Using Flonase or Nasacort for Spring Hay Fever

Spring is the most common time of the year for people to experience seasonal allergy symptoms. As the weather gets warmer and plants start to bloom, trees and grasses release pollen into the air, triggering allergic symptoms in those with seasonal allergies. These symptoms are called hay fever, or allergic rhinitis.

Allergic rhinitis is a very common problem, affecting up to 30% of the population. This condition causes inflammation and irritation of the nasal passages and includes symptoms such as sneezing, runny nose, nasal congestion, itching of the nose, and postnasal drip. There are a number of different treatments for allergic rhinitis, including both over-the-counter (OTC) and prescription medications.

Nasal Steroid Sprays for the Treatment of Allergies

In February 2015, Flonase (fluticasone) nasal spray became available OTC. Flonase is the second intranasal corticosteroid nasal (INS) spray to be sold OTC without being prescribed by a healthcare professional—the first being Nasacort Allergy 24HR, which has been available OTC since March 2014.

Nasal steroids are a commonly used medication to treat the symptoms of allergic rhinitis. These medications work by decreasing the allergic inflammation within the nasal passages and treat symptoms such as sneezing, itchy nose, runny nose, congestion, and post-nasal drip. Since steroids generally take many hours before they begin to work, nasal steroids do not work well on an "as-needed" basis, and therefore need to be used routinely for best effect.

Most studies show that nasal steroids are the single most effective medicine available for the treatment of nasal allergies. In fact, many studies show that nasal steroids are better at treating allergy symptoms than oral antihistamines, nasal antihistamine sprays or Singulair (montelukast). Nasal steroids are also particularly good at treating symptoms of eye allergies.

Is There an Advantage to Using Either Flonase or Nasacort?

Studies comparing the efficacy of the different nasal steroids show no particular differences from one to another, although there are certain subtleties between the nasal steroids that may result in a person choosing one over another. It is certainly possible that a person finds that one of these nasal steroids works better or causes fewer side effects than another. There may be some advantages and disadvantages of using Flonase or Nasacort:

Flonase:

• Advantages: Approved for the treatment of eye allergy symptoms in addition to nasal allergy symptoms.
• Disadvantages: Flowery smell bothers some people, contains an alcohol preservative that may cause irritation in some people.

Nasacort:

• Advantages: FDA approved for children as young as 2 years of age.
• Disadvantages: Not FDA approved for the treatment of eye allergies.

Side Effects

While the word "steroid" may sound alarming, don't worry: Nasal steroids are different from those used in bodybuilding. However, it is important for anyone taking these medications to be aware of them.

Nasal steroids may have a small effect on a child’s vertical growth, although studies seem to show mixed results on this subject. If nasal steroids do in fact affect a child’s growth, it is likely that this effect is very small and only transient, meaning that the child would still likely attain their original expected adult height.

There does seem to be some increased risk of cataracts and glaucoma in people who are using nasal steroids, particularly in those people with a family history of these diseases, or who are otherwise prone to these diseases. It is recommended that these people undergo routine annual eye exams by a qualified optometrist or ophthalmologist.

The majority of side effects from topical steroids occur within the nose at the site of local application. These side effects commonly include nasal irritation and nosebleeds. Should these symptoms occur, a person should stop using the nasal steroid for a few days, and then re-start the medication using the appropriate technique? If bleeding and irritation continue to occur, the nasal steroid should not be used any longer. A person who continues to use a nasal steroid despite these local side effects is at risk for septal perforation.