Nasal steroid sprays
Steroids are naturally-occurring hormones that are produced by the adrenal glands. The corticosteroids have potent anti-inflammatory effects and are very effective in treating allergic inflammation in the nose. They are a “controller” type medication and work best when used on a regular “preventative” basis. They are usually only available by prescription. With seasonal allergies, daily use of these sprays should begin 1 to 2 weeks before the allergy season and continue throughout the season. In people with relatively constant or perennial allergic rhinitis, particularly if symptoms have been unresponsive to OTC or other treatments, daily use of intranasal steroids has been found very effective in controlling symptoms, particularly nasal congestion. The addition of antihistamines to this nasal spray will likely give even better results.
Nasal steroids may also help improve the sense of smell, which is frequently diminished in allergic rhinitis. The medication may work by reducing swelling high up in the nose, where the area for smell is located. Decreasing the swelling allows more air (containing the odors) to reach the nerves that are responsible for the sense of smell.
Bag-like collections of fluid in the nasal membranes, called nasal polyps, are not uncommonly found in allergic rhinitis. Nasal steroids are helpful in shrinking nasal polyps and in preventing them from recurring.
Nasal steroids are available in two forms, aerosol and a spray pump (aqueous). The aerosol form resembles an asthma spray that delivers a predetermined dose of “dry” medication when activated. The more commonly used pump delivers a “water-based” spray, which may provide some moisturizing and soothing effect as well as an anti-inflammatory action. Patients who feel that the drip in their nose and throat increases when using the spray form may prefer the aerosol. In contrast, the spray is favored if the aerosol causes irritation or excessive drying of the nasal membranes.
In 1960, the first nasal steroid spray, Decadron Turbinaire, was introduced in the United States. Although very effective, too much of the drug was absorbed into the bloodstream, which resulted in side effects and limited its use. A different medication, beclomethasone (Qvar), was initially marketed in the 1970s and has been well tolerated. Others have been developed over the years, each having some variable effects on several types of cells that have a role in nasal inflammation.
Most of these intranasal steroids – budesonide, fluticasone, mometasone, ciciesonide, and fluticasone furoate – are faster acting and more potent than the other nasal steroids, with no significant difference in side effects.
The safety record of nasal steroids at the recommended dosages is excellent. Several studies conducted in the U.S., Canada, and Europe have documented the lack of significant systemic (general body) side effects. The common side effects occur locally in the nose, such as burning, stinging, dryness, and sneezing, and are usually reported with the use of dry aerosol sprays. Less common effects include headache and mild nasal bleeding. The latter can be avoided by proper spray technique. Shallow nasal ulcers are rare and can also be avoided by the use of proper technique.
Oral or injectable corticosteroids are occasionally prescribed for a few days in cases of severe allergic rhinitis with almost total obstruction of the nasal passages. In these cases, antihistamines, decongestants, and certainly nasal sprays are not likely to help. After the nasal passages have opened, however, the nasal sprays can be used to prevent further swelling.