Over-the-Counter Nasal Steroids Pros and Cons
Nasacort Allergy 24 Hour (triamcinolone) was the first intranasal corticosteroid nasal spray available over-the-counter (OTC) without a prescription. It is the same medication as the prescription version. Flonase and Rhinocort then also became available OTC. Should you use these medications, or one of the newer OTC antihistamines, such as Zyrtec, Claritin or Allegra? The answer depends on the type and severity of your symptoms.
The intranasal corticosteroids, Nasacort, Flonase, and Rhinocort, are probably the most effective OTC medications for the treatment of nasal allergy symptoms. A downside to them is that they will not work on an as-needed basis. Intranasal corticosteroids take the time to work—they may begin to give relief to allergy symptoms after about six to 10 hours, but full relief may not be obtained for days.Antihistamines, such as Zyrtec (cetirizine), Allegra (fexofenadine) and Claritin (loratadine), on the other hand, tend to work fairly quickly, usually within a couple of hours (or less) of taking the medication. Therefore, these medications work well when taken on an as-needed basis.Antihistamines work best for the treatment of itchy nose, itchy eyes and sneezing—and less well for symptoms of nasal congestion or a runny nose. Of the three types of newer (and less sedating) antihistamines, Zyrtec and Allegra work particularly well for the treatment of nasal allergies—and usually within about an hour. Claritin, on the other hand, doesn’t work as well and takes about three hours to take effect fully. All three of these antihistamines are a good choice for spring allergy relief and would be recommended over taking a sedating antihistamine such as Benadryl.The only other medicated nasal sprays available OTC include topical nasal decongestants (such as Afrin) and NasalCrom (cromolyn).
Controversy Over OTC Availability of Intranasal Corticosteroids
Another aspect to consider is that many professional organizations of allergists, pediatricians, and otolaryngologists were against intranasal corticosteroids being made available OTC. They previously opposed the antihistamine Claritin becoming available without a prescription.However, during the 1990s, the FDA labeled allergic rhinitis as a disease that could be recognized and treated without a healthcare professional. This means that the FDA felt that it was safe to have the public self-diagnose and treat allergic rhinitis using OTC products. Intranasal corticosteroids may not be as safe as antihistamines, however, and therefore the risks and benefits should be considered. Here are the arguments that medical professionals made pro and con.
Nasal corticosteroid sprays have been available on the market by prescription for more than 30 years, with large amounts of safety data collected during that time. The most common side effects include localized nasal irritation and nosebleeds, which are usually mild. The most concerning side effect is the possibility of nasal septal perforation, although this is rare. Most people should be able to follow package instructions that would include information about stopping the use of intranasal corticosteroids if nosebleeds or irritation occur.Outside of localized side effects, intranasal corticosteroids rarely cause whole-body side effects. Studies on intranasal corticosteroids over a 2-year period showed no significant increase in glaucoma or cataract formation. Other studies failed to show any evidence of hypothalamic-pituitary-adrenal (HPA) axis suppression, which is indicative of the amount of steroid absorbed, affecting the body’s own cortisol formation.There have been concerns about vertical growth suppression in children by intranasal corticosteroids, although these effects are small and inconsistent. Measurement of growth by a qualified healthcare professional is recommended for children using intranasal or inhaled corticosteroids.There is also an economic concern for the availability of intranasal corticosteroids OTC. Medical insurance may not cover OTC products that were covered when prescribed. However, this may be an advantage to some people, as the cost of going to a doctor appointment far exceeds that of an OTC product. People may be more likely to try an OTC product for their allergic rhinitis symptoms, as opposed to going to the effort of obtaining a prescription. This may lead to better control of symptoms and improved quality of life.
Numerous professional medical organizations believe that having intranasal corticosteroids available OTC is a bad idea. The reasons for this for mostly relate to safety, as various studies have shown that certain types of side effects may occur. These include:
- Some studies show an effect on vertical growth in children, although other studies have failed to show any significant effect. Experts believe that children who use these medications should have their growth monitored closely.
- In people with a family history of glaucoma, there is an increased risk of developing glaucoma.
- Elderly people appear to be at increased risk of developing cataracts from the prolonged use.
- There seems to be some effect on bone mineral density from the prolonged use, which could lead to osteoporosis.
Opponents to OTC intranasal corticosteroids also believe that consumers won’t understand that this medication needs to be used routinely for it to work. Unlike topical nasal decongestants, which bring relief in a matter of minutes, intranasal corticosteroids take hours to days to work. Therefore, people might use much higher doses than recommended, which may lead to more side effects.Many of the side effects and misunderstandings of how intranasal corticosteroids work could be avoided by having these medications remain by prescription only, which allows for frequent monitoring by a healthcare professional.
A Word From Verywell
Understanding the proper use of OTC medications for the treatment of allergic rhinitis can help you avoid the potential side effects. You may want to discuss your choices with your doctor, especially if considering using them for children or older adults.