Which Nasal Steroid Spray Is Best for Allergies?

The Difference Between Common Brands Like Flonase and Nasonex

Nasal Steroid Spray
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Nasal steroids are a commonly used to treat symptoms of allergic rhinitis,  also known as hay fever. These medications work by decreasing the allergic inflammation within your nasal passages, treating symptoms such as sneezing, itchy nose, runny nose, congestion and post-nasal drip. Since steroids generally take many hours before they begin to work, nasal steroids do not work well on an as-needed basis and need to be used routinely for best results.

Most studies show that nasal steroids are the single most effective medicine available for the treatment of nasal allergies. In fact, many studies show that nasal steroids are better at treating allergy symptoms than oral antihistamines, nasal antihistamine sprays, and Singulair. Nasal steroids are also particularly good at treating symptoms of eye allergies.

Which Nasal Steroid Is Best?

There are a number of nasal steroids available, all by prescription only. There are two generic versions, called fluticasone propionate (formerly marketed under the brand name Flonase) and flunisolide (formerly marketed under the brand name Nasarel). There are also a number of brand name nasal steroids, including Nasonex (mometasone), Veramyst (fluticasone furoate), Nasacort AQ (triamcinolone), Omnaris (ciclesonide), and Rhinocort (budesonide).

Studies comparing the efficacy of the different nasal steroids show no particular differences from one to another, although there are certain subtleties between the nasal steroids that may result in a person choosing one over another.

It is certainly possible that a person finds that one of these nasal steroids works better or causes fewer side effects than another.

Comparison of Brand Name Nasal Steriods

BrandAdvantagesDisadvantages
Flonase (also available as generic fluticasone propionate)Available in generic form (lower cost), also approved by the Food and Drug Administration (FDA) to treat non-allergic rhinitis.Flowery smell bothers some people, contains an alcohol preservative that may cause irritation in some people.
Nasarel (also available as generic flunisolide)Available in generic form (lower cost).Needs to be used two to three times a day for best effect.
NasonexFDA approved for children as young as 2 years of age, FDA approved for the treatment of nasal polyps, generally the lowest cost brand name nasal steroid.None to my knowledge.
VeramystFDA approved for children as young as 2 years of age, multiple studies show consistent benefit for the treatment of eye allergies (although not currently FDA approved for this reason).High cost.
Nasacort AQFDA approved for children as young as 2 years of age.High cost, generally poor medical insurance coverage.
OmnarisFewer steroid side effects since medication is a pro-drug. There is also less nasal irritation given the lack of benzalkonium chloride as a preservative (present in all other nasal steroids).High cost, generally poor medical insurance coverage.
Rhinocort AquaPreferred nasal steroid during pregnancy (pregnancy category 'B' risk).High cost, generally poor medical insurance coverage.

If you are looking for a nasal steroid, work with your medical provider to determine which medication is best for you.

Sources:

Wallace D, Dykewicz M, editors. The Diagnosis and Management of Rhinitis: An Updated Practice Parameter. J Allergy Clin Immunol 2008;122:S1-84.

Flonase package insert. GSK Corporation. 

Nasonex package insert. Merck Corporation.

Nasacort package insert. Sanofi Aventis Corporation.

Veramyst package insert. GSK Corporation.

Omnaris package insert. Sepracor Corporation.

Rhinocort AQ package insert. Astra Zeneca Corporation. 

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