Prescription Nose Sprays


There are four types of nose sprays that can help allergy patients. First are the non-prescription decongestants like Afrin or Dristan. They work quickly for stuffy nose, but the more you use them, the less effective they are. They are addicting, in that if you keep using them for more than a few days, your nose gets used to them and you have trouble stopping their use.

Next are the antihistamine nose sprays (e.g., Astepro, Astelin and Patanase). These sprays don't help stuffy nose, but can reduce itchy nose, sneezing and watery nose. They work quickly and don't lose their effect with regular use the way Afrin does. Often, our patients will use them just before being exposed to something allergic or just before eating spicy foods that make the nose run.

The third type is the anti-cholinergic ipratropium (Attovent nasal). This helps runny nose, but does nothing for stuffy nose, itching or sneezing.

The fourth types are the steroid nose sprays like Nasonex and Flonase. With microscopic amounts of cortisone (steroid), they prevent most allergy symptoms (runny nose, itchy nose and eyes, stuffy nose and sneezing). Notice that word "prevent." The dose of the steroid is so tiny that it isn't strong enough to treat symptoms once you develop them. It's only strong enough to prevent your symptoms; therefore, you have to use these every day.

For the past 9 or 10 years, only liquid steroid nose sprays have been available in the U.S. Before that, we had pressurized, dry nose sprays (e.g., the original Beconase, Vancenase, Rhinocort and Nasacort). Those dry nose sprays contained CFGs (Freon) that hurt the ozone layer, so they were taken off the market. The problem is that about 20 percent of patients who use the steroid nose sprays don't tolerate the liquid sprays – some people say it drips in their throat or feels slimy. For them, we have taken dry, pressurized steroid asthma inhalers and fitted them with silicon baby nipples that act as a funnel to get the spray into the nostril (which is smaller than the mouth).

Finally, a drug company is bringing a dry steroid nose spray back to the U.S. QNASL will contain the same steroid as the asthma inhaler QVAR. QVAR has been in the U.S. for several years. Instead of CFCs, they have the newer propellant called HFA that is safe for the ozone layer. This will be a welcome addition to allergy sufferers who haven't liked the side effects of aqueous (wet) nose sprays.

Note: Information contained in this article should not be considered a substitute for consultation with a board-certified allergist to address individual medical needs.

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