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Jun 21, 2021
4 min read

Nasal spray: separating fact and fiction

“Nasal spray” is a catch-all term for over-the-counter and prescription medications that are inhaled through the nose. These sprays are typically used to help relieve the symptoms that come with seasonal allergies and colds. There are four main types of nasal sprays: decongestant, steroid, saline, and antihistamine; most of these can be used continuously. However, some can potentially cause an “addiction” if used for more than a few days at a time. This is not a true addiction, but using decongestant nasal sprays too often can lead to rebound congestion.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

A stuffy, congested nose can make even the best day miserable. Nasal sprays are sometimes an effective addition to your sniffle-busting arsenal, but persistent myths surround these sprays that might make you hesitant to use them. Let’s debunk these allergy myths with facts about nasal sprays to help get rid of those misconceptions for good.

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What are nasal sprays?

Nasal sprays are medications inhaled into the body via a pressurized canister or spray bottle. Available both over-the-counter and in prescription form, nasal sprays are most often used to treat conditions that cause congestion or inflammation in the nasal cavities, such as allergic rhinitis or upper-respiratory infections (like the common cold). 

The flu vaccine is also available in a nasal spray. However, according to the Centers for Disease Control and Prevention (CDC), people with certain medical conditions opt for the flu shot instead (Grohskopf, 2020).

3 myths about nasal sprays

Nasal sprays may seem like a no-brainer for alleviating congestion and minor pains that come with seasonal allergies and colds. However, long-standing myths about nasal sprays’ effectiveness and safety cause many people to opt for tried-and-true oral medications instead. 

In reality, many of these myths about nasal sprays are exaggerated—or just plain false. 

Myth 1: All nasal sprays are the same

Imagine this scenario: You have a cold or seasonal allergies and head to the pharmacy to get a nasal spray to help clear the congestion so you can breathe. All nasal sprays are the same, so you can grab the first bottle you see, right? Wrong.

There are four different types of nasal sprays, each with a different purpose.

  • Decongestant: Decongestant nasal sprays alleviate congestion and a runny nose by temporarily shrinking the blood vessels in the nose (vasoconstriction). This type of nasal spray is typically sold over-the-counter with two main active ingredients, oxymetazoline and pseudoephedrine (found in brands like Afrin, Dristan, and Neo-Synephrine). Phenylephrine is now replacing pseudoephedrine in many products. Decongestant nasal sprays can be dangerous to use for an extended amount of time and that may cause rebound congestion (Wahid, 2021).
  • Steroid: Steroid nasal sprays contain corticosteroids that help stop the inflammation of allergic rhinitis and seasonal allergies. Steroid nasal sprays work by applying the corticosteroid directly on delicate nose tissues to stop allergy symptoms like nasal congestion. Steroid nasal sprays are available in prescription form and over-the-counter with active ingredients like fluticasone propionate (brand name Flonase) and triamcinolone acetonide (brand name Nasacort) (Akhouri, 2021).
  • Saline: Saline nasal sprays are an all-natural way to treat congestion and mucus build-up with a mixture of sterilized water and sodium chloride (salt) instead of medication. The combination helps loosen mucus and debris inside the nose to clear congestion and blockages.
  • Antihistamine: Antihistamine nasal sprays work by directly blocking an inflammatory chemical—known as histamine—in the nose that is released when an allergen comes in contact with the body. Histamine plays a big role in allergic reactions and allergy symptoms. Antihistamine nasal sprays are available over-the-counter, with active ingredients like azelastine (brand name Astepro). These allergy treatments sometimes work faster than oral antihistamines (like cetirizine, loratadine, fexofenadine, etc.) (Akhouri, 2021).

Myth 2: You can get addicted to nasal sprays

This one is partially true. Decongestant nasal sprays can cause rebound congestion or rhinitis medicamentosa. The rebound effect is when your congestion can worsen when you stop using the decongestant nasal spray after long-term use, and it’s relatively common. In one study, half of the almost 900 participants with nasal congestion used their decongestant sprays for longer than recommended (Mehuys, 2014).

The reason behind rhinitis medicamentosa has to do with how these sprays work. Many over-the-counter decongestant nasal sprays work by constricting blood vessels that cause inflammation and increased mucus production inside the nose. When the blood vessels shrink, so does the inflammation and runny nose (Wahid, 2021). 

The effects of decongestant nasal sprays don’t last long; when the medication wears off, the vessels swell again—and the runny nose returns. You have to use the nasal spray again to experience relief. Some research shows this can create an addictive pattern in some people who feel compelled to continually use more and more of the medication to get the same relief (Wahid, 2021). 

While scientists don’t know the exact mechanism of rhinitis medicamentosa, they hypothesize that using decongestant nasal sprays long-term can lead to changes in your nasal mucosa and its blood vessels, contributing to rebound congestion. Also, some people may need a higher dose of the decongestant for it to work because the nasal mucosa gets used to it (Wahid, 2021). 

Chronic use of a decongestant nasal spray can potentially cause side effects, including:

  • Increased congestion between doses
  • Permanent tissue swelling
  • Infection and pain

You can prevent rebound congestion by (Wahid, 2021):

  • Only using decongestant nasal sprays for three days or less
  • Restricting use to two doses every 24 hours

Myth 3: Nasal sprays take weeks to be effective

A common misconception is that all nasal sprays take several weeks to provide any lasting effect. However, the actual time it’ll take largely depends on the type of nasal spray used.

Saline nasal sprays are the most fast-acting type of treatment because it works by gently flushing mucus and other irritants out. The downside is that the effects are short-lasting, and the process has to be repeated to clear additional congestion.

Antihistamine nasal sprays are designed to provide relief quickly—sometimes in thirty minutes or less. The same goes for decongestant nasal sprays that provide extended relief for several hours. 

Steroid nasal sprays can take two to three days to help symptoms, but it can take a couple of weeks to feel full relief. For best results, people who experience allergies should use their steroid nasal sprays daily throughout allergy season (Akhouri, 2021).

Though nasal sprays can effectively alleviate allergies and cold symptoms, they aren’t always the right choice for every person or every ailment. It’s best to speak to your healthcare provider to discuss your symptoms and which type of treatment—nasal spray, oral medication, or other—is the best option for you.

References

  1. Akhouri S, House SA. (2021). Allergic rhinitis. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538186/
  2. Grohskopf LA, Alyanak E, Broder KR, et al. (2020). Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices: United States, 2020–21 influenza season. MMWR Recomm Rep, 69:RR-8,1–24. doi: 10.15585/mmwr.rr6908a1. Retrieved from https://www.cdc.gov/mmwr/volumes/69/rr/rr6908a1.htm?s_cid=rr6908a1_w
  3. Mehuys, E., Gevaert, P., Brusselle, G., Hees, T. V., Adriaens, E., Christiaens, T., et al. (2014). Self-medication in persistent rhinitis: overuse of decongestants in half of the patients. The Journal of Allergy and Clinical Immunology: In Practice, 2(3), 313–319. doi: 10.1016/j.jaip.2014.01.009. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24811023/
  4. Wahid NWB, Shermetaro C. (2021). Rhinitis medicamentosa. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538318/