Allergy (AR) is a common disease that affects 40 to 60 million individuals in the United States.1 Congestion, coughing, red and watery eyes, runny nose and sneezing are common. Additionally, AR can be seasonal and can occur in spring, summer, and early fall.1 Triggers include mold spores or pollen from grass, trees, and weeds.1 Individuals may experience perennial symptoms caused by cockroaches, dust mites, dander, mold, or pet dander.1 Healthcare professionals can educate patients about OTC intranasal spray medication options for managing AR symptoms in adults.
Avoiding triggers, along with taking medications, can relieve AR symptoms. Evidence shows that saline nasal sprays can relieve dry nasal passages and reduce congestion.2 Patients can use saline nasal spray as often as needed without relapse of nasal congestion. Although nasal spray products typically contain pure water premixed, patients should prepare nasal irrigation devices such as neti pots. To prevent severe brain-eating amoeba (Naegleria fowleri) infection, only filtered, sterilized or boiled and cooled tap water should be used for nasal irrigation devices.3
Intranasal corticosteroids (INCSs) are recommended as first-line drugs to control AR symptoms.2 There are several OTC nasal spray options, such as fluticasone (Flonase), mometasone (Nasonex 24HR), and triamcinolone (Nasacort Allergy 24HR). The usual dose of INCSs for adults is 2 sprays in each nostril once a day.2 These effective and safe drugs are considered to have a low risk of systemic adverse effects (AEs) when administered appropriately. Before using these medicines for the first time, it is important to prime them by shaking and releasing a fine mist on their face. The most common AE symptoms are dryness in the nasal passages, headache, nosebleeds, sneezing and throat irritation.4
Intranasal antihistamines (INAHs) have a rapid onset of action of 15 to 30 minutes for AR symptoms, compared to 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 in improving nasal symptoms.2 Azelastine can be given once a day by 2 sprays in each nostril or twice a day by 1 to 2 sprays in each nostril every 12 hours.5 The most common AEs associated with azalastine are bitter taste and drowsiness.5 The bitter taste can be reduced by not tilting the head back after the infusion. This prevents the medicine from flowing into the throat.
Nasal drops can relieve congestion, but they should not be used as monotherapy for more than 5 days, because of the risk of reactivation of nasal congestion.2 Oxymetazoline (Afrin nasal spray) is an example of an OTC intranasal decongestant.
Intravenous infusions may be given for up to 4 weeks with INCS to control AR symptoms.2 Research results indicate that taking these products together can reduce the risk of congestion after regular nasal spray treatment.2
About the author
Jennifer Gershman, PharmD, CPh, PACS; He is a drug information pharmacist and Pharmacy Times contributor who lives in South Florida.
References
1. Butler S, Rubin-Miller L, Bowlin G, et al. Epidemic or not: Strep test guidelines are ignored for most prescriptions. Epic research. November 30, 2021. Accessed January 7, 2022. https://epicresearch.org/articles/pandemic-or-not-strep-testing-guidance-overlooked-for-the-majority-of-prescriptions
2. Cohen JF, Pauchard JY, Hjelm N, et al. Efficacy and safety of rapid tests to guide antibiotics for sore throat. Cochrane Database Syst Rev. 2020;6:CD012431. doi:10.1002/14651858.CD012431.pub
3. Kalra MG, Higgins KE, Perez ED. Common questions about streptococcal pharyngitis. Am Fam Physician. 2016:94 (1:24-31).
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