How do nasal sprays relieve allergies?

Breathing through your nose is a no-brainer until your allergies make it nearly impossible. You can wait it out and be miserable, or you can try to get allergy relief with a nasal spray. But which type of nasal spray should you pick? Let’s break down the different nasal spray options to help you find the best option to relieve your nasal allergy symptoms. 

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Nasal sprays are medications used to treat nasal symptoms such as inflammation, congestion, and runny nose. In many cases, these symptoms are caused by seasonal allergies, also known as allergic rhinitis or hay fever. But unlike many types of allergy medications taken orally, nasal sprays are sprayed directly in the nasal passages via a spray bottle or pressurized canister.

There are four main types of medicated nasal sprays sold via prescription or over-the-counter (OTC):

• Decongestant

• Steroid

• Saline

• Antihistamine

Exactly how each nasal spray works differs depending on its active ingredient—and each has its own set of advantages and disadvantages for treating allergies.

Decongestant nasal sprays (DNS) 

Decongestant nasal sprays (DNS) relieve your stuffy nose by temporarily shrinking the blood vessels inside the nose (known as vasoconstriction). Examples include oxymetazoline, pseudoephedrine, and phenylephrine. These ingredients are found in brands like Afrin, Dristan, Sinex, and Neo-Synephrine (Wahid, 2021). 

• Advantages: These sprays work fast, alleviating congestion within minutes. 

• Disadvantages: Decongestant nasal sprays should NOT be used for more than 3–5 days. Prolonged use can be dangerous and can cause rebound congestion or rhinitis medicamentosa. Rebound congestion is increased congestion that results from the overuse of nasal decongestant sprays (Wahid, 2021).

Steroid nasal sprays

Corticosteroid nasal sprays are typically the go-to for relieving allergy symptoms. They contain corticosteroids, a class of drugs that works to reduce inflammation. More severe allergy symptoms may require a prescription-strength nasal spray. However, over-the-counter (OTC) nose sprays with active ingredients such as triamcinolone acetonide (brand name Nasacort) or fluticasone propionate (brand name Flonase) are also shown to help provide relief (Akhouri, 2021).

• Advantages: By reducing inflammation, the sinuses can feel less congested, making it easier to breathe. 

• Disadvantages: Though you may experience some relief early on, steroid nasal sprays are most effective after prolonged, consistent use. It can take a full week or more to feel the full effects, meaning you may have to deal with the symptoms for several days or take other medications to get immediate relief. For best results, use a steroid nasal spray throughout the duration of allergy season. Side effects include irritation and nosebleeds (Akhouri, 2021). 

Saline nasal sprays

Saline nasal sprays are the simplest type of nasal spray for allergies because they aren’t a medication. They contain a saline solution to help loosen mucus and debris inside the nose to clear congestion and blockages.

• Advantages: It’s simple to carry around and use and may help flush out mucus, allergens, and other debris from the sinus cavities.

• Disadvantages: Saline is not a medication, so other than its cleaning effect, it will not reduce other symptoms of allergies like inflammation and itching. 

Antihistamine nasal sprays

Histamine is a chemical produced by the immune system that works to rid the body of foreign invaders. During an allergic reaction, histamine is released in response to allergens like pet dander, dust mites, and mold. The result is unwanted symptoms like sneezing, itching, and nasal congestion. 

Antihistamine nasal sprays work by blocking the effects of histamine. Examples include azelastine (brand names Astepro and Astelin) and olopatadine (brand name Patanase). 

• Advantages: Antihistamine nasal sprays work quickly—often within 30 minutes (UpToDate, n.d.).

• Disadvantages: This type of nasal spray is only available via prescription. It may also cause drowsiness.

Nasal sprays can be an effective way to get relief from congestion and other symptoms that accompany allergies, but it’s not a one-size-fits-all solution. It’s best to speak to a healthcare provider about the right option for allergy relief—both in the short and long term.

How to use nasal sprays

Nasal sprays work by delivering the medication directly to the inside of your nose. Follow the individual medication instructions regarding how often to use it—if possible, take medicine at the same time each day. To properly use nasal sprays, follow these steps:

1. Blow your nose to clear it before each use.

2. Before first use, prime the bottle by pumping five times until a mist appears. Also, do this step if it has been three or more days since you last used the medication.

3. Shake the bottle gently.

4. Keep your head upright, or tilt it slightly forward, and insert the applicator tip into your nostril.

5. Hold the applicator tip inside your nose and point the tip toward the outside corner of your eye. The goal is NOT to spray the medication straight back. You also should avoid pointing the tip towards the center of the nose (where the septum is), as this increases your risk of nosebleeds. 

6. Close off the other nostril with a finger. Breathe in, and as you are inhaling, press the pump to release the spray into the nostril.

7. Hold your breath for a few seconds, and then slowly breathe out through your mouth after each spray.

8. Alternate nostrils after each pump (e.g. right-left-right-left). 

9. After using the spray, gently sniff. 

10. Wipe the tip of the applicator with a clean tissue after each use.