Nasal Sprays: How They Work and How to Use Them Correctly

Along with cooler temperatures and vibrant leaf colors, fall brings allergens that trigger frustrating symptoms for many people in East Tennessee. Ragweed, for example, releases pollen from August to November, reaching highest levels in mid-September. Its effects can include runny and stuffy noses, itchy and watery eyes, coughing, and sneezing. Nasal sprays often can provide effective relief for congestion from allergies and other causes.

Types of Nasal Sprays and How They Work

Nasal sprays work by delivering a fine mist of medicine directly to the nasal lining. They reduce the body’s immune response to allergens and other irritants. Available over the counter and by prescription, sprays typically come in pressurized canisters or pump bottles.

Nasal spray treatments differ based on the medications they deliver. The four primary types are saline sprays, steroids, antihistamines, and decongestants.

Saline Nasal Spray

Saline sprays and rinses relieve nasal congestion and soothe irritation caused by allergic rhinitis (hay fever) and other nasal conditions. Available over the counter, these salt-water mixes are drug-free. They can be used daily to hydrate and flush irritants from the nose.

In a recent article about seasonal allergies, Nick Panella, MD, from Ear, Nose, and Throat Consultants of East Tennessee, recommends nasal saline as an effective option for relieving congestion, inflammation, sneezing, and other nasal allergy symptoms.

“Allergens like pollen can accumulate in your nasal lining throughout the day,” says Dr. Panella. “Saline sprays rinse allergens from the nose and keep nasal passages moist and healthy.” Saline is also effective in loosening hardened mucus to prevent cracking and bleeding, and in rinsing away debris and scabbing after sinus surgery.

Steroid Nasal Spray

If saline alone does not provide relief, Dr. Panella recommends an over-the-counter nasal spray like a nasal steroid or antihistamine spray to reduce symptoms.

Also known as corticosteroids, steroid nasal sprays fight inflammation and swelling by inhibiting the release of inflammatory substances and weakening your body’s response to irritants. Steroid sprays such as Flonase^® and Nasacort^® are available without a prescription and are safe for daily use. The generic versions of these medications are also effective in treating symptoms. For maximum effect, Dr. Panella recommends starting use before allergy season begins and using regularly throughout the season.

Antihistamine Nasal Spray

Antihistamine sprays like AstePro^® and their generics work similarly to oral allergy pills but are applied topically to the nose. When allergy sufferers are exposed to allergens like dust, pollen, or pet hair, they produce a chemical called histamine. A histamine reaction causes blood vessels to expand and increases mucus production. This results in symptoms like stuffy or runny nose, sneezing, sore throat, and cough.

“Antihistamine sprays help suppress your histamine release,” says Dr. Panella. “Some also contain a nasal steroid to further alleviate symptoms. Be sure to consult your physician to determine your best treatment option.”

Nasal Decongestant Spray

When you’re sick, the tissues in your sinuses become inflamed and swollen, making it harder to breathe. Nasal decongestants like Afrin^®, Dristan^® and generic versions target receptors in your nose. They shrink blood vessels and open nasal passages, providing nearly immediate relief from nasal congestion. However, it’s important to note that they’re meant only for short-term use (3-5 days) as noted on the label.

Nasal Sprays and Inflammation

Nasal sprays work by targeting inflammation to reduce swelling and clear up stuffiness. They can be used to treat any inflammatory nasal disease that triggers the immune system including allergies, sinus infections, colds, and flu.

Antihistamine sprays treat allergies by suppressing histamines, thus weakening your allergic response and relieving symptoms. Steroids calm the inflammatory effects of allergies by acting on substances your body produces in response to allergens. Steroid sprays can act on all six inflammatory substances your body produces. In contrast, an oral allergy pill may only block one.

“For a patient with allergy symptoms who hasn’t tried treatment, the first medicine I try is a nasal steroid spray,” says Dr. Panella. “It’s often the safest and most effective treatment to relieve nasal congestion.”

Potential Side Effects From Nasal Sprays

Saline, antihistamine, and steroid sprays are safe for most adults and produce minimal side effects. The American Academy of Pediatrics advises against using cold medicines to treat children under the age of 4. Instead, nasal saline sprays and suction can be used to clear congestion, and cool-mist humidifiers can help relieve dryness.

If taken longer than recommended, nasal decongestants can be habit-forming and lead to rhinitis medicamentosa, also known as rebound congestion. This occurs when decongestant overuse inhibits blood vessels from opening back up without continued or increased use of medication. The result is increased swelling, often accompanied by a bitter taste or smell, sneezing, runny nose, and nasal irritation. If you are experiencing this condition, consult your doctor for treatment options and help in tapering off decongestant use.

How to Use Nasal Saline Spray Correctly 

Nasal sprays are most effective when administered properly. Below are steps for correct application of nasal sprays.

1. Before using nasal spray, gently blow your nose to clear your nasal passages and allow the medicine to enter effectively.
2. If instructed, gently shake the spray and complete a test spray to prime the applicator before first use.
3. Position the applicator under one nostril, inserting only the applicator tip into the nostril. It may help to rest the bottom of the applicator on your upper lip.
4. Angle the applicator toward the back wall of your nose so the medicine can reach your sinuses. Spraying directly onto the nasal septum (the cartilage in the center of the nose) can irritate tissue and potentially cause a nosebleed. For the right angle, some find it helpful to use a crisscross position, using the right hand to apply to the left nostril and the left hand to apply to the right.
5. While standing or sitting upright, apply one spray to each nostril and sniff gently to be sure the medicine remains inside the nose. If it’s helpful, hold the opposite nostril closed with your finger. Rely on the pump action of the spray to drive the medicine into your nose and sinuses. Avoid tilting your head back, lying down, or blowing your nose immediately after. You want the medicine to go directly to your sinuses instead of coming out your nose or draining down the back of your throat.
6. Repeat these steps for additional sprays. After each use, wipe down the nasal spray applicator and cover it with the cap. Don’t share the spray with family members. .

How Often to Use Nasal Spray  

Most nasal sprays work most effectively if used consistently. “Nasal sprays are considered a ‘stacking treatment,’ meaning their benefits stack over time,” says Dr. Panella. “Consistent application is key to their success – they aren’t as effective with on-demand or sporadic use.”     

If you already have allergy symptoms when you begin using a spray, it may take several days to feel the medication’s full effects. It’s best to continue use even after symptoms subside. Pausing treatment may cause symptoms to return. Nasal decongestant sprays, however, should only be used for a limited period of time to prevent rebound congestion.

Saline sprays can be used several times a day or more often if you’ve been exposed to known allergens. Antihistamines and steroids can be taken at least once, sometimes twice a day, depending on your symptoms.

As always, use products according to label instructions and consult your doctor to ensure safety. If a nasal spray burns or produces a nosebleed, it’s best to discontinue use for a few days until soreness subsides.

How to Make and Use Your Own Natural Nasal Rinse

Saline rinses relieve sinus infections and allergies by thinning out excessive mucus and rinsing allergens from the nose and sinuses. Rinses can be performed at home without a prescription.

To make your own saline rinse at home, you will need non-iodized salt, baking soda, and lukewarm distilled or boiled water. Mix 3 teaspoons salt, 1 teaspoon baking soda, and 8 oz. of the distilled water in a clean container.

Use a product such as a bulb syringe, neti pot, or nasal irrigation squeeze bottle to apply the solution. Tilt your head downward over a sink or shower and rotate it to one side. Squeeze about four ounces of the solution into the opposite (top) nostril. Breathe normally through the mouth. The solution should come out through the lower nostril in a few seconds. Rotate your head and repeat for the opposite side. Adjust your head position to prevent solution from going down the back of your throat or into your ears. If you experience burning or stinging, weaken the solution by reducing the quantity of dry ingredients.

Continue using your prescribed nasal medications – you may find them more effective after the rinse. Avoid using the rinse if your nasal passages are severely blocked. Do not rinse with plain water that has not been boiled or distilled, as it can dehydrate the nasal lining and worsen irritation.

When to Seek Medical Care for Nasal Congestion 

As with any medical product, speak to your physician about nasal spray use and stop using if you experience pain, nosebleeds, or other problems.  

If these options don’t relieve your symptoms, consult with one of our ear, nose and throat specialists to learn about other treatment options. You can also visit our website to find a primary care provider in your area.