How To Use Nose Sprays Correctly

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

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.

Antihistamine

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

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.

Steroid

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.

Anticholinergic

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.

Allergen blocker

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).

Getting ready

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.

Positioning

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.

Spraying

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.

Finishing up

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.

For more

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!

New Allergy Guidelines for People Over 12 Years Old

If you or your kids suffer from allergies, I’m sure you want to know how to best manage them. In addition to limiting exposure, medications can be a big benefit. Treatment of allergies can be directed by new guidelines. These guidelines cover the initial medical treatment of seasonal allergies in people 12 years and older.

The American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology (AAAAI and ACAAI) have published new guidelines in the Annals of Internal Medicine for the initial medical treatment of seasonal allergies in people 12 years and older.

The guidelines for treatment of allergies essentially state:
  • Use steroid nasal sprays first without an oral or nasal antihistamine. Many intranasal steroids are available over the counter without a prescription. A great list is included on the AAAAI website. (Be careful to not to confuse them with the nasal antihistamines, which are in the same chart but identified in the column titled “Class”.)
  • In those over 15 years, the nasal steroid is preferred over a leukotriene receptor antagonist (ie Singulair or montelukast). For those with asthma, the leukotriene receptor antagonist might offer an additional benefit for asthma, but it is not the preferred treatment in either allergies or asthma. (I think the age change is simply due to the ages studied but it was not specified.)
  • In moderate to severe allergic conditions, a combination of nasal steroid and nasal antihistamine can be considered.

These recommendations are based on a review of many studies to show what treatments worked and what didn’t.

They also took into consideration the fact that oral antihistamines can cause sedation and the nasal antihistamines do not.

In general the nasal steroids worked better than other treatments. They did note that for people who do not tolerate nasal sprays, alternates would be oral antihistamines or leukotriene receptor agonists.

UPDATE 3.27.18

I have a new blog on the general identification and treatment of allergies. Check out Spring is Here!

 

Which Supplements Help Prevent and Treat Infections?

I don’t know anyone who wants to get sick, so most of us try our best to avoid illnesses. We do this by washing our hands and encouraging our kids to cover their coughs. Avoiding sick people as much as possible can help. We should routinely get enough sleep (most Americans fail in this regard) and eat more fruits and vegetables (again, most of us fail to get the minimum recommended amounts of plants in our diets). Can supplements help prevent and treat infections?

What will boost our immune system?

I’m often asked if vitamin C, zinc, or essential oils will help various ailments or boost our immune system.

I know that many people try natural products that are promoted to boost or support the immune system. They’re hopeful that stimulating immune system activity will help the body fight off a virus.

But research doesn’t show that our immune system works that way.

A virus can cause illness even in healthy people.

If you want to read an in-depth summary of how our immune system works, the Skeptical Raptor has done a nice job discussing the complexities and why it’s not as easy as eating healthy and taking supplements.

Not to mention the fact that we don’t necessarily want an overactive immune system, which is associated with allergies and autoimmune diseases.

Lacking regulation

One thing we need to remember first and foremost in the discussion of supplements is that this is an under-regulated industry.

The FDA is not authorized to review dietary supplement products for safety and effectiveness before they are marketed. For this reason I hesitate to recommend supplements at all.

Even though I do recommend Vitamin D supplements because studies support the need for additional Vitamin D in most people, I cannot endorse one particular product.

Over the years many supplements, homeopathic products and herbs have been reported to have significant variances in amounts of product and unnamed contaminants, including lead and other hazards.

Summaries of supplement and other “natural treatment” effectiveness:

Probiotics

Probiotics may actually help prevent the number of infections.

There are many, many types of probiotics, so further studies are needed on how to choose the best strain.

Zinc

Zinc has been shown to help prevent upper respiratory tract infections in children and teens and to decrease the duration of the common cold symptoms.

It is best given as a lozenge to help with absorption. Intranasal zinc has been linked to a permanent loss of smell and should not be used.

High doses can cause significant side effects, so talk to your doctor and pharmacist before supplementing.

Nasal rinses

Nasal saline rinses show benefit in treating symptoms of upper respiratory tract infections.

Learn how to do these correctly before trying it.

I often recommend Nasopure products as an unpaid endorsement. They’re a local company with a very helpful website. Use their library to learn how to properly use nasal rinses in kids as young as 2 years of age.

Honey

Honey may reduce the frequency of cough and improve the quality of sleep for children with the common cold.

Honey should never be used in children younger than 1 year of age because of the risk of botulism.

Echinacea

Echinacea has consistently been shown to be ineffective in many studies.

I know that many people have heard of its benefits, so if you aren’t convinced that you shouldn’t waste money on it, see the NCCIH’s Echinacea page.

Garlic

Garlic shows overall low evidence of benefit.

Vitamin C

Vitamin C can shorten the duration of illness mildly with daily supplementation.

Herbal Medicines

Chinese herbal medicines do not have high quality studies so effectiveness is unknown.

Geranium extract (Pelargonium sidoides) has insufficient evidence of benefit for cold and cough symptoms.

Turmeric‘s supposed anti-inflammatory properties have not been shown to be effective by research.

Essential oils

Essential oils have the potential for beneficial effects – but they also have the potential for adverse reactions.

Although they are touted as a cure for many ailments, published studies regarding the uses of aromatherapy have generally focused on its psychological effects on stress and anxiety or its use as a topical treatment for skin conditions.

Both Young Living and dōTERRA have received warning letters from the FDA about improper marketing and unsubstantiated claims for uses of their oils.

While many people think essential oils are safe, they can lead to significant problems.

Some people suffer from allergic reactions to oils.

They can increase sensitivity to the sun when applied topically.

Tea tree oil and lavender have estrogen-like effects and caution should be used with these.

Some of these substances can even lead to seizures, liver damage, and death if used improperly. Ingestion of the oils is a growing concern – as more households have them, more children are ingesting them.

For more:

Alice Callahan’s “Immune-Boosting” Supplements Won’t Protect You from Back-to-School Germs is a great review of many of the supplements touted to prevent or treat illnesses. Her background in nutrition provides a solid base for reviewing claims that many of us don’t understand completely.

Cautious use

Generally supplements are not recommended, but if you choose to use them, use them cautiously.

Read ingredients, but no guarantees

Supplements contain a wide variety of ingredients – including vitamins, minerals, amino acids, and herbs. Remember that these are unregulated, so what is on the package isn’t necessarily true.

Research has confirmed health benefits of some dietary supplements but not others. The woo can be strong in this area, so be cautious where you get your information.

Supplements have been known to include unlisted ingredients and to have inconsistent levels of product. When they are recalled, there is no mechanism in place to identify and notify people who have purchased affected products.

Learn from reliable sources

Find a reliable source to evaluate effectiveness and risks.

Some reports have shown that people who take supplements have higher risks of cancer, liver damage, birth defects, bleeding, and other health problems.

When looking for information, use noncommercial sites (National Institutes of HealthFood and Drug AdministrationUS Department of AgricultureNational Center for Complementary Health) rather than depending on information from sellers.

Natural does not mean safe

I’ve always said that I wouldn’t give my picky eater marijuana to stimulate his appetite and encourage him to eat. Not even if it was organic. That usually gets the point across. You need to know the risks of a product, even if it’s natural.

Talk to your doctor & pharmacist

If supplements will be taken, talk to your doctor and pharmacist about drug interactions.

Sometimes it’s difficult to know the risks because not all ingredients are included on the label and not all ingredients have been well studied, especially in combination with other supplements and medications.

Pregnancy

Most dietary supplements have not been tested in pregnant women, nursing mothers, or children.

Remember just because something’s natural doesn’t mean it’s safe. Arsenic is natural but I wouldn’t advise taking it in high doses.

If something sounds too good to be true, it probably is

There are no miracle cures.

Avoid being manipulated by advertising.

It’s easy to fall prey because we all want to feel better quickly and parents want their kids to be healthy.

But if it claims to be 100% effective or to have no side effects, it’s probably false advertising.

Personal accounts of something working are as likely to be based on bias or coincidence as to be from real benefit.

Rely on large clinical studies that have been reproduced by other researchers.

For more:

Dr. Chad Hayes has a very long, but wonderful post on how many of the integrative medicines are not simply not beneficial but potentially dangerous – Citations Needed: The curious “science” of integrative medicineMy experience at “Get Your Life Back NOW!”

A bit on antibiotics

This post isn’t about antibiotics, but they don’t work against viral illnesses any better than supplements.
They don’t prevent the development of ear infections or pneumonia, so even if your child seems to always develop these complications, your doctor should not prescribe them preventatively.
Don’t use antibiotics for routine upper respiratory infections, stomach bugs, and other viral illnesses.

Do you know what really boosts your immune system?