Nasal Sprays vs Oral Medications for Allergies

Two common treatment options for allergy sufferers are nasal sprays and oral medications. Not all forms of allergy treatments work the same. Some come in a tablet and are meant to be administered orally, while others come in a nasal spray and are intended to be directly applied at the source—inside the nose. So, which one is better for treating allergies?

In this article, you will learn the differences between nasal sprays and oral medications for treating allergies. You will discover how they work, their advantages, effectiveness, potential side effects, and costs.

1. How They Work

Nasal sprays and oral medications have different mechanisms of action when treating allergies. Let's take a closer look at how each one works to provide relief.

Nasal Sprays

Nasal sprays for allergies target symptoms like nasal congestion, runny nose, itching, and sneezing caused by airborne particles like pollen or pet dander. When these particles enter the nose, they trigger the release of histamines and other chemicals, causing allergic reactions.

Nasal allergy sprays work by delivering medication directly to the nasal lining, reducing inflammation and alleviating symptoms. Different nasal sprays include:

• Steroid Sprays: Reduce inflammation in the nose and sinuses, relieving congestion, runny nose, itching, and sneezing.
• Antihistamine Sprays: Block the effects of histamines, offering relief from symptoms like congestion, runny nose, itching, and sneezing.
• Decongestant Sprays: Narrow blood vessels in the nose, providing short-term relief from nasal congestion.
• Mast Cell Inhibitor Sprays: Block the action of mast cells, preventing the release of histamines and relieving allergy symptoms.
• Combination Sprays: Contain a mixture of allergy medications like steroids, antihistamines, or mast cell inhibitors for maximum effectiveness.
• Saline Sprays: Made of salt water, these help loosen mucus and clear allergens from the sinus cavity.

Oral Medications

Oral medications, such as antihistamines, target the histamine response triggered by allergens. They come in various forms, including:

• Tablets
• Capsules
• Liquids

Antihistamines like cetirizine, loratadine, and fexofenadine block the effects of histamine, relieving symptoms like sneezing, itching, and runny nose.

Types of Antihistamines:

• First Generation (Older): Brompheniramine, chlorpheniramine, diphenhydramine. These are known to cause more drowsiness.
• Second Generation (Newer): Cetirizine, loratadine, fexofenadine. These are known to have fewer side effects.

2. Advantages

Nasal sprays and oral medications have unique advantages that make them suitable for managing allergies. Here are some of the key benefits of each method.

Nasal Sprays

Nasal sprays provide fast, targeted relief by delivering medication to the source of allergic reactions. They are an excellent option for controlling nasal allergy symptoms. To break it down, here’s what you need to know:

• Localized Action: Nasal sprays deliver medication directly to the nasal lining, targeting symptoms at the site of the allergic reaction. This localized action ensures efficient relief where it's needed.
• Reduced Systemic Absorption: Nasal sprays often require smaller doses than oral medications since they act directly on the affected area. This can reduce the risk of systemic side effects.
• Effective for Nasal Symptoms: Nasal sprays, particularly intranasal corticosteroids, are highly effective in treating nasal symptoms such as congestion, runny nose, itching, and allergy sneezing.
• Combination Options: Some nasal sprays come in combination formulations containing a mixture of steroids, antihistamines, or mast cell inhibitors. These combination sprays provide comprehensive relief for multiple symptoms.
• Prevention of Rebound Congestion: Unlike decongestant nasal sprays, which can lead to rebound congestion if used for an extended period, other types of nasal sprays, like corticosteroids and antihistamines, are less likely to cause this issue.

Oral Medication

Oral allergy medications offer convenience and flexibility in managing various allergy symptoms. Their ease of use makes them a popular choice for many. Here are more advantages:

• Convenience of Administration: Oral medications are generally more convenient than nasal sprays. They come in various forms, including tablets, capsules, and liquids, making them easy to take on-the-go.
• Broad Symptom Coverage: Antihistamines taken orally can address allergy symptoms, including sneezing, itching, runny nose, and watery eyes. This broad coverage makes them suitable for individuals with multiple symptoms.
• Ease of Use: Oral medications are typically easy to use and do not involve the application of a spray directly into the nasal passages. This simplicity makes them accessible to a wide range of individuals.
• Variety of Options: There is a wide variety of oral antihistamines available, both over-the-counter and prescription, allowing individuals to choose based on their preferences, tolerance, and specific allergy symptoms.
• Less Irritation Risk: Some individuals may find nasal sprays irritating or uncomfortable. Oral medications, being ingested, avoid any potential discomfort associated with direct application to the nasal passages.

3. Effectiveness

Numerous clinical trials have assessed the effectiveness of nasal sprays and oral medications in treating various types of allergies. Here's an overview of the evidence.

Nasal Sprays

In a study on a nasal spray-type allergen blocker combined with oral antihistamines for dust mite allergic rhinitis, 90 patients were randomly divided into experimental and control groups. The experimental group used a nasal spray allergen barrier agent with citrate tablets, while the control group used physiological seawater with a citrate sheet.

The experimental group showed significantly better symptoms, signs, and quality of life scores than the control group. No obvious adverse reactions were observed, indicating the remarkable effect of the nasal spray-type allergen blocker combined with antihistamine in treating dust mite allergic rhinitis.

A trial for the drug-free, barrier-forming nasal spray (AM-301) involved 36 participants. The study found that AM-301 demonstrated noninferiority to hydroxypropyl methylcellulose (HPMC) in reducing grass pollen-induced allergic rhinitis symptoms. The mean total nasal symptom score during exposure without protection was 5.91, reduced to 4.82 with AM-301.

The study emphasized the noninferiority, efficacy, and safety of AM-301, with 31% of subjects rating its efficacy as good or very good.

A comparative clinical study for the fixed-dose combination of Fluticasone Furoate and Oxymetazoline Hydrochloride Nasal Spray included 250 patients randomized into two groups. The results demonstrated a significant reduction in the night-time Total Nasal Symptom Score with the combination compared to Fluticasone alone at various time points, starting as early as day 3 and sustained until the end of treatment (Day 28).

Additionally, a significantly greater number of patients experienced complete relief in Nasal Congestion with the combination. Both treatments were well-tolerated, with no significant difference in adverse events between the groups.

For Fluticasone furoate nasal spray (FFNS) in perennial allergic rhinitis, a study involved 315 participants in a randomized, double-blind, placebo-controlled trial. FFNS, administered once daily for 4 weeks, showed significant improvement over placebo in daily reflective total nasal symptoms, morning and evening reflective total nasal symptoms, daily reflective individual nasal symptoms, and quality of life scores. Adverse events reported with FFNS included epistaxis (15%) and nasopharyngitis (5%), higher than the placebo group.

In a study on FFNS for seasonal allergic rhinitis caused by grass pollen, involving 285 participants, FFNS significantly improved the mean change from baseline in daily reflective total nasal symptoms compared with placebo. The treatment difference was -1.757, establishing its effectiveness. FFNS was well-tolerated, with a significant improvement observed in various efficacy measures as early as day 1.

These studies provide robust data supporting the efficacy and safety of nasal sprays, especially those containing corticosteroids, in treating different forms of allergic rhinitis.

Oral Medications

The efficacy of oral medications in treating allergic rhinitis has been extensively studied, focusing on oral H1 antihistamines and other therapeutic approaches.

A systematic review and network meta-analysis of randomized controlled trials evaluated various oral H1 antihistamines for allergic rhinitis, highlighting that rupatadine, especially at a dosage of 20 mg, demonstrated the highest efficacy in reducing total symptom scores, nasal congestion, rhinorrhea, and ocular symptoms. In contrast, loratadine 10 mg exhibited inferior efficacy compared to other antihistamine treatments.

This suggests that oral antihistamines can significantly impact symptom relief, with rupatadine emerging as a particularly effective option.

The evaluation of montelukast's effectiveness in treating allergic rhinitis through a systematic review and meta-analysis highlighted its superiority over placebo in improving daytime and nighttime nasal symptom scores, composite nasal symptom scores, daytime eye symptom scores, and rhinoconjunctivitis quality-of-life questionnaires. However, oral antihistamines were more effective than montelukast in certain aspects.

Furthermore, combining montelukast and oral antihistamine showed superior efficacy compared to either treatment alone, emphasizing the potential benefits of combination therapies in allergic rhinitis management.

Overall, oral medications, particularly oral H1 antihistamines and montelukast, have effectively alleviated symptoms associated with allergic rhinitis and food allergies. The choice of drugs and potential combination therapies should be tailored to individual patient needs, considering efficacy, safety, and the specific characteristics of the allergic condition.

Ongoing research aims to refine these treatment approaches further and explore additional options, such as oral desensitization and immunotherapy, to enhance the management of allergic rhinitis and food allergies.

4. Side Effects

While generally safe when used as directed, both nasal sprays and oral allergy medications can potentially cause side effects.

Nasal Sprays (Antihistamines, Decongestants, Corticosteroids)

Common side effects

• Dryness
• Stinging
• Burning
• Irritation in the nose

Serious side effects

• Thick nasal discharge
• Fever
• Sore throat
• Signs of infection
• Whistling sound from the nose
• Hives
• Rash
• Itching
• Swelling of face or throat
• Difficulty breathing or swallowing
• Wheezing
• Severe or frequent nosebleeds

Oral Medication

Common side effects

• Headache
• Cough
• Tiredness
• Sore throat
• Abdominal pain or discomfort
• Nausea or vomiting

Potential serious side effects

• Vary depending on the specific type of medication (e.g., corticosteroids may have long-term effects like osteoporosis, high blood pressure, weight gain)

5. Cost

The costs of prescription and over-the-counter nasal sprays and oral allergy medications can vary. Let’s break them down below.

Nasal Sprays

The cost of nasal sprays and oral medications for allergies can vary depending on factors like the specific brand, generic versions, and discounts available.

For the 12 Hour Nasal Decongestant Spray (oxymetazoline nasal), the price is around $12 for 30 milliliters, or you can opt for the generic version starting from $10.60 for 15 milliliters.

Oral Medications

As for other allergy medications with GoodRx discounts:

• Hydroxyzine hydrochloride (Atarax) antihistamine can be as low as $5.
• Diphenhydramine (Benadryl) antihistamine can be as low as $3.
• Chlorpheniramine antihistamine can be as low as $4.

Wrap Up

Both nasal sprays and oral medications can effectively treat allergy symptoms but work differently. Nasal sprays deliver targeted relief to the nasal passages, while oral medications work throughout the body.

Nasal steroid sprays are particularly effective for nasal congestion and other localized symptoms. Oral antihistamines help control systemic effects like sneezing and itching. Combination therapies may provide optimal symptom relief. Nasal sprays tend to cause local irritation, whereas oral medications can lead to fatigue or headaches. Generics and discounts make both treatment options more affordable.

Overall, the choice between nasal sprays and oral medications depends on each allergy sufferer's specific symptoms and needs.

FAQs on Nasal Sprays and Oral Medications

When should I avoid nasal sprays?

If you have diabetes, high blood pressure, hyperthyroidism, or take certain medications, your doctor or pharmacist might suggest alternatives. Also, avoid nasal sprays if your nasal passages are damaged.

What medications don't mix with antihistamines?

Be cautious with antidepressants, stomach ulcer or indigestion medicines, and cough/cold remedies containing antihistamines.

What shouldn't be combined with nasal sprays?

Exercise caution with HIV medications (ritonavir or cobicistat), antifungal drugs (ketoconazole or itraconazole), and other steroids like eczema creams, asthma inhalers, tablets, injections, and eye drops.

Can I combine oral and nasal allergy medications?

Yes, using oral antihistamines (like Zyrtec or Claritin) and nasal steroid sprays (such as Nasonex or Flonase) is generally fine based on your clinical symptoms and treatment response.