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Using a decongestant nasal spray can be a literal breath of fresh air when you’re dealing with a cold or seasonal allergies. While nasal sprays are safe when used appropriately, rebound congestion is one of the side effects of overusing decongestant nasal sprays.
What is rebound congestion?
Rebound congestion is the easier-to-remember name for rhinitis medicamentosa, a condition that develops from the overuse of nasal decongestant sprays (Wahid, 2021).
While these sprays are supposed to make you feel better, overusing them can make your congestion worse. Congestion happens when the blood vessels inside the nose dilate due to a virus, bacterial illness, or allergens. This narrows the passageway for air and mucus to move through the nose, leading to that familiar “stuffed up” feeling.
Nasal decongestant sprays temporarily relieve the pressure, allowing air and built-up mucus to flow freely. The relief is temporary until you use the spray again. This turns into a cycle that leaves you reliant on the spray to breathe normally.
Overusing nasal decongestant sprays doesn’t just mean using one or two extra doses. Some people with rebound congestion use them multiple times an hour for weeks or even months at a time instead of the regular recommended dosage (every 12 hours for only two or three days). This overuse is common. In one study looking at rebound congestion, half of the participants with nasal congestion used their decongestant sprays for longer than the recommended time frame (Mehuys, 2014)
That said, rebound congestion isn’t a one-size-fits-all condition, and we don’t exactly understand why it happens. One theory is that nasal decongestant sprays affect the blood supply to the nose (because it restricts the blood vessels), causing more severe swelling in the turbinates and nasal passages. (Wahid, 2021)
Another thought is that, over time, your nasal mucosa gets used to the medication in the decongestant spray. You may need a higher dose of the decongestant for it to work, a situation called tachyphylaxis. Some people equate rebound congestion with nasal spray addiction (Wahid, 2021).
What are nasal decongestants?
Nasal decongestants are one of the four main types of nasal spray used to treat the symptoms of illnesses like the common cold and flu, including a runny or stuffy nose. They’re also used to relieve congestion that often comes with perennial allergic rhinitis or seasonal allergies (allergic rhinitis), like hay fever.
Other types of nasal sprays include steroid, antihistamine, and saline nasal sprays.
How do decongestant nasal sprays relieve allergies?
Decongestant nasal sprays (DNS) work by shrinking the blood vessels (vasoconstriction) in the nasal passages. They use the active ingredients oxymetazoline hydrochloride, xylometazoline, or phenylephrine hydrochloride. This effect helps provide short-term relief to congestion but won’t cure what caused it (Wahid, 2021).
The nasal sprays are available over-the-counter (OTC) in many pharmacies and drugstores under a few different brand names, including:
- Vicks Sinex
What are the symptoms of rebound congestion?
It’s often easy to tell when you’re experiencing allergies, thanks to tell-tale symptoms like itchy eyes and a scratchy throat. The same goes for when you get a cold or flu.
However, it’s not always easy to recognize the signs of rebound congestion, and there isn’t a formal test to diagnose it. Nasal congestion without a runny nose or sneezing (in the setting of long-term use of the nasal decongestant sprays) is usually the only symptom—and it may last as long as you continue to use decongestant nasal spray. You may also feel like you need to start using more nasal spray to achieve the same effect, but this may worsen the condition (Wahid, 2021).
How does Flonase work to help relieve allergies?
There’s also a chance you might not have rebound congestion at all. Other underlying reasons for continued congestion include (Wahid, 2021):
- Allergic or non-allergic rhinitis
- Acute or chronic sinusitis
- Nasal polyps
- Upper respiratory infection
Regularly using a continuous positive airway pressure (CPAP) device may also cause congestion that doesn’t respond to DNSs.
How do you treat rebound congestion?
If you think you are experiencing rebound congestion, talk to a healthcare provider about the best treatment option for you. Rebound congestion often goes away once you stop using decongestant nasal sprays, but abruptly stopping the medication cold turkey can cause more congestion and swelling. Some people may benefit from decreasing the use of decongestants gradually. It may take days to weeks for congestion to completely resolve (Wahid, 2021).
If the congestion and swelling are unbearable, different types of nasal sprays may help. Saline nasal (made with salt and water) and steroid nasal sprays like fluticasone propionate (brand name Flonase) and triamcinolone acetonide (brand name Nasacort) are two other medications that can help relieve congestion. Antihistamine nasal sprays made with azelastine (brand name Astepro) may also help. Lastly, using oral decongestants after stopping the nasal spray can help with rebound congestion (Wahid, 2021).
- 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/
- Wahid NWB, Shermetaro C. (2021). Rhinitis medicamentosa. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538318/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.