Nasal Allergy Medications (cont.)
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. With seasonal allergies,
daily use of these sprays should begin 1 to 2 weeks before
the allergy season and continue throughout the season. In
year round or perennial allergic rhinitis, particularly if
unresponsive to 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.
Allergy Assist
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.
Allergy Fact
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, was initially
marketed in the 1970s and has been well tolerated.
Table VI: Common Intranasal Steroids (See Appendix.)
| Generic Name |
Brand Name |
| beclomethasone
| Beconase, Vancenase (pump, aerosol) |
| flunisolide
| Nasarel, Nasalide (pump) |
| triamcinolone
| Nasacort, Nasacort AQ (pump, aerosol) |
| budesonide
| Rhinocort (aerosol) |
| fluticasone
| Flonase (pump) |
| mometasone
| Nasonex (pump) |
The latter of these intranasal steroids - Rhinocort,
Flonase, and Nasonex - are faster acting and more potent
than the other nasal steroids, with no 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 good spray technique. Shallow nasal ulcers are
rare and can also be avoided by the use of good
technique.
Corticosteroids are occasionally prescribed orally 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.
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