, but they are not a great choice for continued treatment of allergies,” he says. “Oral decongestants can cause a lot of side effects and should not be used in patients with heart disease, high blood pressure, and more.”
If you go this route, Dr. Jain recommends supplementing with a nasal spray to achieve better results.
Risks or side effects
It’s worth noting that there are side effects that come with OTC nasal sprays, though they can vary based on ingredients.
Antihistamine nasal sprays may cause headaches, coughing, nose bleeds, sleepiness, throat irritation, bitter tastes, dry mouth, and nasal burning, according to Dr. Jain.
Corticosteroid nasal sprays can cause side effects that include irritation, bleeding, septal perforation (a hole in the septum), and with long-term use in children, possibly a decreased rate of growth due to systemic absorption.
Decongestant nasal sprays can cause rebound congestion and swelling of the nasal passage.
“Nasal decongestants restrict blood flow to the nasal tissues, and when this happens for too long, it can cause tissue damage, which triggers more swelling,” Dr. Jain says.
How do you use a nasal spray?
First things first: insert the nozzle into a nostril.
You want to direct the tip slightly towards the eye and away from the midline, or septum, according to Raphael E. Strauss, MD, an allergist with Allied Physicians Group in Long Island, New York.
The blood vessels are concentrated at the nasal septum, so by pointing the spray away from them you’ll reduce your risk for nose bleeds.
“The easiest way to do this is to use the left hand [when squirting up] your right nostril and the right hand for your left nostril, with the head tilted slightly downward,” he says. “The medicine will naturally be carried backward by the mucous in your nose and sinuses.”
Dr. Strauss discourages sniffing the medicine up your nose, as this may cause sneezing and leave you with a stronger medicinal taste.
Typically, you’ll use decongestant nasal sprays for only three- or four-day periods. But you can use antihistamine nasal sprays, saline nasal sprays, and steroid nasal sprays as needed for as long as symptoms persist—even long term, says Dr. Jain.
But, he cautions, not all nasal sprays require the same dosing. Always check the packaging for proper instructions on how and when to use the medication.
How to shop for an OTC nasal spray
Before shopping for an OTC allergy nasal spray, it’s always a good idea to consult with a board-certified allergist for advice in regard to these medications.
During this consultation, your allergist can do a skin test to determine the seasons and year-round allergens that might be triggering your nasal allergies.
It’s always a smart idea to check the packaging before buying a nasal spray.
“Many nasal sprays will just say ‘allergy nasal spray’ and do not make it obvious which type of medication is contained in the nasal spray,” Dr. Jain says.
Plus, if you’re buying a nasal spray for a child, you’ll want to double check to be sure the particular product is safe for use in children.
The best nasal sprays for allergies
Here are some of the top-rated nasal sprays that help alleviate seasonal allergy symptoms.
Nasacort is an intranasal corticosteroid, which has an anti-inflammatory effect and decreases allergic inflammation, explains Dr. Ferastraoaru.
While this type of nasal spray tends to be effective, it’s important to note that it takes time to work.
“Although they may begin to give relief to allergy symptoms after the first day, full relief may be achieved only after four to eight weeks with daily use,” he says.
Also an intranasal corticosteroid, Flonase Sensimist reduces inflammation by lessening the immune system’s response to the allergen when it comes in contact with the nasal passage, explains Dr. Jain.
Each bottle contains about 60 sprays, which should last you long enough for your allergy symptoms to subside.
In the case that they are still prevalent, it’s a good idea to seek out the opinion of a board-certified allergist before trying anything else.
Vicks Sinex Severe
This doctor-approved nasal spray offers up to 12 hours of relief from stuffiness and sinus pressure. Just keep experts’ warnings about decongestant sprays in mind.
Although short-term use of OTC nasal decongestant sprays, such as Vicks Sinex Severe, can relieve persistent nasal congestion, they are likely to lead to worsening and protracted congestion if used for a longer period of time (generally five or more days of continuous use), says Clifford Bassett, MD, founder and medical director at Allergy & Asthma Care of New York and author of The New Allergy Solution.
This corticosteroid nasal spray is a great option because it is affordable and safe for daily use.
It helps reduce symptoms related to seasonal allergies, including sneezing, runny nose, and congestion. Because it is nondrowsy, it’s an ideal option for those looking for relief during the workday or before a big event.
Rhinocort Allergy Nasal Spray
Dr. Jain recommends Rhinocort because it is affordable and comes in a formulation for both adults and children.
Each bottle contains about 120 sprays and delivers 32 mcg of the allergy medication budesonide per spray. It’s meant to be used once daily while symptoms persist.
4-Way Fast Acting Nasal Spray
Decongestant nasal sprays like this one from 4-Way shrink the swollen blood vessels and inflamed nasal mucosa that cause congestion, explains Dr. Ferastraoaru.
The active ingredient is phenylephrine, which relieves sinus pressure as well. Just keep in mind you’ll need to stop using it after a few days to avoid rebound congestion.
NasalCrom Nasal Spray Allergy Symptom ControllerShop Now
This nasal spray from NasalCrom prevents the release of histamine and other inflammatory mediators to prevent swelling of the tissues and therefore alleviate symptoms.
“These are not effective for immediate relief of symptoms but can help to prevent symptoms,” Dr. Jain says.