Over-the-Counter Allergy Nasal Spray Triamcinolone - What Does It Mean for Patients?

This article has been reviewed by Linda Cox, MD, FAAAAI, Samuel L. Friedlander, MD and Thanai Pongdee, MD, FAAAAI.

The U.S. Food and Drug Administration (FDA) recently approved nasal triamcinolone for over-the-counter use. This means that consumers will soon be able to go to their local drugstore and purchase a nasal steroid spray. Other brands will still be available by prescription. Previously, all nasal steroids were available only with a prescription so they required occasional monitoring by a medical provider.

There are benefits and risks that come along with the decision to allow access to over-the-counter corticosteroids. To help you make an informed decision, this article will describe the pros and cons. It will also explain the importance of working with your doctor even if the medicines may be obtained without a prescription.

What Are Nasal Steroids?
Nasal steroids are important medicines to help treat allergic rhinitis (hay fever). They are helpful in reducing nasal inflammation, nasal congestion, runny nose and sneezing.

Other medicines that are available to treat allergic rhinitis include oral antihistamines, nasal antihistamines, anti-leukotriene modifiers and nasal saline. Allergy immunotherapy (allergy shots) can also be given to improve the immune system to not react or desensitize itself to the allergens.

If you’re wondering which medicines and treatment strategies will work for you, your doctor will help you navigate the many options and will work with you to decide the best treatment plan.

What Are the Concerns with Using Nasal Steroids?
Although these medicines are safe under a medical provider’s care, they do have some potential risks and concerns:

1. Symptoms of allergic rhinitis can be similar to other ailments like sinus infections, viral colds, chronic sinus inflammation, sinus polyps, and in rare cases certain cancers and other serious problems. It is possible that consumers may treat the wrong condition and a more serious problem could go unnoticed.
2. Nasal steroids can lead to nose bleeds that can be very concerning to patients, which is why proper usage and technique are important. Your doctor can examine the nasal tissues to make sure no damage is occurring. A rare complication that can occur is a hole, or perforation, in the nasal septum (bone separating each nostril). To make sure this does not happen, individuals should be monitored and receive nasal exams.
3. Growth restriction is a well-known risk of using steroids, although topical steroids like nose sprays are less much risky than oral corticosteroids. Even so, every person is different and some are more sensitive than others. For that reason, height and weight should always be monitored.
4. Side effects involving the eyes, which include glaucoma and cataracts, are potential yet uncommon risk factors of topical steroids. Those at risk for these conditions should talk with their physician.
5. Since the medicine will be over-the-counter, you will likely have to purchase it “out of pocket,” which is the case with many antihistamines and heartburn medications. This could increase the amount of money you pay each year for health costs.

Unlike taking a pill, the way you use the nasal spray is important. As mentioned above, it is important to avoid spraying the medicine into the middle of the nose, the septum bone that separates the nostrils. Sometimes it helps to use a mirror, or have another person or doctor make sure this is being done correctly. If you do not use the medicine correctly, it may not work, or worse, could cause serious side effects.

As with all medications, the benefits and risks should be weighed before deciding on a treatment plan. When used properly, nasal steroid sprays can be very effective at treating allergies. It is just important to recognize that steroid nose sprays can create risks if not monitored or used correctly.

Your allergist is trained to help you navigate the best treatment course and monitor your health. He or she can explain the benefits and risks of these treatments and answer any concerns you may have. Together, you and your allergist can decide the best treatment plan.

Find out more about hay fever.

AAAAI - American Academy of Allergy Asthma & Immunology