Nasal Steroid Sprays

Nasal Steroid Sprays ShutterStock

If your allergy symptoms last longer than 14 days, it could be time to see an allergist. Most people that experience lingering common colds or ones that turn into bacterial sinus infections have inhalant allergies. Those allergies are the underlying culprit, predisposing them to infections and persistent colds.

Due to their high efficacy, safety, and ease of use, nasal steroid sprays are considered the first line of treatment for allergic rhinitis and other nasal conditions. These sprays relieve nasal congestion, sneezing, watery eyes, runny nose, itchiness, altered sense of smell, post-nasal drip, headaches, and tenderness over the sinus region.

Nasal steroid sprays are the single most effective medication for allergic rhinitis. They have been used safely for decades. In fact, they are so safe that the FDA even approves their use in children, with some preparations approved for those as young as two years. Many are now available over-the-counter for relatively low cost.

How Do Nasal Steroids Work?

Nasal corticosteroids are known for their excellent anti-inflammatory properties. They inhibit the production of multiple inflammatory mediators (e.g., histamine, prostaglandins, leukotrienes, and cytokines). Inflammatory mediators cause the swelling, congestion, and drainage of the mucous membranes in the nose and sinuses.

Inhibiting the production of those inflammatory mediators allows easier clearance of accumulated mucus (slimy fluid), relieving congestion in the nose and sinuses. Nasal steroids reduce mucous membrane swelling in the nose from allergy and infections, sinusitis, nasal polyps, and other non-specific cases - without thickening nasal secretions.

How to Use Nasal Steroids?

Although more powerful than over-the-counter topical decongestant sprays, topical nasal steroid sprays are slower since they do not give immediate relief. Unlike topical decongestant sprays, nasal steroid sprays are not addictive, and one does not develop tolerance to rebound effects. Therefore, it is vital to use the spray regularly (not on an "as needed" basis) because missing doses will decrease its effectiveness.

To achieve maximum improvement, nasal steroids need to be used regularly for at least one month for nasal congestion, two months for sinus congestion, and three to four months for ear congestion and pressure. We recommend that they be used daily until your allergies are resolved by the process of desensitization through sublingual allergy drops.

After the desired relief is obtained, it is recommended to reduce the maintenance dose to the smallest amount necessary to keep symptoms under control. By keeping the application to a minimum, you can minimize cost and rare side effects. Your nose should be examined at least yearly by a physician when taking this medication for prolonged periods.

Commercial Nasal Steroid Sprays

Brand Name Recommended Adult Starting Dose Age Approved
Flonase® Nasal Spray (generics available) 2 sprays each nostril once daily 3 & up
Dymista® Nasal Spray* 1 spray each nostril twice daily 12 & up
Nasacort AQ® Nasal Spray 2 sprays each nostril once daily 6 & up
Nasarel® Nasal Spray 2 sprays each nostril 2 times daily 6 & up
Nasonex® Nasal Spray (Generics Available) 2 sprays each nostril once daily 2 & up
Rhinocort Aqua® Nasal Spray 1 spray each nostril once daily 6 & up
Omnaris® Nasal Spray 2 spray each nostril once daily 6 & up
QNasl® Nasal Aerosol 2 puffs each nostril once daily 12 & up
Veramyst® Aqua Nasal Spray 2 sprays each nostril once daily 2 & up
Zetonna® Nasal Aerosol 1 puff each nostril once daily 12 & up
*Combination of azelastine hydrochloride and fluticasone propionate

Some of these preparations are FDA-approved for use in children starting from a certain age. Doctors have sagely prescribed these medications (off-label) for younger children.

Directions for Use


Shake the bottle before each use


Gently blow your nose (to clear any nasal secretions)


Lean forward and hold the bottle straight


Insert the tip of the spray bottle into one of the nostrils


Direct the nozzle slightly up and in the outward direction*


Spray without sniffing to prevent spray from entering the throat


Hold your breath while activating the dose


Repeat on the other nostril

*Do not direct the spray towards the middle of the nose or nasal septum (the thin cartilaginous wall that separates the nose into two halves). Spraying towards the center may increase the risk of bleeding, crusting (excessive mucus accumulation), or other complications.

Possible Side Effects and Concerns

Intranasal steroids have been in use since the 1970s as one of the safest and most effective drugs marketed to treat nasal disorders. New generation nasal steroid sprays have up to a 100-fold decrease in bioavailability (i.e., theoretically safer) compared with older generation nasal steroids. Even these older nasal steroids were nearly complication-free. However, some side effects may occur, including:

  • Nose or throat irritation, cough, and headaches.
  • Nosebleeds, especially when sprayed toward the middle of the nose. If nosebleeds occur, discontinue the spray (continued use risks forming a septal perforation).
  • Increased susceptibility of glaucoma in older adults.
  • Decreased growth rate in children (although this has not been proven despite decades of use and extensive study).

People who are not using corticosteroids in any other form (oral, pulmonary, injection) except via the nasal route have a low risk of experiencing side effects.

The incidence of corticosteroid complications is directly proportional to the lifetime absorbed dose. Minimize risk by reducing the dose as soon as relief is obtained and then increase use only during seasons when symptoms flare up.

Patients with systemic fungal infections, tuberculosis, ocular herpes, nosebleeds, and recent exposure to chickenpox or measles should not use this medication.