Nasal Sprays Help Manage Allergic Rhinitis

OTC Guide2023 OTC Guide

Study results indicate that taking these products together reduces the risk of rebound congestion typically seen with intranasal decongestant therapy.

Allergic Rhinitis (AR) is a common condition affecting 40 million to 60 million individuals in the United States.1 Congestion, coughing, red and watery eyes, runny nose, and sneezing typically occur. Additionally, AR can be seasonal and occur in spring, summer, and early fall.1 Triggers include mold spores or pollen from grass, trees, and weeds.1 Individuals may also experience perennial symptoms caused by cockroaches, dust mites, hair, mold, or pet dander.1 Health care professionals can educate patients about OTC intranasal spray medication options to manage AR symptoms in adults.

Avoiding triggers, along with taking medications, can relieve AR symptoms. Evidence demonstrates that saline nasal spray can alleviate dry nasal passages and reduce congestion.2 Patients can use saline nasal spray as frequently as needed without the risk of rebound nasal congestion. Although nasal spray products typically contain sterile water premixed, patients must prepare nasal irrigation devices such as neti pots. Only distilled, sterile, or boiled and cooled tap water should be used for nasal irrigation devices, to prevent a serious brain-eating amoeba (Naegleria fowleri) infection.3

Intranasal corticosteroids (INCSs) are recommended as first-line medications for managing AR symptoms.2 There are a variety of OTC nasal spray options, such as fluticasone (Flonase), mometasone (Nasonex 24HR), and triamcinolone (Nasacort Allergy 24HR). The typical dose for INCSs is 2 sprays in each nostril once daily for adults.2 These are considered effective and safe medications with a minimal risk of systemic adverse effects (AEs) when administered properly. Before using these medications for the first time, it is important to prime them by shaking and releasing a fine mist away from the face. The most common AEs are dryness in nasal passages, headaches, nosebleed, sneezing, and throat irritation.4

Intranasal antihistamines (INAHs) have a faster onset of action of 15 to 30 minutes for AR symptoms compared with approximately 150 minutes for oral antihistamines.2 Additionally, INAHs can be used in combination with INCSs to manage moderate to severe AR symptoms.2 Azelastine (Astepro Allergy) is an example of an OTC INAH that is effective at improving nasal symptoms.2 Azelastine can be administered either once daily as 2 sprays in each nostril or twice daily as 1 to 2 sprays in each nostril every 12 hours.5 The most common AEs associated with azelastine are a bitter taste and drowsiness.5 The bitter taste can be minimized by not tilting the head back right after administering the sprays. This prevents the medication from dripping into the throat.

Intranasal decongestants can relieve congestion, but they should not be used as monotherapy for more than 5 days because of the risk of rebound nasal congestion.2 Oxymetazoline (Afrin nasal spray) is an example of an OTC intranasal decongestant.

Intranasal decongestants can be given in combination with INCS for up to 4 weeks to manage AR symptoms.2 Study results indicate that taking these products together reduces the risk of rebound congestion typically seen with intranasal decongestant therapy.2

About the Author

Jennifer Gershman, PharmD, CPh, PACS, is a drug information pharmacist and Pharmacy Times contributor residing in South Florida.


1. Butler S, Rubin-Miller L, Bowlin G, et al. Pandemic or not: strep-testing guidance overlooked for the majority of prescriptions. Epic Research. November 30, 2021. Accessed January 7, 2022.

2. Cohen JF, Pauchard JY, Hjelm N, et al. Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat. Cochrane Database Syst Rev. 2020;6:CD012431. doi:10.1002/

3. Kalra MG, Higgins KE, Perez ED. Common questions about streptococcal pharyngitis. Am Fam Physician. 2016:94(1):24-31.

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