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How to Treat Nasal Allergies

There's been a dramatic evolution of treatments for allergy sufferers in the past few years. A safe nasal spray can nearly eliminate symptoms of nasal allergies. New antihistamine drugs positively won't make you sleepy. And don't forget nasal saline sprays.

One of the best treatments for nasal allergies is Flonase or Nasonex: cortisone in spray form. If you use it on a regular basis during the allergy season, your allergy symptoms should essentially disappear. So you can expect your nasal congestion, postnasal drip, sneezing, and watery eyes will be a lot better.

Flonase is different from other allergy medications in important ways:

  1. It may take a few days before it works. Most allergy drugs work as soon as you take them. Flonase or Nasonex may take a week. Not only that, if you change the dose, it takes a few days before the effects of the change show up.
  2. Flonase and Nasonex don't treat allergy symptoms. They prevent them in the first place. However, you may have to keep using the medication on a regular basis for this preventive effect to take place. After the allergy season is over, stop the drug and see if your symptoms don't stay away. If you usually have allergy symptoms all year, you'll have to use Flonase continuously to have an uninterrupted effect.
  3. We can't tell in advance how much you'll need. Some people need more, some less. But the correct dose is easy to figure out. If your nose is too wet (runny, congested), use it more often: two or three squirts a day in each nostril rather than one. If your nose gets too dry (it may actually bleed), use Flonase less often. Don't forget it takes a few days to tell what the effect will be of a change in dose.
  4. You may have mild local irritation for a few seconds after spraying when you first use this medication. But this side effect usually goes away soon.

There are now three antihistamines on the market that won't make you drowsy. One, Claritin, is available over the counter. Others require a prescription: Clarinex and Allegra. They work well, have few side effects, and don't interact with other drugs. However, you may notice drying of your nose and mouth, and you should not use these medications if you have serious liver or kidney problems. One pill a day works well. One caution: When there's a "D" added to the name (Claritin D and Allegra D), the drug also contains a decongestant that can make you edgy.

One of the simplest and most effective nose and sinus treatments is nasal irrigation: cleansing your nasal passages with a "normal saline," a dilute solution of salt and water that's soothing and cleansing like artificial tears. Clean once or twice daily with a salt solution that's neither too concentrated nor too dilute. Spray gently but deeply enough in your nostrils to rinse out thick mucous. Check out "SaltAire Sinus Relief," "NielMed Sinus Rinse," and Waterpik's "Gentle Sinus Rinse." If you want something simple, sometimes the little Ocean Nasal Spray (or the generic equivalent) is all you need. The only problem with the Ocean Spray is it's a fine mist. So the saline doesn't get very far into your nostrils. It's good for moisturizing, but it won't clean out the mucous.

Questions and Answers About Flonase and Nasonex

How are these inhalers different from the nasal sprays I can get without a prescription? Over-the-counter nasal sprays like Afrin and Dristan Mist are decongestants. They are addicting if used for more than three days. Flonase is a completely different medication, just as a penicillin pill and an aspirin are different even though they look the same. In fact, Flonase is the best treatment for people addicted to spray decongestants.

Won't I get side effects from the cortisone in these sprays? It's true that cortisone pills or injections can cause serious side effects including weight gain, loss of bone mineral, etc. But you won't get total body side effects just from cortisone skin cream -- it stays on your skin, period. In the same way, Nasonex or Flonase (they're virtually identical drugs) stay put in your nostrils and are not absorbed into the blood stream. Using too much of this medicine can, however, cause thinning and drying of nasal tissues.

Will I become dependent or addicted to Flonase or Nasonex? No, but you may have to keep using it throughout your usual allergy season.

Are there any precautions in using this medication? Be sure to point the spray directly into your nostril, rather than toward the septum (the wall in the middle between the nostrils).

Last updated Sun, Nov 1, 2009

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©2011, James Gagné, MD