Johnn asked
In our latest question and answer, our pharmacist discusses which over the counter nasal spray works the best for allergy symptoms.
Answer
There are 3 commonly used steroid nasal sprays available over-the-counter for allergies including Flonase (fluticasone propionate 50 mcg nasal spray), Nasacort (triamcinolone acetonide), and Rhinocort (budesonide). Flonase has an advantage over the other nasal sprays in that it is FDA approved for use in all nasal and eye-related allergy symptoms. Additionally, Flonase is more commonly used and has more evidence overall than other nasal steroids. Nasacort and Rhinocort are only approved for nasal related allergy symptoms.
Each of the steroid nasal sprays have a similar mechanism of action. The steroids in these nasal sprays are considered glucocorticoids and they work by inhibiting inflammatory cell types that cause allergy symptoms. When given nasally, these steroids work locally to reduce runny nose, sneezing, itching, and congestion. Because these nasal sprays are given locally, there is less risk for side effects throughout the body (relative to oral medications). These can still cause nasal irritation, including bleeding.
The unique feature of Flonase being indicated for eye symptoms, as well as nasal symptoms, comes from at least two clinical trials. This does not necessarily mean that the other available nasal steroids do not help with eye symptoms, however, there is not enough evidence to support their use for that indication. Flonase was recently approved for over-the-counter use which has helped give more Americans access to allergy treatment.
In February 2017, Flonase Sensimist (fluticasone furoate) was approved for over-the-counter use. Fluticasone furoate has been shown to be bind more strongly to the glucocorticoid receptor, however, there is not enough evidence to support a significant difference to fluticasone propionate. The delivery of Flonase Sensimist is said to be gentler, scent-free, and alcohol-free. Being that Flonase Sensimist will likely be more expensive than Flonase, it may be best to start with Flonase (fluticasone propionate).
For proper use of Flonase watch this video:
