The Benefits and Risks of Nasal Antihistamines

Nasal sprays are commonly used to treat sinus and allergy issues, and they generally fall into one of three categories.

The most commonly used nasal spray to treat nasal allergies is the intranasal steroid. It works over several days to decrease swelling of the nasal/sinus tissue and mucous production, but it must be used every day to really work. Examples of intranasal steroid sprays include: Flonase, Nasacort AQ, Qnasl and Nasonex.

Nasal antihistamines work in a different way to decrease swelling and mucous production. Symptomatic improvement can occur within about 30 minutes, and this class of medications can be used as needed in many cases. Examples include: Patanase and azelastine.

As much as nasal decongestants are a lifesaver during a cold, they can stir up many more problems if not used correctly.

The third class of nasal sprays are the over-the-counter nasal decongestants, like Afrin. These are a blessing and a curse for patients (and allergists!). They work very rapidly to decrease stuffiness, but if used more than three days in a row they have the potential to cause “rebound congestion.” When this happens the patient feels they need more and more of the spray to attain the same results and essentially become “addicted” to their nose spray. This happens only with the nasal decongestants, and we often have to use the nasal steroids (like Flonase) to get patients off these nasal decongestants. As much as nasal decongestants are a lifesaver during a cold, they can stir up many more problems if not used correctly.

Kids and adults alike are generally hesitant to use nasal sprays. Reasons for the hesitancy to use nasal sprays include: patients just don’t like spraying something up their nose, they are afraid of “rebound congestion,” they don’t like the way the spray tastes or smells, they dislike the spray dripping down the back of their throat, or they get nosebleeds. Although some patients are really unable to use nasal sprays, we can typically come up with something that works with minimal symptoms.

So as the fall allergy season starts, keep in mind that the right nasal spray can help make the season tolerable, but the wrong one can end up making it even more miserable!

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