Over-the-counter allergy medicines are often a quick fix to alleviate symptoms of patients suffering from environmental allergies. While these treatments do not treat the root causes behind allergy symptoms, they can help significantly reduce symptom severity and are often recommended as part of a comprehensive treatment plan. In addition, many patients turn to products like Flonase or other nasal steroid sprays to reduce one of the most bothersome allergy symptoms - congestion.
Unlike over-the-counter allergy pills that only address histamines, nasal steroid sprays address multiple inflammatory triggers through a light mist sprayed directly into the nostril, reducing inflammation. Products like Flonase are recommended for daily use and relieve symptoms caused by a variety of allergy triggers, including both indoor perennial and outdoor seasonal triggers. In addition, these products are generally safe and usually cause minimal side effects, but of course patients should seek counsel from a physician about long term use, since adverse reactions can occur, including but not limited to nasal dryness, septal ulceration, and elevation of eye pressure in glaucoma patients.
Depending on the type of nasal steroid selected, products differ in their systemic uptake, but there are even nasal steroid sprays designed for pediatric patients. Topical glucocorticoids, like Flonase, are widely available and easy to use, but to ensure maximum efficacy your patients must know how to administer these steroids correctly, and there are some common mistakes we have seen patients make.
Björn Herman, MD, is an Assistant Professor of Otolaryngology at the University of Miami, Miller School of Medicine, and a valued member of our expert medical advisory board at AllergiEnd®. When we asked his advice on how physicians should instruct their patients to administer Flonase or other nasal steroid sprays, he recommended the following: "Physicians typically recommend using fluticasone (Flonase) by administering 1-2 sprays to each nostril, one or two times daily. Dosing depends on the severity of allergic rhinitis, chronic sinusitis, or nasal polyps. Aim the spray up and towards the inside corner of the eye. It is better applied to the nasal tissues when sprayed like this, and consequently more effective, since these tissues swell up due to allergies and block the sinuses. Generally, this method is most easily done by using the left hand to apply fluticasone to the right nostril and the right hand to the left nostril. Should you also be using nasal saline sprays or washes, fluticasone should be applied after performing them, so as not to wash out the medication. If the nose becomes dry due to using fluticasone, patients can apply nasal saline gel to the nose after spraying it to keep the nasal lining from drying out."
According to the NIH, here are the steps that your patients need to take when administering nasal steroids at home.
Make sure your patients understand your dosing instructions.
Spray only the number of prescribed sprays in each nostril.
Read the package instructions before using your spray the first time.
Most corticosteroid sprays suggest the following steps:
Wash your hands well.
Gently blow your nose to clear the passageway.
Shake the container several times.
Keep your head upright. Don't tilt your head back.
Breathe out.
Block one nostril with your finger.
Insert the nasal applicator into the other nostril.
Aim the spray toward the outer wall of the nostril.
Inhale slowly through the nose and press the spray applicator.
Breathe out and repeat to apply the prescribed number of sprays.
Repeat these steps for the other nostril.
Avoid sneezing or blowing your nose right after spraying.
Flonase and other nasal steroids can play a role in alleviating symptoms, but they can cause adverse reactions when using:
Headache or dizziness
URI sx
Epistaxis
Nasal burning, irritation, septal perforation, or ulcers
GI symptoms including vomiting, diarrhea, or abdominal pain
Bronchitis
Candidiasis (nasal or oral)
Other adverse reactions include hypersensitivity and even anaphylaxis, but there are serious conditions associated with long-term use including:
Ocular conditions including glaucoma or cataracts
Immuno, adrenal, and growth (in pediatrics) suppression
Hypercorticism
While these products can temporarily provide relief, physicians need to address the root causes of allergy suffering is essential for true, lasting allergy relief. AllergiEnd® offers a three-step system to screen, test, and treat allergy symptoms and provides reimbursements through proven CPT codes for each of these steps.
First, screen your patients with our easy-to-use digital assessment that patients can complete from the comfort of their home or in the waiting room before their appointment. Additionally, this assessment provides you, the physician, with valuable insights into your patient's symptoms, severity, overall health, and lifestyle behaviors. Next, confirm suspected allergies with an FDA-cleared test for some of the most common allergy triggers. These skin tests are virtually painless and provide results in just 15-20 minutes - no more waiting on labs! They are even safe for pediatric patients. Finally, AllergiEnd® offers convenient immunotherapy treatments in the form of injections or convenient sublingual drops. In addition, if patient treatment is needed, our pharmacy creates patient-specific allergy treatments that arrive directly at your office within ten days of placing an order.
