Nasal Spray for Allergies: What to Know and How to Choose

If you deal with seasonal allergies and don’t use a nasal spray, we’ve got just one question for you: What are you waiting for?

“Nasal sprays really are the best medical therapy we have for managing allergic rhinitis, or hay fever,” says allergist Mark Aronica, MD. He weighs in on what nasal sprays do, how to figure out which one is best for you and how to use them.

What are nasal allergy sprays?

Itchy eyes, stuffy nose, sneezing and wheezing … you’re already very familiar with the symptoms that accompany allergy season. When the symptoms start to hit, it can be truly miserable to try to make it through the day.

But nasal sprays can help — a lot.

“You generally use them just once a day in most instances, but they do take a little time to kick in and have benefits,” Dr. Aronica says. “I usually tell my patients that because of that time lag and efficacy, you want to start using your nose spray at least two to three weeks before allergy season starts.”

How to use a nasal spray

Before you spray, take a moment for proper positioning and best practices. Dr. Aronica shares some tips.

• Spare your septum. You want to spray straight up and steer away from the midline of your nose, known as your septum; it’s the cartilage and bone that separates your nasal cavity. Directing your spray here can damage the tissue, causing irritation and a bloody nose.
• Take a gentle sniff. No giant snorts! “The biggest mistake people make is doing a big sniff when they spray,” Dr. Aronica says. “If you suck the medicine to the back of your throat and it’s swallowed, it’s not doing anything for the nose or sinus.” So, after you’ve sprayed, take just a light sniff.
• You shouldn’t taste it. If you can taste the medicine down the back of your throat, it’s not staying where it belongs — in your nose. “You want as much of that medicine to stay in the nose and sinus as possible,” Dr. Aronica advises.

If you’re banking on a nasal spray to keep your allergy symptoms at bay, it’s important that you use it right so it can do its job. Follow all tips for using nasal spray properly to give it the best chance of working its medical magic.

Choosing an allergy nasal spray

There are two main classes of these medications: nasal steroid sprays and antihistamine nose sprays. But you might have to figure out which nasal spray works best for you — and your primary care doctor or allergist can guide you.

Dr. Aronica explains the differences between them, including how they work and where to get them.

Nasal steroid sprays

Nasal congestion happens when your nasal tissue become swollen and inflamed. Nasal steroid sprays, a popular over-the-counter (OTC) option, target inflammation to reduce swelling and help clear up stuffiness. They’re sold as:

• Fluticasone (Flonase®).
• Betamethasone (Nasacort®).

“Nasal steroid sprays are generally once-a-day medications, but the benefits take a little bit of time to kick in,” Dr. Aronica explains. “Because of that time lag, you should start using them two to three weeks before allergy season starts.”

Antihistamine nose sprays

When your allergies make you feel itchy, you can blame it on histamine, a chemical that causes your blood vessels to be more permeable (leaky) and leads to overall stuffiness.

“Antihistamine sprays block some of the effects of histamine,” Dr. Aronica says, “and studies show that they have anti-inflammatory properties, as well.”

They do what their OTC counterparts do, but they’re only available by prescription, sold as azelastine (Astepro® and Astelin®) and olopatadine (Patanase®).

“Both are very effective, and they work a little bit quicker than nasal steroid sprays,” Dr. Aronica says. “But they usually have to be used twice a day for maximum benefit.”

Can you use pills and sprays together?

It depends. Some don’t mesh well, while others can go together as long as they’re used correctly and safely. Here are some rules of thumb; though, it’s always best to check with your doctor.

• Take it easy on the antihistamines. “It’s technically not really a problem to take both an antihistamine spray and an oral antihistamine, as the spray is delivered locally and has little systemic effect,” Dr. Aronica says. But it also may not do much. Though some people find it helpful to take both, most studies show minimal benefit.
• Do add an antihistamine pill if you need it. “I recommend nasal steroid sprays for regular use,” Dr. Aronica says, “but it’s OK to sometimes add an oral antihistamine on top of that.” Long-acting, non-sedating antihistamines are generally safe for everyday use, though check with your doctor to be sure they’re OK for you. They include cetirizine (Zyrtec®), fexofenadine (Allegra®) and loratadine (Claritin®).
• Don’t mix and match multiple nasal sprays. Unless your doctor has specifically instructed you otherwise, stick to one at a time. If an antihistamine spray isn’t working for you, you can wait until tomorrow and try a nasal steroid spray, and vice versa. But you may want to give them a chance, even if relief is slow to come. “I do tell patients that a 30-day trial of one spray, used daily and as directed, is generally a good indicator of whether it is going to be helpful or not,” Dr. Aronica says.

Are nasal allergy sprays safe?

Nasal sprays are generally considered safe for use, and the risk of side effects is pretty low. But if you overuse them, they can cause health issues, like:

• Dryness or stinging in your nose.
• Headaches
• Nausea.
• Sinus pains.
• Sore throat.
• Vomiting

Other sprays called decongestant sprays (oxymetazoline, sold as Afrin®) shouldn’t be used for more than three or four days, as they can be habit-forming (and they don’t cure allergies, they just treat your symptoms in a pinch). But nasal steroid sprays and antihistamine nose sprays aren’t habit-forming and should be used regularly for best effect.

Still, Dr. Aronica recommends taking the minimal effective dose.

“If you’re getting benefit from a nasal spray, try dropping your dose to find the lowest dose that keeps your allergy symptoms under control,” he suggests. “You may want to bring the dose back up during pollen season or if your symptoms increase.”

Are they safe for children?

Some nasal sprays are specifically formulated for kids, though different sprays have different minimum ages — usually 2 or 4 years old. As with all medications, be sure to follow the instructions closely, and talk to your pediatrician about any questions or concerns.

Are they safe while pregnant?

There are plenty of medications you shouldn’t take or should scale way back on while you’re pregnant, but you can probably keep taking your nasal spray as needed for allergies. As you’ll hear so often while pregnant, it’s best to check with your own doctor.

And don’t forget saline sprays!

Not to be confused with medicated nasal sprays, saline sprays and rinses are simple, over-the-counter options that help flush irritants out of your nasal lining.

“Clearing out your sinuses with a nasal lavage can provide a nonmedical treatment,” Dr. Aronica says. “When you rinse the sinuses with saline, you remove some of that pollen that accumulates during the day.”