Key takeaways:
Over-the-counter (OTC) steroid and antihistamine nasal sprays work best to treat allergy symptoms. Flonase, Nasacort, and Astepro are common examples. They’re safe for both adults and children for daily use.
OTC decongestant nasal sprays provide fast, temporary relief of congestion. But they’re not the best choice for allergy symptoms. And they can only be used for up to 3 days at a time.
If you need to use an OTC steroid or antihistamine nasal spray long-term, it’s best to let your healthcare provider know. They can make sure it’s safe, and decide if a prescription medication might be better.
Table of contents
What works best
Steroid sprays
Antihistamine sprays
Decongestant sprays
Dosages
Side effects
Prescription options
Bottom line
References
02:06
Featuring Clifford Bassett, MD | Reviewed by Mera Goodman, MD, FAAP
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Sneezing? Runny nose? Watery eyes? Sounds like you’ve got allergies. And whether it’s due to pollen, dust, or pet dander, you might be looking for a nasal spray to help manage your allergy symptoms.
But with so many different nasal sprays to choose from, finding the right one can feel overwhelming. Let’s break down the types of nasal sprays that are available over the counter (OTC) and find out which one works best.
Which OTC nasal spray works best for allergies?
There are three main types of OTC nasal sprays for allergy symptoms: steroids, antihistamines, and decongestants.
Steroid nasal sprays work best for treating allergy symptoms. They’re considered a first-choice treatment since they generally work better than antihistamines for congestion and reducing mucus.
Antihistamine nasal sprays can also be an effective choice. They work faster than steroid sprays and are more effective than oral antihistamines for treating nasal allergy symptoms.
Decongestant nasal sprays only treat congestion and should only be used for a very short time (up to 3 days). These should be reserved for situations like flying on an airplane or when your congestion is severe.
Can you combine different nasal sprays?
Yes, you can combine different types of OTC nasal sprays. In fact, steroid nasal sprays and antihistamine sprays might work better together. But you’ll need to wait 15 minutes between each type of spray. And using more sprays increases your chances of side effects, like nasal irritation.
Let’s look at each type of nasal spray in detail.
OTC steroid nasal sprays
Steroid nasal sprays work by calming your immune system’s response to the allergen that’s causing your symptoms. This helps to reduce swelling in your nasal passages and lessen the amount of mucus in your nose.
OTC steroid nasal sprays include:
Flonase Allergy Relief (fluticasone propionate)
Flonase Senismist (fluticasone furoate) — a finer, gentler spray than regular Flonase
Nasonex (mometasone)
Nasacort (triamcinolone)
Rhinocort (budesonide)
See Also5 Best OTC Nasal Sprays
Steroid nasal sprays work well, but you shouldn’t expect instant relief. You’ll need to use them daily and it may take a few weeks to see their full effect. If you have seasonal allergies, starting a steroid nasal spray a week or two before allergy season may be better for managing your symptoms.
OTC antihistamine nasal sprays
Antihistamine nasal sprays work by blocking histamine. Another class of nasal sprays, called mast cell stabilizers, affect special allergy cells (called mast cells). They’re not antihistamines, but they work in a similar way. Histamine and mast cells cause most allergy symptoms when they’re released. So blocking them helps treat a runny or itchy nose and sneezing.
These nasal sprays include:
Astepro (azelastine), which blocks histamine
NasalCrom (cromolyn sodium), which stabilizes mast cells
Antihistamine nasal sprays work quickly — within 15 minutes. Nasalcrom takes longer, providing relief in about 1 to 2 weeks. Both can be used to both treat and prevent symptoms.
OTC decongestant nasal sprays
Decongestant nasal sprays work by tightening blood vessels in your nose. They temporarily treat swollen nasal passages and congestion. They don’t treat other types of allergy symptoms, like runny nose or sneezing.
OTC decongestant nasal sprays are sold under many brand and generic names. A few popular examples are:
Afrin (oxymetazoline)
Sinex (oxymetazoline)
Zicam Sinus Relief (oxymetazoline)
Neo-Synephrine (phenylephrine)
Decongestant nasal sprays start working immediately. But there’s a catch — the effects are only temporary and typically fade within hours. You also shouldn’t use them for more than 3 days in a row. Otherwise, they can cause rebound congestion that can take up to 1 year to go away.
What’s the best dose of OTC nasal sprays for allergies?
The dosing for OTC nasal sprays differs depending on the medication. Most include directions for adults and children. Be sure to read the instructions carefully. You can also find separate children’s versions for products like Flonase, Nasonex, and Astepro.
Steroid Nasal Sprays | ||
Medication | Dose range | Duration of Use |
(Flonase, generics) | Adults and children ages 12+: 2 sprays in each nostril daily for 1 week. Then 1-2 sprays in each nostril daily Children 4-11 years old: 1 spray in each nostril daily | Adults: Daily up to 6 months at a time Children: Up to 2 months per year |
Fluticasone furoate (Flonase Sensimist) | Adults and children ages 12+: 2 sprays in each nostril daily for 1 week; then 1-2 sprays in each nostril daily. Children 2-11 years old: 1 spray in each nostril daily | Adults: Daily up to 6 months at a time Children: Up to 2 months per year |
(Nasacort, generics) | Adults and children ages 12+: 2 sprays in each nostril daily; lower to 1 spray in each nostril once symptoms improve Children 6-11 years old: 1 spray in each nostril daily; can increase to 2 sprays in each nostril for a short time if needed Children 2-5 years old: 1 spray in each nostril daily | Adults: Daily up to 6 months at a time Children: Up to 2 months per year |
Mometasone (Nasonex) | Adults and children ages 12+: 2 sprays in each nostril daily Children 2-11 years old: 1 spray in each nostril daily | Adults: Daily up to 6 months at a time Children: Up to 2 months per year |
(Rhinocort, generics) | Adults and children ages 12 and up: 2 sprays in each nostril daily; lower to 1 spray in each nostril once symptoms improve Children 6-11 years old: 1 spray in each nostril daily; can increase to 2 sprays in each nostril for a short time if needed | Adults: Daily up to 6 months at a time Children: Up to 2 months per year |
Antihistamine / Mast Cell Stabilizer Nasal Sprays | ||
Medication | Dose range | Duration of Use |
(Astepro) | Adults and children ages 12+: 2 sprays in each nostril daily or 1-2 sprays every 12 hours Children 6-11 years old: 1 spray in each nostril every 12 hours | Adults and children: Ask your healthcare provider or pharmacist |
Cromolyn sodium (NasalCrom, generics) | Adults and children ages 2+: 1 spray in each nostril every 4-6 hours | Adults and children: Daily up to 3 months |
Decongestant Nasal Sprays | ||
Medication | Dose range | Duration of Use |
(Afrin, Zicam Sinus Relief, Sinex, generics) | Adults and children ages 6+: 2-3 sprays in each nostril every 10-12 hours, as needed | Adults and children: Up to 3 days |
Phenylephrine (Neo-synephrine, generics) | Adults and children ages 12+: 2-3 sprays in each nostril at least 4 hours apart, as needed | Adults and children: Up to 3 days |
Can you use a nasal spray every day?
Yes, most nasal sprays work best if you use them every day. But if you or your child need a steroid or antihistamine nasal spray for more than a couple months, it’s best to let your healthcare provider know. Adults can use some nasal sprays longer, but it’s still best to loop your provider in.
Keep in mind that even though you can use a decongestant nasal spray every day, you shouldn’t use them for more than 3 days in a row. This could lead to rebound congestion.
What are common side effects of OTC nasal sprays?
The most common side effects of OTC nasal sprays are nasal irritation and a bad taste in your mouth. Sometimes nasal irritation can cause nose bleeds. Talk to your healthcare provider if nosebleeds are severe or frequent. Aiming the spray away from the center of your nose can sometimes help.
When should you consider a prescription nasal spray for allergies?
There are some reasons your healthcare provider may recommend a prescription nasal spray for you. These may include:
Cost. Not all OTC nasal sprays have generic options available. And insurance is also more likely to cover a prescription nasal spray. You also have access to more savings, such as GoodRx discounts, copay savings cards, and patient assistance programs for prescription nasal sprays.
Combination sprays. If you need both a steroid and an antihistamine spray, your provider may prescribe a combination spray, like Dymista (azelastine / fluticasone) or Ryaltris (olopatadine / mometasone). These are often more convenient than two separate OTC sprays.
For nasal polyps. Some prescription steroid nasal sprays treat nasal polyps (noncancerous growths inside the nose). OTC versions aren’t approved for this.
Treatment failure. If you’ve tried OTC nasal sprays but they don’t seem to be working, a prescription option may be the next step.
Even if an OTC nasal spray is effective, be sure to let your healthcare provider know you’re using it. They may want to switch you to a prescription version depending on your symptoms and what’s causing them.
The bottom line
OTC steroid and antihistamine nasal sprays work best for treating allergy symptoms. Common examples include Flonase, Nasacort, and Astepro. They’re safe for both adults and children to use every day. Just be sure to follow the recommended dosage. Let your provider know if you need to use these nasal sprays long-term.
Decongestant nasal sprays can temporarily treat congestion, but they’re not preferred to treat allergies. They work fast, but can only be used for up to 3 days at a time.
References
Akhouri, S., et al. (2022). Allergic rhinitis. StatPearls.
American Academy of Allergy, Asthma & Immunology. (n.d.). Mast cell activation syndrome (MCAS).
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GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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