How to choose a nasal spray for allergies

Seasonal allergies are commonly associated with spring, but summer and fall can also trigger allergy symptoms. Also known as hay fever or allergic rhinitis, seasonal allergies can cause symptoms like sneezing, a runny nose, and itchy, watery eyes. 

No matter how often your allergies flare up, you don’t have to live with the symptoms as there are many effective treatments, including eye drops, shots, and oral medications. The best allergy treatment depends on your unique case of allergies. An allergist can help you narrow down your best options, but nasal sprays are generally a good place to start. 

“Nasal sprays are medications delivered as a mist directly into the nasal passages,” explains Patrick J. DeMarco, MD, a board-certified allergist at Allergy & Asthma Specialists of North Florida. “The choice of nasal spray really depends on the specific conditions someone may have.” 

Here’s what to know about the various types of nasal sprays for allergies, so you can identify the right one for you.

5 nasal sprays for allergies

Administered through the nostrils, both over-the-counter (OTC) and prescription nasal sprays can relieve some symptoms of seasonal allergies. Here we break down the most common types and when it makes sense to use each one.

1. Steroid sprays

All steroid nasal sprays previously required a prescription from your healthcare provider, but some have since received FDA approval for OTC use, such as Flonase (fluticasone propionate), Nasacort (triamcinolone), Nasonex (mometasone), and Rhinocort (budesonide). Others are still available with prescription only.

“Nasal corticosteroid sprays are the first line of treatment for allergy symptoms,” says Tania Elliott, MD, a board-certified allergist in Westport, Connecticut, and chief medical officer at Nectar. “They work to reduce inflammation in the nasal passages and are used for both allergic and non-allergic rhinitis.”

Steroid sprays are best for reducing nasal inflammation and managing allergy symptoms like congestion, sneezing, and runny nose, adds Dr. DeMarco. The advantage of steroid sprays is that they’re very effective and most provide 24-hour relief, but the downside is that they take some time to work. It could take up to three weeks of daily use to notice improvements, per the Mayo Clinic.

RELATED: Rhinocort vs. Flonase | Flonase vs. Nasacort 

2. Antihistamine sprays

Antihistamines refer to allergy medications that block histamines—chemicals released by immune cells that trigger allergies, per the National Library of Medicine. Oral antihistamines, such as Zyrtec (cetirizine) and Claritin (loratadine), are common treatments for seasonal allergies, but OTC nasal antihistamine sprays like Astepro (azelastine) may be even more effective. When used as an add-on therapy to steroid sprays, nasal antihistamine sprays were superior to oral antihistamine medications, according to a 2020 meta-analysis published by the American College of Allergy Asthma and Immunology (ACAAI).

“This is a good option to relieve typical allergy symptoms, such as sneezing, itchy eyes, and runny nose,” Dr. DeMarco says. Unlike some sprays, antihistamine sprays can be used daily, and they work fairly quickly. Dr. Elliott recommends using them as needed.

RELATED: Flonase vs. Claritin

3. Decongestant sprays

As the name suggests, decongestant sprays are used for relieving nasal congestion, which occurs when something irritates the tissues in your nose, causing them to become inflamed and making it harder to breathe. OTC decongestant nasal sprays are available from brands like Zicam, Afrin, and Sudafed.

“Nasal decongestants work by reducing swelling in the nasal passages,” Dr. Elliott says. This helps open up the nasal airways, making it easier to breathe through the nose, according to the Cleveland Clinic.

While these decongestants provide nasal relief, they don’t treat other symptoms—and they’re not a long-term option. 

“These should only be used for short periods of time to avoid rebound congestion, which actually worsens congestion,” Dr. Elliott says, adding that these sprays should only be used for up to three days. 

RELATED: What is rebound congestion?

4. Cromolyn spray

Also known as a mast cell stabilizer spray, cromolyn nasal spray works similarly to an antihistamine. They’re not the same, but they both block common causes of allergy symptoms. In the case of mast cell stabilizers, they block cells called mast cells, which release histamine, are linked to allergy-related inflammation, and are thought to initiate the body’s allergy response, according to a January 2012 review published in Respiratory Medicine.

“Cromolyn prevents allergy symptoms by stabilizing mast cells in the nasal passages,” Dr. DeMarco says. Mast cells can cause the nasal passages to swell with inflammation, so getting ahead of this can improve symptoms like sneezing, stuffy nose, and itchy nose.

Cromolyn is most effective when used cumulatively. If possible, start using it about a week before the allergy season. Its effects are short-lived, so your allergist may recommend using it up to six times per day for 12 weeks. It can take a while for the effects of cromolyn to kick in—up to four weeks, per the National Library of Medicine. 

NasalCrom is the leading brand of OTC cromolyn sprays, but generic versions are usually available. 

5. Saline sprays

Saline sprays are a mild option. They’re made from a mixture of salt and water, and as long as they don’t contain any medication, they’re safe for all ages and are free from side effects, says Dr. DeMarco. They’re not only safe for children, but effective at alleviating allergies in children, according to a January 2019 review published in the Journal of Clinical Medicine.

In terms of allergy symptoms, saline nasal sprays are best used for moisturizing and clearing nasal passages, reducing dryness, and aiding mucus clearance, says Dr. DeMarco. They can also help flush out the nasal passages of allergens, adds Dr. Elliott. Both name and generic brands of saline nasal sprays are available OTC, and you can use them as needed or daily.

Which nasal spray works best for allergies?

The best nasal spray depends on your symptoms and the cause of your allergies.

Broadly, steroid nasal sprays are the preferred treatment for people with allergic rhinitis, per a September 2021 review published in the Journal of Asthma and Allergy. Older research published in The Journal of the American Osteopathic Association also found steroid sprays superior to antihistamine sprays when treating seasonal allergies. They’re best for nasal symptoms like congestion, sneezing, and runny nose, but they don’t work immediately. 

In some cases, the ACAAI recommends antihistamine sprays. For quicker allergy relief, antihistamine sprays may be the better choice. While antihistamine sprays are generally less effective than steroid sprays, per December 2017 guidelines published in the Annals of Internal Medicine, they get the job done in mild cases or in combination with other treatments. If your allergy symptoms involve itchiness, antihistamines are usually a good choice. Still, they can cause drowsiness, Dr. DeMarco says, which can interfere with your daily life. His advice is to take a nasal spray’s side effects into consideration.

Determining the nasal spray that best suits your needs also depends on whether you need long- or short-term relief, Dr. DeMarco adds. Some nasal sprays aren’t intended for long-term use, such as nasal decongestants, so you’ll want to account for that.

Ultimately, there isn’t a one-size-fits-all approach to choosing the best nasal spray for allergies. An allergist can recommend the right nasal spray for you depending on your symptoms and the underlying cause, Dr. Elliott says. In some cases, your allergist may prescribe a combination nasal spray, which contains both antihistamines and steroids to treat allergies. Dymista nasal spray contains the antihistamine azelastine and steroid fluticasone, which would save you from juggling two different products.

How often should you use nasal sprays?

The frequency with which you should use an allergy relief nasal spray depends on the type. Some nasal sprays are suitable for daily use while others are intended for short-term use only. 

The nasal sprays that are safe for daily use include steroid sprays, antihistamine sprays, and saline sprays. “You can use these daily and on an ongoing basis,” Dr. Elliott says. “The most common side effects of nasal steroid sprays and nasal antihistamines are nasal crusting or nosebleeds.” Saline sprays are generally free from side effects, Dr. DeMarco adds.

The nasal sprays that are not safe for daily use are nasal decongestants. They’re intended for short-term use—up to three days. After three or four days, you run the risk of rebound rhinitis, which can worsen nasal congestion, per the Mayo Clinic.

If you experience any symptoms from using nasal sprays, Dr. Elliott says to notify your healthcare provider. He or she can work with you to find an alternative treatment.

Alternatives to nasal sprays 

Nasal sprays aren’t a cure for allergies, but they can certainly help. To alleviate your symptoms, you might try combining nasal sprays with the following tips to seek relief.

• Take oral antihistamines. OTC antihistamine tablets can help relieve allergy symptoms. Benadryl (diphenhydramine) is a classic choice, but it’s known for causing drowsiness. Non-drowsy options include Claritin (loratadine), Zyrtec (cetirizine), and Allegra (fexofenadine).
• Use a saline nasal rinse. Also known as nasal irrigation or sinus rinsing, a saline rinse is similar to saline nasal sprays. Rinses, such as Neti Pot, use a larger volume of saline solution, so they may be more effective. If you try this option, Dr. Elliott emphasizes the importance of using distilled water since tap water may contain contaminants.
• Reduce your exposure to allergens. Identifying your allergy triggers can help you avoid them. Pollen, dust mites, and pet dander are common allergens to avoid, Dr. DeMarco says.
• See a healthcare provider. Unsurprisingly, allergists specialize in allergy medicine, so your provider can recommend the best allergy treatment for you, which may or may not include nasal sprays. Other treatments could include allergy shots (aka immunotherapy), prescription-strength medications, and eye drops.

If your symptoms aren’t going away, keep at it. Your provider can help to find the combination of treatments that helps stop your sniffling and sneezing for good.