There’s been a dramatic evolution of treatments for allergy sufferers in the past few years. A safe nasal spray can nearly eliminate symptoms of nasal allergies. New antihistamine drugs positively won’t make you sleepy. And don’t forget nasal saline sprays.

Fluticasone (Flonase) nasal apray

One of the best treatments for nasal allergies is fluticasone nasal spray (brand name Flonase): cortisone in spray form. If you use it on a regular basis during the allergy season, your allergy symptoms should dramatically improve. So you can expect your nasal congestion, postnasal drip, sneezing, and watery eyes will be a lot better.

Flonase is different from other allergy medications in important ways:

  1. It may take a few days before it works. Most allergy drugs work as soon as you take them. Flonase or Nasonex may take a week. Not only that, if you change the dose, it takes a few days before the effects of the change show up.
  2. Flonase doesn’t treat allergy symptoms. It prevents them in the first place. However, you may have to keep using the medication on a regular basis for this preventive effect to take place. After the allergy season is over, stop the drug and see if your symptoms don’t stay away. If you usually have allergy symptoms all year, you’ll have to use Flonase continuously to have an uninterrupted effect.
  3. We can’t tell in advance how much you’ll need. Some people need more, some less. But the correct dose is easy to figure out. If your nose is too wet (runny, congested), use it more often: two or three squirts a day in each nostril rather than one. If your nose gets too dry (it may actually bleed), use Flonase less often. Don’t forget it takes a few days to tell what the effect will be of a change in dose.
  4. You may have mild local irritation for a few seconds after spraying when you first use this medication. But this side effect usually goes away soon.

Nonsedating antihistamines

There are now three antihistamines on the market that won’t make you drowsy. All are available without a prescription. They work well, have few side effects, and don’t interact with other drugs. However, you may notice drying of your nose and mouth, and you should not use these medications if you have serious liver or kidney problems. One pill a day works well. One caution: When there’s a “D” added to the name (Claritin D and Allegra D), the drug also contains a decongestant that can make you edgy.

Neilmed Sinus Rinse

One of the simplest and most effective nose and sinus treatments is nasal irrigation: cleansing your nasal passages with a “normal saline,” a dilute solution of salt and water that’s soothing and cleansing like artificial tears. Clean once or twice daily with a salt solution that’s neither too concentrated nor too dilute. Spray gently but deeply enough in your nostrils to rinse out thick mucous. Check out “NielMed Sinus Rinse” and Waterpik’s “Gentle Sinus Rinse.” If you want something simple, sometimes the little Ocean Nasal Spray (or the generic equivalent) is all you need. The only problem with the Ocean Spray is it’s a fine mist. So the saline doesn’t get very far into your nostrils. It’s good for moisturizing, but it won’t clean out the mucous.

Questions and Answers About Flonase — the generic fluticasone spray; get whichever is cheaper

How is Flonase different from the nasal sprays I can get without a prescription? Over-the-counter nasal sprays like Afrin and Dristan Mist are decongestants. They are addicting if used for more than three days. Flonase is a completely different medication, just as a penicillin pill and an aspirin are different even though they look the same. In fact, Flonase is the best treatment for people addicted to spray decongestants.

Won’t I get side effects from the cortisone in these sprays? It’s true that cortisone pills or injections can cause serious side effects including weight gain, loss of bone mineral, etc. But you won’t get total body side effects just from cortisone skin cream — it stays on your skin, period. In the same way, Nasonex or Flonase (they’re virtually identical drugs) stay put in your nostrils and are not absorbed into the blood stream. Using too much of this medicine can, however, cause thinning and drying of nasal tissues.

Will I become dependent or addicted to Flonase? No, but you may have to keep using it throughout your usual allergy season.

Are there any precautions in using this medication? Be sure to point the spray directly into your nostril, rather than toward the septum (the wall in the middle between the nostrils).

How do I know much to Flonase and sinus rinse to use?

I call these “Goldilocks drugs,” as in Goldilocks and the three bears. Goldilocks was a little girl who didn’t want food that was too hot or too cold, or a chair too high or too low, or a bed too hard or too soft. So you don’t want your nose to be too wet or too dry. Too wet and you need to use more Flonase and Neilmed. Too dry (and if it’s really bad you can get nose bleeds): use less or stop for a day or two until things calm down.

Here’s an example of Fluticasone Nasal Spray from Amazon. You can get yours pretty much anywhere.

There are probably a bunch of brands of Neilmed Sinus Rinse, but for some reason people usually wind up with this one. It’s just salt and water. Get the squeeze bottle so it has more “umph” and can really clean out that pollen and mucous. Neilmed will happily sell you salt packets to mix up your salt solution, but you can make your own at home. Do not use well water to make the solution. If you’re not sure your water has been freed of bacteria, use bottled or distilled water instead!