Nasal Sprays and Management of Allergic and Non-Allergic Rhinitis

Nasal inhalant sprays are commonly recommended for the management of allergic and non-allergic rhinitis. Hayfever nasal sprays deliver medication directly into the nasal passages, where they have a localised effect on the lining of the nasal mucosa. When used properly, nasal sprays can effectively provide relief from sneezing, itching, nasal congestion, runny nose and postnasal drip, associated with rhinitis.

Not all nasal sprays used for the management of rhinitis are the same. Some nasal sprays contain medications to alleviate symptoms, while others contain medications to prevent symptoms from occurring. Choosing the right nasal spray is very important to ensure the optimal management of rhinitis. It is recommended individuals always seek advice from a doctor or pharmacist before commencing a nasal spray hay fever treatment.

There are several different types of nasal spray used within the management of allergic and non-allergic rhinitis.

Corticosteroid nasal sprays

– Rhinocort (budesonide)
– Nasonex (mometasone)
– Avamys (fluticasone)

Corticosteroid nasal sprays are the first choice treatment for moderate to severe rhinitis sufferers. Corticosteroids have a potent action on inflammation, and with regular use, prevent symptoms of rhinitis by reducing swelling and mucus production in the nose. Corticosteroids are more effective than oral anti-histamine medications in controlling symptoms of rhinitis. They do not however provide immediate relief from symptoms; maximum benefit comes with regular use. It can take up to 2 weeks for individuals to gain the full therapeutic benefit of treatment. Corticosteroids are safe to use long term. For individuals with seasonal allergies, it is recommended treatment with a corticosteroid nasal spray is commenced 1-2 weeks prior to the beginning of the problem season (NACA, 2012).

Sometimes a very congested or runny nose prevent corticosteroid nasal sprays from working effectively. A decongestant spray may be useful to clear the nose for the administration of the steroid spray. Nevertheless decongestant sprays should always be used with caution (see below).

Anti-histamine nasal sprays

– Azep (azelastine)
– Zyrtec (cetirizine)
– Telfast (fexofenadine)
– Claratyne (loratadine)

Anti-histamine nasal sprays help to reduce and alleviate symptoms of rhinitis, by blocking the action of histamine, which is released upon exposure to an allergen or trigger. They provide fast acting hay fever relief from symptoms (usually within 15 minutes), however are not as effective as corticosteroids in controlling severe nasal congestion and drip. Anti-histamine nasal sprays do not need to be used regularly to be effective, rather they can be used as symptoms arise. Anti-histamine nasal sprays can provide relief from symptoms of rhinitis for up to 24 hours at a time.  

Combination anti-histamine and corticosteroid nasal sprays

– Dymista (azelastine + fluticasone)

There are some combination anti-histamine and corticosteroid nasal sprays available which offer the advantages of both medications.

Decongestant nasal sprays

– Flo (zylometazoline)
– Sudafed (oxymetazoline)
– Nyal (phenylephrine)

Decongestant nasal sprays are topical vasoconstrictive medications, which relieve nasal congestion by prompting the small blood vessels in the nose to constrict and become narrowed. When the blood vessels are narrowed, blood flow to the lining of the nose is restricted. This reduces swelling and opens the nasal passages.

Decongestant nasal sprays have a fast onset on action and very often relieve nasal congestion almost immediately. However they should always be used with caution. Decongestants must not be used for longer than 3-5 days as they can begin to have a rebound effect and cause the nasal passages to become inflamed, swollen and congested. This condition is called rhinitis medicamentosa (Davis, 2013).

Non-medicated saline nasal sprays

– Fess

The regular use of a non-medicated saline nasal spray is very beneficial for relieving nasal congestion associated with rhinitis. Saline sprays help to flush away problem allergens and irritants from within the nose, and keep the nose clear by loosening and thinning mucous. Saline sprays are gentle, and soothe and moisturise inflamed nasal membranes. The use of a saline solution to clear a congested nose prior to using medicated nasal sprays, is sometimes recommended to enhance the absorption and effectiveness of medicated sprays (Care Pharmaceuticals, 2015).

References:

Australasian Society of Clinical Immunology and Allergy [ASCIA]. 2015. Is it allergic rhinitis (hay fever)? Information for patients, consumers and carers. Accessed August 14, 2015, http://www.allergy.org.au/images/pcc/ASCIA_PCC_Is_it_allergic_rhinitis_2015.pdf

Care Pharmaceuticals. 2015. Nasal & Sinus Congestion. Accessed August 19, 2015, http://www.fess.com.au/about-fess/nasal–sinus-congestion

Davis, S. 2013. Nasal Sprays. SA Pharamacist’s Assistant 13, 3, 14-16. Accessed August 19, 2015, http://reference.sabinet.co.za/sa_epublication_article/mp_sapa_v13_n3_a4

National Asthma Council Australia [NACA]. 2012. Allergic Rhinitis and Asthma: Information Paper for Health Professionals. Accessed August 14, 2015, http://www.nationalasthma.org.au/uploads/publication/allergic-rhinitis-asthma-hp.pdf