Nasal Corticosteroid Spray vs. Oral Antihistamine: Which Is Better?

Nasal corticosteroid sprays reduce swelling and mucus in the nasal passages to relieve sneezing, runny nose, and other allergy symptoms. Unlike oral steroids, which treat allergy symptoms throughout the body, nasal sprays only treat nasal symptoms. They work best when taken regularly throughout the allergy season.

Nasacort Allergy 24 Hour (triamcinolone) was the first intranasal corticosteroid nasal spray made available without a prescription—meaning over the counter (OTC). Soon after, Flonase (fluticasone) also became available OTC.

Deciding whether to use an OTC nasal corticosteroid spray or an oral OTC antihistamine like Zyrtec or Allegra can be confusing. Nasal corticosteroid sprays work locally to reduce nasal inflammation and mucus, effectively relieving symptoms of nasal allergies. Oral antihistamines work throughout the body to block the action of the specific chemical causing allergy symptoms.

This article discusses the pros and cons of using OTC nasal corticosteroid sprays like Nasacort, Flonase, or Rhinocort (budesonide). It also compares oral antihistamines to nasal corticosteroid sprays.

Nasal Sprays vs. Antihistamines

Nasal corticosteroids are the most effective treatment for nasal allergy symptoms. They are safe and effective, including for children. Nasacort, Flonase, and Rhinocort are OTC nasal corticosteroids.

How Quickly Do Nasal Corticosteroid Sprays Work?

Nasal corticosteroids take time to completely relieve your symptoms—possibly two weeks or more. However, you'll likely start feeling better much earlier: For example, Nasacort may improve your symptoms from day one and provide full relief in a week. In fact, if you don't feel any relief after using OTC Nasacort for a week, or if your symptoms worsen, make sure to talk to a healthcare provider.

Flonase and Rhinocort may improve your symptoms as soon as one to two days. Talk to a healthcare provider if you don't feel any relief after one week of daily Flonase use or after two weeks of daily Rhinocort use.

To get the best effects, you may need to continue using the nasal corticosteroid sprays daily throughout the allergy season.

A Closer Look at Antihistamines

Oral antihistamines such as Zyrtec (cetirizine), Allegra (fexofenadine), and Claritin (loratadine) work by blocking the action of a chemical called histamine. Histamines get released by your immune system when it senses an allergen. Blocking this mechanism can treat many allergy symptoms, not just nasal.

Oral antihistamines work quickly. Zyrtec and Allegra, for example, can start working after an hour. Claritin typically begins working within three hours. Their effects may last for 12-24 hours, depending on the product you choose. Some antihistamines only last four to six hours.

Oral antihistamines are less effective for nasal allergy symptoms (especially congestion) than nasal corticosteroids. However, they may still work well for someone with mild nasal allergy symptoms.

Note that you may need to avoid antihistamines if you have certain health conditions, including the following:

• Diabetes
• Epilepsy
• Heart disease
• High blood pressure
• Glaucoma
• Enlarged prostate
• Problems urinating
• Hyperthyroidism

If you experience any of these, or if you are pregnant or breastfeeding, talk to a healthcare provider before taking any OTC antihistamines.

Which Antihistamine Should I Choose?

Any oral antihistamine may make you sleepy, but some types are less likely to do so. Zyrtec, Allegra, and Claritin all cause less sleepiness—though they can still worsen your reaction time and focus. Every time you use an oral antihistamine, exercise caution while driving or operating any machinery.

While Zyrtec, Allegra, and Claritin are often preferred for allergy relief because they're non-drowsy, a more sedating oral antihistamine such as Benadryl (diphenhydramine) may be a better choice if your allergy symptoms interfere with sleep.

Another antihistamine option is Astepro (azelastine hydrochloride), a nasal spray approved for OTC use in adults and children older than 6. Just like an oral antihistamine medication, Astepro may make you drowsy. About 15–20% of people also report a bitter taste starting one to three hours after using Astepro.

Pros

Nasal corticosteroids are typically the first therapy recommended for nasal allergy. They are the most effective treatment for nasal symptoms and are considered generally safe.

All adults can use nasal corticosteroid sprays, including those who are pregnant—your healthcare provider can help you choose the safest nasal corticosteroid spray during pregnancy. Some sprays are also safe for children aged 2 and older.

Additionally, nasal corticosteroids aren't absorbed throughout the body, so none of their side effects affect the person as a whole. That means corticosteroid sprays won't make you drowsy, dizzy, or nervous—but oral antihistamines might.

A 2017 task force from the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology strongly recommended using nasal corticosteroids alone as the first line of treatment for nasal allergy symptoms in people aged 12 and older.

What Role Will Health Insurance Play?

Insurance coverage may vary, but medical insurance providers usually do not cover the cost of OTC drugs.

However, there are some exceptions for Medicare Advantage OTC cardholders. Medicare Advantage OTC offers allowances for some non-prescription drugs, including generic fluticasone nasal sprays.

Cons

You may experience side effects of nasal corticosteroids, which are typically mild and can include:

• Nasal irritation—which can often be avoided by shifting the direction of the spray away from the septum
• Nasal dryness or burning sensation—which can be reduced by placing your head into a steam-filled sink or shower for five to 10 minutes
• Sneezing
• Throat irritation
• Headaches
• Nasal infection

Very rarely, overuse or misuse of nasal sprays can damage the cartilage in the septum. Make sure to aim the spray tip away from the septum. Talk to a healthcare provider right away if you experience a nosebleed while using nasal corticosteroids.

Nasal corticosteroid sprays work best when used regularly, so you may choose oral antihistamines if you have infrequent or short-term nasal allergy symptoms. Oral antihistamines may be an appealing option for people with mild nasal allergy symptoms because the pills are easy to take and work quickly and effectively.

Summary

Nasal corticosteroid sprays can safely and effectively reduce symptoms of allergic rhinitis such as runny nose, nasal irritation, and sneezing. They may begin working on the same day or one to two days later, depending on the spray you choose, but can take two weeks or more to take full effect. The three nasal corticosteroid sprays available without a prescription are Nasacort, Flonase, and Rhinocort.

Nasal corticosteroid sprays are the most effective treatment for nasal allergy symptoms. Their side effects, if you experience them, are mild and local. In rare cases, a nosebleed would require immediate medical attention.

Oral antihistamines are also effective for nasal allergies. They can relieve symptoms within three hours but may cause drowsiness and other local and whole-body side effects. People with mild and short-term nasal allergies may choose oral antihistamines because nasal corticosteroid sprays need to be used throughout the allergy season for best effects—while oral antihistamines work quickly when needed.