Nasal sprays are the preferred treatment for allergies based on guidelines, but I hear many reasons why people don’t use them. Some simply think they don’t work well. Others have gotten nosebleeds. Some simply don’t like the bad taste they get from using them. If used incorrectly you’ll taste medicine or feel a drip down the back of your throat. Nose sprays won’t work as well if used incorrectly and they might even traumatize the nose, leading to nosebleeds – and that traumatizes some kids and many of their parents. Using them correctly can help alleviate symptoms of allergies and allow kids to enjoy the great outdoors!
Start by using the right nose spray – or sprays
There are many nose sprays out there, and you need to be sure you’re using the correct product for your needs.
First you’ll need to know that allergy symptoms are caused by histamines. In a person who is sensitive to pollen, dust mites, or animal dander, histamine is released in response to exposure. The histamine can cause swelling of the nose or eyes, watery eyes, runny nose, and itch. Allergy treatments either focus on limiting allergen exposure, preventing the histamine release, or blocking the histamine response.
All of the nose sprays used for allergy management (except saline) are listed on the American Academy of Allergy Asthma & Immunology ALLERGY & ASTHMA MEDICATION GUIDE.
Saline is great for the nose. I actually prefer saline washes over saline sprays, but the sprays are good too. See the 2nd video below for why I love saline washes.
Saline helps to remove the pollen from the nose to limit the exposure time. It also helps to shrink swollen nasal tissues, which makes it easier to breathe, and loosens mucus to help get it out.
Saline is just salt water, so if you want something natural, this is it!
Many parents ask how often to use saline sprays, and it really can be used whenever it’s needed. For prevention of allergies, use it after going outside and before bed during pollen seasons. If you’re using it because of a stuffy nose, you can use it several times a day.
Saline can be used even in babies. If you use saline spray or saline drops they can be followed with blowing the nose (or using an aspirator).
I love to use saline first followed by a good blow (or suction) to clear out the nose. After the nose is cleared, if that’s not sufficient to last the whole day, the other sprays are more effective. Saline doesn’t have medicine to last several hours, but can be used before medicated sprays to help them be more effective.
Mast Cell Inhibitor
Cromolyn sodium is a mast cell inhibitor that can be used for allergies. It prevents the release of histamine, which causes allergic symptoms.
Cromolyn sodium must be started 1-2 weeks before pollen season and continued daily to prevent seasonal allergy symptoms. It doesn’t work as well as corticosteroid nasal sprays, so I generally don’t recommend cromolyn.
These sprays can be used in children as young as 2 years of age.
The biggest drawback is that it is recommended every 4 hours, up to 4 times a day. This is really hard to keep up every day during allergy season.
If you don’t want the dry mouth or sleepiness associated with an oral antihistamine, you can try a nose spray antihistamine. Both oral and nasal antihistamines block the histamine from causing the typical allergy symptoms.
Antihistamine nasal sprays are approved for use down to 5 years of age.
Corticosteroid sprays tend to work better in the long run, but antihistamines are effective more quickly, so are good for rapid relief.
Antihistamine nose sprays are only needed once or twice a day, but since most kids like oral medicines better than nose sprays and you shouldn’t duplicate with both, I generally recommend that antihistamines be given orally.
Decongestant sprays are popular because they work quickly, but I rarely recommend them. The most common time I use them is to help get things stuck in the nose out.
Oxymetazoline hydrochloride (Afrin, Dristan, Sinex) and phenylephrine hydrochloride (Neo-Synephrine) are some examples of nasal spray decongestants. They are available over the counter.
Decongestant sprays shrink swollen blood vessels and tissues in your nose that cause congestion.
They can be used temporarily in kids over 6 years old, but if you use them longer than 3 days they actually cause more congestion.
Corticosteroid nasal sprays can be used in kids over 2 years of age and are the preferred treatment in allergy guidelines because they work well.
These can be used once or twice a day year-round or just as needed for allergy relief. It’s best to start them 2-3 weeks before allergy season starts because it does take time for them to be most effective. If you forget to use them until symptoms start, it may take several days to feel benefit.
Corticosteroid nasal sprays are available over the counter. There are many brands, including less expensive store brands. They have various steroid active ingredients, but all work pretty well.
I generally recommend the non-fluticasone brands for kids. This is not because of the effectiveness of fluticasone. It works. But it smells flowery and many kids will resist it due to the smell.
Nasal steroids are approved for use to help allergies, but they also decrease the amount of mucus from other causes, such as the common cold.
If you’re worried about the side effects of steroids, know that the risk is very low with nasal corticosteroids. The dose is extremely small and nasal corticosteroids are considered to be safe for prolonged use, even in kids.
Because they work so effectively and are well tolerated, nasal steroids are my preferred allergy medicine. They can be used with antihistamines if needed.
Ipratropium is the ingredient in anticholinergic nasal sprays. It helps to decrease a runny nose by stopping the production of mucus. One downside to ipratropium is that it doesn’t help congestion or sneezing very well.
Ipratropium nasal spray can be used over 5 years of age for up to 3 weeks at a time for runny noses from allergies and colds.
It is available by prescription only and I’ve never personally prescribed it. I personally think it has too many limitations and few benefits.
I have to admit that I’ve never even heard of this before, but I saw it on the American Academy of Allergy and Immunology site referenced above.
Alzair produces a protective gel-like barrier that evenly coats the nasal membranes and acts to block inhaled allergens within the nasal cavity. It’s available by prescription and looks like it’s approved for kids 8 and over.
One downside is that it needs to be used every time you blow your nose, so I don’t see it useful for school aged kids who have to go to the nurse for all treatments.
If anyone has used it, I’d love to hear your comments below about how it works!
Using nose sprays – it’s all about technique
Most people use nose sprays incorrectly, even if they pick the right one.
It’s not intuitive how to use them correctly. We tend to aim towards the center of the nose (which leads to nosebleeds) and inhale too much (which leads to icky drip down the throat).
Blow your nose. Or even better, rinse it with saline!
Take off the cap. You’d be surprised how many people skip this step.
Shake the bottle before each use. Think of Italian salad dressing. If you don’t shake it, you won’t get the good stuff.
You will need to be sure the tube inside the bottle has the liquid in it if it’s a new bottle or hasn’t been used in awhile. Much like when you get a new pump soap, you need to pump a few times to get results. Once you see the mist come out, you know the medicine’s ready to spray out.
Be sure to keep the bottle fairly upright during the spraying. See the 1st video below for why this is important.
Many people tilt their head back when using nose sprays. Don’t. You’ll get more drip down your throat and less effective spray onto the nasal tissues.
Look slightly down.
Put the tip of the spray bottle into the nose and aim toward the back of the eye on the same side of the head. Don’t ever aim toward the center of the nose. This causes nosebleeds. Use the right hand to spray the left nostril and the left hand to spray the right nostril to help get the proper positioning.
When the tip of the spray bottle is in your nose properly, squeeze the bottle.
Take the bottle out of your nose before releasing the squeeze. If it’s still in your nose, it will suck up whatever’s in there… including germs that can grow in the bottle.
Don’t feel like you need to inhale the stuff to your brain. The medicine works in the nose. Sniffing too much will make the medicine bypass your nasal tissue and go to the back of your throat. This misses the opportunity for the medicine to work where it’s supposed to work and it’s an icky feeling in the throat.
Sniff only enough after the spray to keep it from dripping out.
Wipe the top of the bottle clean before putting the lid back on.
Store the bottle out of reach of children and keep it out of the direct sunlight.
I’ve always said that one day I’d make videos of how to use nose sprays and nose wash systems correctly. I know this post is about nose sprays, but if your nose is plugged with mucus, the sprays just won’t work.
Nasopure has a number of videos on how to use nose washes that I frequently recommend. I don’t get paid at all from Nasopure — I just love the bottle and their website resources. And they’re even made in Kansas City!
Until now I haven’t found a great video on how to use nose sprays. Thanks to Dr. Mark Helm, I’ve finally found a great video for how to use nasal sprays.
I’m off the hook for making videos!
I like this video from AbrahamThePharmacist. He gives great information with a fun style.
I’ve shared the video below many times because it shows just how well a good nose wash can work. I warn parents that most kids don’t love it as much as this girl does. It usually involves a lot of crying and fighting in my experience, but it is so worth it! I don’t know where she got the tip for the syringe, but I’d recommend the Nasopure bottle as shown above.
And finally, for those who think their child is too young to do a nose wash, check out this cutie! She’s in several of the Nasopure videos but she shows perfect technique here!