Nasal Spray: Are You Overdoing It?
Why overusing your nasal spray may backfire.
OTC decongestant nasal sprays are "my least recommended interventions for nasal congestion," says Anne L. Maitland, MD, PhD, assistant professor of medicine and clinical immunology at Mount Sinai School of Medicine in New York City. Prescription nasal corticosteroids, such as Flonase and Nasonex, "are the gold standard of medications for allergic rhinitis," Maitland tells WebMD.
Prescription nasal sprays are longer-lasting, more targeted treatments that work in several ways.
- Nasal corticosteroids are anti-inflammatory sprays that control the allergic immune response at the site of the problem; one dose typically provides relief for the day. Only one steroid spray, Nasacort, is available over the counter.
- Nasal antihistamine sprays work by blocking histamine, what causes the inflammation, and one dose typically lasts for 12 hours. But antihistamines do not "calm down the immune cells responsible for the symptoms," Maitland says.
Maitland says patients may prefer a nonpharmacological approach, such as Neti pots, to treat their congestion, but this, too, comes with some risks.
"Washing the allergens and irritants out of your nose is very safe, but surprisingly, you can use this too much," Maitland says. "Imagine washing your hands frequently every day. You will end up with dry, irritated skin. The same for your [nasal] passages."
The Only Way to Quit Is to Quit
If chronic nasal spray overuse occurs, doctors recommend patients stop using the product altogether.
"The only real way to fix the problem [of rhinitis medicamentosa] is to stop cold turkey," says James N. Palmer, MD, director of the division of rhinology in the department of otolaryngology: head and neck surgery at the University of Pennsylvania in Philadelphia. "It's kind of like smoking. What's the way to stop smoking? It's to stop smoking."
Palmer says he sees one patient a month with this problem. "They're usually pretty frustrated," Palmer says.
He often recommends prescription nasal steroids to shrink the nasal lining a bit and counseling to help address the patient's behaviors that led to overuse. OTC sprays are OK to use briefly, Palmer says, but if patients don't see any improvement in their symptoms in one week, they should visit a physician and get to the root of what's causing the congestion. "A lot of things," Palmer says," could be causing your nose to be blocked."