Are you confused about nasal sprays? Nasal sprays help reduce nasal symptoms associated with allergies, nasal polyps and viral infections. Nasal sprays are commonly available with active ingredients under the categories of decongestant, antihistamine, steroids and saline. These can work to reduce symptoms of congestion, excess mucus production and sneezing for example. Some nasal sprays have also been developed which work as preventatives of the common cold virus.
Common culprits causing nasal symptoms
Allergic rhinitis is a common non-infectious form of rhinitis (nasal inflammation) due to an allergic response by the body to a perceived allergen. It results in nasal congestion, frequent sneezing, runny nose, post nasal drip, itchy eyes, ears, nose and throat; red, itchy or watery eyes, and headaches. Treatment prescribed is commonly medication for allergies and nasal sprays. These can address the allergic reaction and reduce the inflammatory response.
The common cold virus causes symptoms of a runny nose, nasal congestion and frequent sneezing.
Nasal polyps are benign growths in the nasal passages. They are the result of inflammation from conditions such as allergic rhinitis, asthma or chronic sinusitis. Symptoms include nasal congestion or sensation of nose being blocked, runny nose and post-nasal drip. Steroid nasal sprays are often prescribed to reduce polyp size and symptoms.
Which nasal spray to choose?
Antihistamines
Antihistamines block the action of histamine which is released in response to allergens or an irritant. Symptoms include swelling and irritation in the nasal passages. Antihistamines can reduce mucous secretions, reduce sneezing, runny nose and itchy eyes.
What is histamine? Histamine is a compound found in the skin, intestinal mucosa, heart, lung, and nerve endings in the brain. It is involved in local immune responses, regulating physiological responses and acts as a neurotransmitter in the brain. In regard to allergens, histamine is released in response to a perceived allergen.
It starts the process of removal of the allergen out of the body – thus the symptoms of sneezing, runny nose, watery eyes and itchy skin. When the symptoms are overwhelming, an antihistamine can calm things down.
Common non-threats perceived as danger (allergens) by the body include pollen, animal dander and dust mites. Histamine is also found in foods and for some people who are sensitive, eating too many foods containing histamine can result in gastrointestinal and other reactions.
Histamine intolerance. Symptoms of histamine intolerance include rhinorrhoea, rhinitis, nasal congestion, sneezing and dyspnoea, gastrointestinal symptoms and other various symptoms. Unlike allergies, histamine intolerance is considered due the intake of histamine and a deficiency of the enzyme diamine oxidase (DAO), in the intestines. DAO is involved in protecting the body against histamine, either from ingested food or generated by the intestinal microbiota. Diagnosing histamine intolerance is usually established after other possible causes have been ruled out. This includes allergic reactions/symptoms.
Steroids
Corticosteroids help reduce nasal swelling and are often suggested for chronic congestion related to allergies and irritants. Correct use of nasal sprays is needed to ensure adequate medication uptake.
Decongestant
Decongestant work quickly to reduce swelling of blood vessels inside nasal passages and provide relief for nasal congestion. Decongestants are often suggested for use in short-term disorders such as colds and flu. They are only recommended for short-term use due to possible rebound effects.
What are rebound effects? Rebound effects or rebound congestion is inflammation of the nasal mucosa due to the overuse of topical nasal decongestants. Medically it is referred to as Rhinitis medicamentosa (RM) (drug-induced rhinitis). RM will often resolve on discontinuation of the topical decongestant.
Saline
The mucus layer covering nasal tissues needs to remain moist to enable it to trap and prevent inhaled viruses, bacteria and irritants from reaching the lungs. Airborne pathogens (viruses and bacteria) and irritants, such as dust and pollens, are removed through swallowing and destroyed by acid in the stomach. Saline can thin excess nasal mucus, flushing away inhaled airborne irritants, reducing pathogenic load and reducing congestion. Saline also helps keep nasal passages moist.
Saline nasal sprays are non-medicated - containing just saline (salt water). Some may contain preservatives which can be irritating on nasal passages. Some are available including essential oils of tea tree or eucalyptus offering a pleasant scent and provide added benefit by helping in the reduction of virus, bacteria and fungi.
Preventative measures
Some nasal spray ingredients create a physical barrier capable of blocking virus uptake. These passive barriers are generated via semi-synthetic or natural gelling agents such as hydroxypropyl methylcellulose (HPMC) or carrageenan.
Carragelose
Carragelose is a natural ingredient sourced from red seaweed. When applied to the nasal passages, carragelose forms a natural moisturising gel barrier which traps viruses causing the common cold, allowing the body's own defenses to remove them from the body. Best used at the first sign of infection. Its moisturising ability help keep the mucus membranes of the nasal passages moist for long-term benefits.
Hydroxypropylmethylcellulose
Hydroxypropylmethylcellulose (pHPMC) is a powdered nasal spray which forms a protective gel against airborne allergens. It has been proven an effective barrier for people suffering with rhinitis, shown to reduce symptoms and works with medicated nasal sprays to enhance their effectiveness. It is also being studied as a possible viral preventative.
Not sure which one is the right one to use?
For best result discuss with your pharmacist or health-care provider the most appropriate product for you. It is also helpful to get clear instructions on the use of nasal spray to ensure medication is being effectively administered.
Herbal and nutritional medicines
Oral intake of immune supporting herbal and nutritional medicines can be used alongside of nasal sprays for symptoms or allergies and upper respiratory infection. Suggestions include:
Natural antihistamines
Quercetin has anti-histamine, anti-allergic and antioxidant properties. Quercetin reduces the release of histamine, down-regulating the immune response.
Vitamin C, known for its ability to reduce symptoms of the common cold, is also an antihistamine action.
Eyebright (Euphrasia officinalis/rostkoviana) has an astringent action which helps reduce nasal secretions and reduce inflammation.
Chamomile (matricaria recutita) can be helpful for allergic disorders and inflammatory mediated diseases. It offers potent anti-allergic activity by inhibition of histamine release from mast cells.
Albizia (Albizia lebbeck) inhibits histamine signalling, preventing allergic reactions.
Thyme contains vitamin C and compounds which reduce histamine release and inflammation.
Ginger (Zingiber officinale) can help in the prevention or alleviation of allergic rhinitis symptoms.
Turmeric offers anti-inflammatory, antiallergic and inhibitory effects on histamine release from mast cells.
Probiotics bacteria have been shown to both reduce symptoms of allergy and also reduce the allergic response.
- Lactobacillus rhamnosus (particularly GG) - stabilize mast cells and reduce the sensitivity of allergy-associated receptors.
- Bifidobacterium longum is a histamine degrading probiotic.
- Bifidobacterium lactis – helps break down histamine and tyramine.
- Lactobacillus plantarum – helps break down biogenic amines, including histamine and tyramine.
Immune support
- Elderberry – offers potent immune-modulatory activity.
- Echinacea – helps support the immune system.
- Zinc is important for immune function.
- Vitamin C - reduce the duration and severity of colds.
Nasal sprays could battle against COVID-19
A study led by an expert from The University of Western Australia has found a virus-killing nasal spray could be effective in reducing the spread of COVID-19. This study was based on In vivo (human) and in vitro inactivation of SARS-CoV-2 using a nasal spray containing 0.5% povidone-iodine. Further studies are warranted to evaluate its use as an adjunct in the management of C0VID-19 (1).
Iota-Carrageenan (I-C) is a sulfate polysaccharide synthesized by red algae which has demonstrated antiviral activity and to be clinically effective as nasal spray in the treatment of common cold, has been shown in vitro to inhibit SARS-CoV-2 infection in cell culture. It is suggested it could give significant protection aganist COVID-19 for health care workers managing patients with COVID-19 disease (2).
References
- Rhinitis Medicamentosa https://www.ncbi.nlm.nih.gov/books/NBK538318/
- Real-life treatment of rhinitis in Australia: a historical cohort study of prescription and over-the-counter therapies for patients with and without additional respiratory disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101013/
- Inadequate quality of administration of intranasal corticosteroid sprays https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6452790/
- Nasal Polyps: Causes, Symptoms, and Diagnosis (healthline.com)
- Histamine Intolerance: The Current State of the Art https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463562/
- Histamine - an overview | ScienceDirect Topics
- Carrageenan nasal spray in virus confirmed common cold: individual patient data analysis of two randomized controlled trials https://mrmjournal.biomedcentral.com/articles/10.1186/2049-6958-9-57
- In vitro and in vivo Evaluation of the Efficacy and Safety of Powder Hydroxypropylmethylcellulose as Nasal Mucosal Barrier https://pubmed.ncbi.nlm.nih.gov/32308507/
- Methyl-cellulose powder for prevention and management of nasal symptoms https://pubmed.ncbi.nlm.nih.gov/28862062/
- Hydroxypropyl Methylcellulose-Based Nasal Sprays Effectively Inhibit In Vitro SARS-CoV-2 Infection and Spread https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8705245/
- Polysaccharides from European Black Elderberry Extract Enhance Dendritic Cell Mediated T Cell Immune Responses https://pubmed.ncbi.nlm.nih.gov/35409309/
- Zinc as a Gatekeeper of Immune Function https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5748737/
- (1) https://www.uwa.edu.au/news/Article/2022/February/Study-finds-nasal-spray-could-aid-battle-against-COVID
- (2) Efficacy of a Nasal Spray Containing Iota-Carrageenan in the Postexposure Prophylaxis of COVID-19 in Hospital Personnel Dedicated to Patients Care with COVID-19 Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8493111/
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