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Published: May 17, 2015 06:00 AM
Both are good options. Research suggests that nasal steroid sprays like fluticasone (Flonase Allergy Relief) and triamcinolone (Nasacort Allergy 24 HR) are the most effective stand-alone medications available for relieving congestion, sneezing, postnasal drip and other allergy symptoms. For that reason, many experts consider them the best first option for allergy sufferers. Plus, Flonase and Nasacort are both available as over-the-counter medications.
One drawback of Flonase and Nasacort is that it can take several hours before you begin to feel some relief from your allergy symptoms. And it may take several days before you get the full benefit of the drug. This means to get the best results, you should use them every day during the allergy season and not just when you have a flare-up.
To get the most benefit from the steroid sprays, it’s important to follow the proper technique to make sure the medication stays in your nose and doesn’t run down the back of your throat. First, keep your head upright and don’t tilt it backwards. Insert the tip of the device into your nose, aiming to the outside of your nasal passage (away from the cartilage that divides the two sides of your nose). A gentle sniff after your spray is enough. A powerful sniff could make it drain down your throat. If that happens, spit it out.
The steroid sprays are usually well tolerated, but some people may experience nosebleeds and nasal dryness and irritation.
Find out why it's not a good idea to take Benadryl long term.
If your child uses one of these sprays, another potential side effect is a slightly reduced rate of growth. To reduce the risk of that, don’t allow them to use it for longer than two months a year. If their allergy symptoms last for longer than that, talk to your doctor about other options. And tell your doctor if your child also uses inhaled steroids to treat asthma or a topical steroid for itchy skin—using those with a steroid spray could increase the risk of slowed growth. Another option is to try a cromolyn spray instead. It’s not as effective, but it is not associated with growth problems and is very safe for children.
If the steroid sprays don’t provide enough relief for you, considering adding an antihistamine spray (such as azelastine or olopatadine). Those are available by prescription, but studies show the combination can provide more relief than the steroid spray alone. Another option is an antihistamine pill, like fexofenadine (Allegra and generic), loratadine (Claritin and generic), or cetirizine (Zyrtec and generic). And if you’re already taking one of those and it’s working to relieve your symptoms, our medical advisers say there’s no need to switch or add a steroid or antihistamine spray.
Editor's Note:
These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
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By Beth Coopman, Pharm. D.
In this three-month series of articles, we’ve been tackling the topic of seasonal allergies, giving you some tips and tricks to stay ahead of your allergy symptoms and keep you as healthy as possible.
You can revisit April’s article about allergen prevention and oral antihistamines by clicking here. This month we focus on nasal spray options for helping with allergy symptoms.
Which Nasal Spray Brand is the Best?
Flonase, Rhinocort, Nasonex and Nasacort are examples of steroid nasal sprays and a great starting point for addressing and minimizing uncomfortable allergy symptoms like sinus congestion, sneezing, itchy or runny nose and itchy/watery eyes.
In fact, for persistent allergy symptoms, nasal steroids are the most effective option. They all work similarly, have generic options and, excepting Nasonex, are available over-the-counter (OTC). Generic nasal steroids are comparable to brand name products and save you money.
For those with extra nasal sensitivities, Flonase Sensimist, Nasacort and Rhinocort are all scent- and alcohol-free. Flonase Sensimist and Rhinocort also have less liquid per spray, resulting in less nasal drip.
What is the Best Way to Use a Nasal Spray?
To limit nosebleeds and irritation, nasal sprays should be pointed slightly away from your septum (the middle hard part of your nose). The alternate-hand method of administration, spraying your left nostril with your right hand and your right nostril with your left hand, naturally tilts the nasal spray away from your septum to promote proper technique.
Are Allergy Pills or Nasal Sprays Better?
There are notable differences between using oral antihistamine allergy medications versus nasal steroids.
- A nasal spray is absorbed exactly where it’s needed – directly into the sinus cavity. For this reason, warnings about oral steroids do not apply. Worried about swallowing some from it leaking down the back of your throat? Don’t be. If you do happen to swallow some nasal spray (very common), it is unlikely to wind up in the blood in any quantity. This is because the stomach absorbs most of it and the liver metabolizes the rest. In contrast, oral allergy medications are absorbed and metabolized to reach our bloodstream which can result in full-body side effects like tiredness, dry mouth, constipation, vomiting and headache.
- Nasal steroids are effective for sinus congestion. Oral antihistamines are not. If congestion does persist after using a nasal steroid, however, a few days of the oral decongestant pseudoephedrine may be beneficial. Use caution with pseudoephedrine because of possible increases in blood pressure and heart rate.
- If itchy, watery eyes persist with a nasal steroid, adding antihistamine eye drops is recommended. For most, adding an oral allergy medication to a nasal steroid does not work better. Ketotifen, and now Pataday, are allergy eye drops available OTC.
- If quick relief is what you need, you’ll want to know that nasal steroids take longer to “kick in” than oral allergy medications. For this reason, using oral allergy medication short-term for immediate relief and nasal steroid sprays long-term for persistent allergies makes sense. Some may notice relief a few hours after starting a nasal steroid. However, the maximum benefit is seen after at least two weeks. Start nasal steroids about two weeks before allergen exposure.
Other Nasal Spray Options and How they Compare
Nasalcrom and Afrin are other popular allergy nasal sprays.
Afrin works quickly and is effective for congestion. However, Afrin should only be used for up to three days, as directed on the label. If used longer, recurrent and worsening nasal congestion may occur. Oral decongestants may be a better option due to the challenges with Afrin’s dosing guidelines.
Nasalcrom prevents sneezing, allergic sinus congestion and runny or itchy nose and should be started one to two weeks before allergen exposure. Nasalcrom is most useful for those with inadequate congestion relief with other treatments or if parents have safety concerns using other allergy medications.
Nasal saline solutions can be used to for nasal allergy symptoms to clear the nose of mucus, relieve nasal irritation and dryness. All ages can use nasal saline and because it has few side effects, it is a good first choice in pregnancy, breastfeeding and children with allergy-related sinus congestion.
Flonase vs. Nasonex vs. Afrin and others
| Brand Name | Generic Name | Age Allowed | Onset of Effect | Peak | Duration | Common Side Effects | Cost/Bottle |
| Flonase ClariSpray | Fluticasone Propionate | ≥ 4 yrs | 12 hrs | 2 weeks | 24 hrs | Headache Nose irritation Bloody nose | $14 |
| Flonase Sensimist | Fluticasone Fumarate | ≥ 2 yrs | 12 hrs | 2 weeks | 24 hrs | Headache Bloody nose | $23 (no generic) |
| Nasonex Rx only | Mometasone Rx only | ≥ 2 yrs | 12 hrs | 2 weeks | 24 hrs | Headache Bloody nose | $50 |
| Nasacort | Triamcinolone | ≥ 6 yrs | 12 hrs | 2 weeks | 24 hrs | Bloody nose Sore throat | $13 |
| Rhinocort | Budesonide | ≥ 2 yrs | 12 hrs | 2 weeks | 24 hrs | Bloody nose Sore throat | $14 |
| Afrin | Oxymetazoline | ≥ 6 yrs | rapid | 15 min | 12 hrs | Nasal burning or stinging | $4 |
| Nasalcrom | Cromolyn | ≥ 2 yrs | 1 wk | 2-4 weeks | 6-8 hrs | Nasal stinging sneezing | $18 |
| Ocean Saline | Sodium Chloride 0.65% | All | rapid | rapid | 4-6 hrs | Nasal discharge Nasal burning | $4 |
*Reference: Micromedex® and pricing estimates from Walmart.com and Goodrx.com
** Cost listed is for generic product and cost decreases per dose as package size increases.
The Best Nasal Spray is the Best Nasal Spray for You
Be an informed health care consumer. Know how your prescription choices impact your plan’s costs. Ask your doctor or pharmacist about cost alternatives for your prescriptions or OTC selections. If you have any questions pertaining to this article, email the pharmacy team at .