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Nasal Sprays vs. Oral Allergy Meds: Which Are Better?

by Melissa Caravella  

If the 2018 allergy season is anything like last year’s, allergy sufferers could see—through red, itchy eyes—more severe symptoms that start earlier and last longer than usual. But that doesn’t mean months of misery are inevitable. Experts say your best defense against the sniffling and sneezing is right under your nose.

Intranasal corticosteroids—formulated as prescription or over-the-counter nasal sprays—offer sustained relief that outperforms oral allergy medications like loratadine (Claritin), fexofenadine (Allegra), and cetirizine (Zyrtec) with fewer unpleasant side effects. In an updated allergy treatment guideline published in November 2017 in the Annals of Internal Medicine, allergy, asthma, and immunology specialists said the nasal sprays are your best bet for quick, effective relief based on three key findings.

1. Evidence shows nasal sprays are more effective than oral antihistamines.

When you experience an allergic response, your body releases histamines in an effort to flush allergens out of the body. Many over-the-counter allergy pills contain antihistamines, which work by preventing histamines from attaching to cells. Corticosteroid, or steroid, nasal sprays work differently: They stop certain cells in the nasal passages from producing histamine, thus suppressing your body’s immune response.

In evaluating whether treatment with an oral antihistamine plus a steroid nasal spray was more beneficial than using a spray alone, doctors found the combination didn’t provide additional benefit and could lead to other side effects, like drowsiness.

Nasal steroids available by prescription include fluticasone propionate (Flonase), fluticasone furoate (Veramyst), and mometasone furoate (Nasonex). Flonase, Rhinocort, and Nasacort are brand namesof similar sprays available over the counter.Differences between the prescription and nonprescription sprays include cost, type of spray device, and frequency of doses.

2. Nasal sprays also beat leukotriene receptor antagonists.

Steroid nasal sprays improved nasal congestion, runny nose, itching, and sneezing more effectively than oral leukotriene receptor antagonist drugs like montelukast (Singulair) or zafirlukast (Accolate). However, people who have both asthma and allergies may benefit from a leukotriene receptor antagonist—a common asthma medication—since it can lessen symptoms for both conditions.

3. For moderate to severe allergies, using a steroid spray with a nasal antihistamine spray may provide the most benefit.

If you experience itchy, watery eyes, or your nasal symptoms don’t respond to a steroid spray, it might be time to attack allergies with a one-two punch. You might benefit most by combining a nasal steroidwith a prescription nasal antihistamine, such as azelastine (Astelin) or olopatadine (Patanase). Alternatively, your doctor can prescribe one nasal spray that combines both azelastine and fluticasone (Dymista).

The experts acknowledge that some people may not respond to the recommended treatments, and modifications should be made by tailoring treatment to the individual patient. Doctors also must take into account other medications patients are taking and potential interactions between drugs. What’s more, some patients may prefer an oral medication to a nasal one, even if it’s less effective.

Using nasal sprays correctly

Nasal corticosteroids shouldn’t be confused with over-the-counter decongestant sprays like Afrin, which are intended only for short-term use (up to three days) to shrink swollen tissues. Although you can use steroid nasal sprays only when needed, they’re most effective when used daily. They can start to work within a few hours, but maximum relief can take up to two weeks.

Directions for using most corticosteroid sprays suggest washing your hands, gently blowing your nose to clear the passageway, and shaking the container before administering. Follow these tips to ensure you get the proper dosage:

  • Keep your head upright and chin slightly tucked, breathe out, and insert the applicator into one of your nostrils. Block the other nostril with your finger. Aim the spray toward the nostril’s outer wall.
  • Inhale or sniff gently as you press the applicator. Don’t inhale so hard that the medicine drains down your throat where it will be wasted. If it does drip down your throat, it’s OK to spit out the excess.
  • Breathe out and repeat as directed before applying to the other nostril.
  • Try to avoid sneezing or blowing your nose right after spraying.

Sprays typically only affect the nasal passageway and are safe for older adults. Common side effects may include nasal dryness, crusting, bleeding, or stinging; throat irritation; and an unpleasant taste. To help prevent side effects, be sure to follow the medication’s instructions for use, including the number of sprays in each nostril and where to direct the spray.

You can take additional steps to lessen and help prevent symptoms:

  • Start any allergy medicine about two weeks before the season begins.
  • Postpone outdoor activity during peak pollen times. Counts are generally lower in the evenings.
  • Allergy-proof indoor spaces. Avoid smoke and other irritants indoors, keep windows closed, and use an air conditioner.
  • Wash off pollen when coming inside.

In particular, wash your hair to avoid pollen buildup on your pillow. Avoid contact with a pet that’s been outdoors, and bathe your furry friend regularly.

This article first appeared in the April 2018 issue of UC Berkeley Health After 50.

Also see Hay Fever: Causes and Treatments.