Ah, spring! Say hello to sunshine, warm breezes and allergies. Wheezing, sneezing and congestion come with the season for those unfortunate people who react to spring pollens, and relief is promised in many forms at the local drugstore. Nasal sprays are among the most commonly used allergy medications.
“There are now three kinds of over-the-counter nasal sprays,” says Dr. James Wedner, chief of allergy and immunology with Washington University Physicians and director of The Asthma and Allergy Center of Washington University. “There are sprays that are just saline to wet and clean the nose. Up until recently, the remainder of the nasal sprays contained a decongestant either phenylephrine (short-acting) or oxymetazalone (longer-acting), both of which are in a class known as alpha agonists. More recently, the FDA has approved an over-the-counter intranasal corticosteroid triamcinolone, which goes by the name Nasacort Allergy 24 hour.”
Wedner notes that the antihistamine agents are fine for occasional use, but they do have a rebound effect in which the amount of congestion is greater after use than before. “This can lead to repeated use of these drugs, and to a condition called rhinitis medicamentosa,” he says. “The latter (Nasacort) is a steroid spray, which is also effective, but is better used under the direction of a physician.”
The recent approval for over-the-counter (OTC) sales of Nasacort was controversial. The American College of Allergy, Asthma and Immunology opposed approval due to concerns about misuse of the product without physician supervision.
“Now, with the availability of an OTC nasal steroid, many insurance companies will decide not to cover certain, if not all, prescription nasal steroids, which is a disservice to the patients/consumers,” notes Dr. Elyra Figueroa, an allergist with SSM Medical Group Sunset Hills and on staff at SSM St. Mary’s Health Center. “Patients will not have a choice, and they will be forced to use the OTC nasal steroid spray despite its ineffectiveness in relieving the allergy symptoms. Not all nasal steroids are the same, and not all patients effectively respond to the same medications.”
Prescription nasal sprays include other intranasal steroids and antihistamines. Patients who do not completely respond to OTC medications should see their primary-care physician or allergist for an appropriate prescription, says Dr. James Temprano, a physician with Mercy Clinic Allergy and Immunology. In some cases, the physician will prescribe a combination of steroid nasal spray and antihistamine nasal spray, which can be more effective than either medication alone.
“A person may experience relief of their allergies with certain OTC medications; but over time, they may eventually lose the effective response,” Figueroa says. “It is always safe to treat your immediate symptoms, and then seek medical care to ensure that the symptoms are only due to allergies and not something that may be more serious. It is not advisable to self-medicate without really knowing the underlying problem at hand.”