Last week, 66-year-old Betty confided, “This year, my allergies are really bad. I have a nose spray, Flonase® to take care of my stuffy nose and sneezing, but this year, it isn’t helping. What else I can try? Do you think I need to see my doctor?”

A new prescription nose spray will soon be available over the counter (OTC). Prescription strength Nasonex® 24HR Allergy (mometasone) was approved last month to become available without a prescription, and may help Betty.

There are several types of nose sprays and drops available OTC to relieve symptoms of seasonal and year-round allergies. These include saline, decongestant, and anti-inflammatory products.

Pollens and animal dander can trigger sinus pressure, nasal congestion, watery eyes, runny nose or sneezing. Doctors call plant-based allergic reactions allergic rhinitis, but years ago, symptoms like Betty’s were called “hay fever” because they were more common during the late spring and summer, when hay was harvested.

Saline nose drops or spray can help liquefy mucus and relieve stuffiness. To make your own saline, add ½ teaspoonful salt to 1 cup of distilled water or boiled tap water. I like to add a pinch of baking soda to make it sting less.

Decongestant nose drops and sprays such as Afrin® (naphazoline) and Neo-Synephrine® (phenylephrine) relieve nasal congestion by rapidly shrinking the blood vessels in your nose, reducing swelling. There’s a catch, however; they often stop working after several days of continuous use, called rebound.

Some people use decongestant nose sprays for months without getting rebound stuffiness while others have problems after only a few days of frequent use. Because they can increase blood pressure, if you have high blood pressure or a heart condition, you should avoid decongestant nose sprays completely.

Steroid nose sprays like Betty’s Flonase® are a very effective way to treat allergy symptoms. They decrease inflammation and help ease sneezing, sniffling and stuffiness. Use the highest dose until you get full relief, then lower it to a dose that still controls your symptoms.

Nasalcrom® (cromolyn) nasal spray is a type of anti-inflammatory agent that can stop an allergic reaction even before it gets going. Available without a prescription, Nasalcrom® works best when you start several weeks BEFORE being exposed to what you’re allergic to, and is used 3-4 times daily for best effect.

7 Tips for Getting the Most Out of Your Nasal Spray:

1.Try a steroid nasal spray first.

Betty could switch from using Flonase Allergy Relief® (fluticasone) to Nasacort Allergy 24-Hr® (triamcinolone), Rhinocort® (budesonide), or the new OTC Nasonex® 24HR Allergy (mometasone).

2.Start your steroid or Nasalcrom® nose spray 1-2 weeks before exposure.

It can take several days to weeks before you get the maximum effect from a steroid nasal spray or Nasalcrom®, so starting them before you are exposed to your allergy trigger will help them work much better for you.

3.Limit decongestant nasal spray use to 5-7 days. 

Decongestants like Afrin® work fast, but for more extended relief you should switch to a steroid nasal spray to avoid rebound stuffiness. You can use both steroid and decongestant sprays together at first.

4.Shake steroid nasal sprays well and “prime” them before using. 

Before you use it for the first time, first shake the spray bottle gently and then, while pointing it away from you, use the sprayer over and over until you see a fine mist appear. This usually takes 6-10 actuations. The bottle may be stored unused for up to 1 week without needed to be primed all over again.

5.Watch where you point it.

To avoid irritation, aim the tip of the sprayer toward your ear, away from the tissue between your nostrils. Breathe in gently while spraying. Snorting can carry the medicine down the back your throat, instead of where it is needed.

6.Try a different nose spray.

There will soon be four different steroid nasal sprays to choose from. If at first you don’t get relief, or experience side effects like having a nosebleed, try a different one. Betty’s friend, Sally got nosebleeds using Rhinocort®, but is having no trouble with Nasacort Allergy 24-Hr®.  

7.Use saline nose drops for infants and small children.

Using saline nose drops to relieve stuffiness is safer than decongestants or steroid nose sprays, and nearly as effective. Place 1-2 drops in each nostril, wait 15 minutes, and then suck out the liquified goo with a small bulb syringe. For more severe symptoms, Nasacort Allergy 24-Hr® is safe for children as young as 2 years old.

Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog    ©2022 Louise Achey


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