OTCs Today
Mary Warner
When allergies cause congestion, itchy and runny nose, sneezing, and watery eyes, most patients reach for antihistamines and decongestants. While both are available as tablets and capsules, nasal sprays are also readily accessible and often work much faster than pills. Several types of nonprescription decongestant, antihistamine, and corticosteroid sprays are convenient and suitable for allergy relief.
Decongestant nasal sprays
Decongestant sprays relieve congestion by shrinking swollen blood vessels and tissues in the nose. Oxymetazoline hydrochloride (Afrin, Dristan, Sinex) and phenylephrine hydrochloride (Neo-Synephrine) are the most commonly used medications in decongestant sprays. Notably, although phenylephrine is ineffective as an oral decongestant, it is effective in nasal spray form. Numerous generic versions of both medications are available.
Dosage differs between the two medications. Oxymetazoline should be used only every l0 to 12 hours, while phenylephrine can be used every 4 hours. Neither medication is recommended for children under 6 years old. Decongestant nasal sprays should not be used for more than 3 days, as longer use can increase congestion rather than decrease it.
Steroid nasal sprays
Corticosteroid nasal sprays are particularly effective at reducing sneezing and itchy, watery eyes while also helping to stop a runny nose. Most are available only by prescription, but three nonprescription steroid nasal sprays are available: budesonide (generic only), fluticasone (Flonase Allergy Relief), and triamcinolone (Nasacort Allergy). Patients looking for Rhinocort, which has been removed from the U.S. market, can use the many generic versions of budesonide instead.
Dosage for all three of these medications is two sprays in each nostril once per day for adults, and one spray in each nostril per day for children 6 to 12 years old.
Patients may feel some relief within 1 to 2 days, but it may take up to 2 weeks before the full benefit of the medication is felt, making these sprays most useful for patients with perennial or seasonal allergies who are willing to commit to daily dosage.
Antihistamine nasal spray
The newest product in the nonprescription nasal spray market is Astepro (azelastine hydrochloride nasal spray, 0.15%), which was approved for nonprescription sale in June 2021 as part of FDA’s prescription to nonprescription switch program. For a drug to switch from prescription to nonprescription status, the data provided to FDA must demonstrate that the drug is safe and effective for use in self-medication as directed in proposed labeling and that patients can use the medication safely and effectively without supervision from a health care professional.
Astepro’s approval is a first-in-class switch for a nasal antihistamine, and Astepro is the only nonprescription nasal antihistamine approved by FDA. The switch is considered partial because the 0.1% strength, which includes the perennial allergy indication for children 6 months to 6 years old and the seasonal allergy indication for children 2 to 6 years old, remains prescription-based.
Astepro has been shown to work very quickly, often within 30 minutes. Dosage recommendations are for one spray in each nostril every 12 hours or two sprays in each nostril once per day, with no more than four sprays per nostril within a 24-hour period. For children ages 6 to 11 years old, one spray per nostril every 12 hours is recommended, with no more than two sprays in each nostril in a 24-hour period. Astepro is not for use in children under 6 years old.
Adverse effects include headache, bitter taste, and sore throat. Astepro usually causes less drowsiness than antihistamine pills but may still make patients sleepy.
What to tell your patients
Ensure that patients understand which allergy nasal spray is best for their situation. That is, decongestant nasal sprays are best for short-term needs, and they should not use decongestant nasal sprays for longer than 3 days. Corticosteroid nasal sprays are most suitable for patients with perennial or seasonal allergies who are willing to consistently spray once per day, as they may take up to 2 weeks before the full effects are felt. Azelastine, the only available nonprescription antihistamine nasal spray, provides fast relief from allergy symptoms, but may cause drowsiness. ■