nasal spray, saline spray

Not that long ago, corticosteroid nasal sprays were available only by prescription. Doctors had to monitor a patient’s progress and make sure there were no complications from cortisone-like medications such as beclomethasone, budesonide, fluticasone, mometasone and triamcinolone. Now that people can buy allergy sprays containing corticosteroids over the counter, there is no longer much supervision. Many people assume that when such drugs are applied topically as nasal allergy sprays they are not absorbed into the body. This is not the case.

A Doctor Shares His Experience:

Q. As a cataract surgeon, I have seen several patients over the years with posterior subcapsular cataracts that I thought were attributable to steroid nasal sprays. It is quite common to see them in asthma or COPD patients who need inhaled steroids in order to breathe freely.

The nasal sprays for allergies are not so likely to cause cataracts as the inhalers, but I suspect some of the drug is getting into the bloodstream and circulating throughout the body from either route of administration.

A. Corticosteroid nasal sprays such as Beconase AQ, Flonase or Nasacort AQ were once available only by prescription. The prescribing information alerted physicians to adverse reactions such as:

Nosebleeds, sore throat, cough, headache or loss of the sense of smell. Nasal septal perforation, glaucoma and cataracts were also mentioned as possible complications.

Now the OTC Allergy Spray label reads:

“Ask a doctor before use if you have or had glaucoma or cataracts.”

Not all doctors are aware that steroid sprays can lead to posterior subcapsular cataracts, although the link has been established (Journal of Ocular Pharmacology, Oct. 2007). People who rely on steroid sprays should be alert for any changes in vision. Regular eye exams are crucial for anyone using a corticosteroid medication, prescription or OTC.

Steroid Allergy Sprays and Smell:

The official prescribing information for steroid nasal allergy sprays like Flonase note:

“alterations or loss of sense of taste and/or smell”

How serious is this potential complication? Here are some stories from readers:

Cathy in southern California reports:

“I used Flonase for about a year. Cooking breakfast one morning my son in-law came flying down the stairs raced to the stove and turned off the burner I was using. He could smell gas upstairs and I couldn’t smell it standing at the stove! That was my wake-up call and have never used Flonase again!”

Robert G in South Carolina shares a similar story:

“I used Nasacort for over a year. Over that time I gradually lost my sense of taste and smell. After I stopped using Nasacort, I gradually had my sense of smell and taste come back. Why is the fact that use of Nasacort can cause loss of smell and taste not on their list of things that can occur?”

J.L.W. in Georgia also had a corticosteroid allergy spray reaction:

“My sense of smell is not completely gone, but altered. I know I am smelling something but cannot identify it or it smells like something else. One day, I can only smell strong odors, then another day, I smell things no one else does. It’s very frustrating!”

The Benefits and Risks of Allergy Sprays:

Corticosteroid sprays are quite helpful when it comes to easing nasal congestion. When you are miserable because of allergy symptoms, occasional use (according to the instructions on the label) can be very helpful. There is far less steroid exposure to a nasal spray than from an oral corticosteroid like prednisone.

Sadly, many people do not bother to read the instructions on the label. They just assume that if it is available over the counter it must be safe. Here are just a few of the cautions on the OTC label:

“Ask a doctor before use if you have or had glaucoma or cataracts”

“When using this product”

  • “the growth rate of some children may be slower” [suggesting systemic absorption]

“Stop use and ask a doctor if”

  • “you have, or come into contact with someone who has, chicken pox, measles or tuberculosis” [suggesting some immune modifying activity]
  • “your symptoms do not get better within 7 days of starting use or you get new symptoms such as severe facial pain or thick nasal discharge. You may have something more than allergies, such as an infection.”
  • “you get a constant whistling sound from your nose. This may be a sign of damage inside your nose”
  • “you get changes to your vision that develop after starting this product”
  • “you have severe or frequent nosebleeds”

Share your own experiences with Flonase of other corticosteroid nasal allergy sprays below in the comment section.

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  1. Stormy
    TN
    Reply

    I’m wondering if you get cataracts while using it, and Quit using it, will the cataracts go away without surgery??!?

  2. Roxie
    Bremerton, WA
    Reply

    It appears to me that many doctors either don’t pay that much attention to possible side effects of meds, or are just unaware of the dangers!

    Thankfully, we have the internet and People’s Pharmacy to turn to for our own research on such matters. Many people are poo-pooed by doctors who don’t take their concerns and questions seriously, the “I’m the doctor!” types that don’t want informed patients asking questions.

    Doctors and other health care professionals need to be more sensitive to their patients’ needs and questions, and try to give informed answers, even if it’s “I’ll get back to you” and then actually do it. They get paid a great deal of money to offer a professional service and patients deserve good answers and follow up care!

  3. Carey
    Chicago
    Reply

    What about Azelastine HCI? It’s not supposed to be a steroid. I use both; do I quit both or just the steroid spray? Thank you!

  4. Diane in Western New York
    Reply

    I have had extreme allergic rhinitis for the last 68 years. At first, I used saline spray and Afrin. After a number of decades, that did not do the job for me.

    My allergist put me on a new spray that worked great but was rather expensive. When I had to go on Medicare, they would not pay for it and insisted that I use Flonase (while it was still a prescription). At the time, my allergist said it was too bad because it is associated with cataracts and the drug I was using was not.

    The Flonase worked for me, so I had no grounds to file an appeal. That was 9 years ago. Now, Flonase is over the counter, but medicare still pays for the generic version and I now have cataracts! I feel like Medicare should foot the entire bill for the cataract surgery I will need and can’t afford. Medicare gave me cataracts!

  5. Naomi B
    West Palm Beach, FL
    Reply

    This is not the first time I have garnered invaluable “tips” from your column, and I thank you again, VERY much. I changed to a different Pulmonologist about a year ago; the previous doc did not seem to be paying attention to what I said. He was always busy (too busy) typing his notes! After reading your July 18th report, I checked my “drug closet” and found 2 containers of Fluticasone Propionate nasal spray.

    I have had cataracts removed from both eyes, although my previous doctor, the prescriber, never bothered to ask or discuss my eye condition. My drug plan didn’t either. Prednisone was his “go-to” medication if something “extra” was required, which it was more than a few times in the 6-7 years he treated me.

    Again, I am so grateful that your column is available and that you are proactive with the FDA. We need to have more pressure (and staff?) applied to the FDA, to make it as protective of citizens as I think it once was. Thank you again.

  6. Laurence
    Ayr
    Reply

    I use Monetasone Furoate nasal Spray for nasal polyps and I have a very good sense of smell–I do not have cataracts , but get retinal injections of Eyelia for retinal oedema –? is there a connection?

  7. Vicky
    chicago
    Reply

    I’m not surprised, but I never would have thought of it without this article — I had an eye infection and it was treated with eye drops that had a steroid compound in them.

    My eye pressure shot up to 30, and a different eye doctor at first thought I had glaucoma, but when he saw the prescription he said he suspected I was “allergic” to the steroids.

    If he hadn’t gotten the eye pressure down with another prescription, I would have had damage and lost my vision at least partially. I bet any steroid in the eyes/nose is a significant risk.

  8. Ken
    Reading, PA
    Reply

    I have used Nasacort first & then generic Flonase for more than 20 years for relief of nasal congestion due to allergies, prescribed by my family doctor and then by my allergist. In February 2017 I noticed my sense of taste had changed after a severe cold. I had a metallic taste in my mouth. Neither my family physician nor my ENT physician have indicated any connection to my long term use of the corticosteroid, but I cannot help but wonder it there is a connection, especially since the change in my sense of taste occurred after a course of Medrol, a steroid, used to treat the cold symptoms.

  9. Carol Parkola
    Florida
    Reply

    I don’t use nasal sprays but have a diminished sense of smell and taste that I think is caused by my use of inhalers. I’ve used Advair for many years and Qvar for not quite as long. Some days I can taste things and other days I don’t taste what I’m eating.

  10. Pamela
    MO
    Reply

    I had cataract surgery 3 years ago, and used Flonase this spring for a week. I then developed a secondary cataract. It may be coincidental, as my opthalmologist had mentioned that sometimes after cataract surgery, patients get blurriness that needs a laser treatment to clear vision. However, this came on within days of using Flonase. I have not been able to find any information about secondary cataracts after Flonase use, but I will remain suspicious that it can cause them.

  11. Bill
    Maine (ME)
    Reply

    The information is very interesting, and most important for nasal spray users. I guess that I need to read more because I did not see anything regarding beneficial alternatives. If I missed such coverage, please include it in your next issue of comments.

  12. SusieQue
    NC
    Reply

    Is the problem related to getting the spray in the eye? Or is it via the body systems?

  13. Mary
    Reply

    I too use nasal spray too. Along with my other meds for my Asthma. For several years when I have gone to see my eye doctor. I have mentioned to him that I am on meds for my asthma. From reading all of the pamphlets that come with your meds, it does mention about eye problems.

    The eye doctor said that was not true. Now, last week I had my left eye cataract removed. Next month, I’ll have my right eye done. This Thursday, I go back for a follow up with my eye surgeon. I’ll ask him about this. Probably, he will also will deny the claim.

  14. Luke
    Reply

    Nasalcrom best stuff on earth and no steriods.

  15. Marilyn
    NJ
    Reply

    I’ve been using fluticasone for at least 5 years, daily at bedtime, with no side-effects other than some dryness. Is it therefore safe to continue? Are the people having problems taking it more often? I’m pretty sure my doctor is going to minimize my concerns when I bring it up at next visit. According to him I have allergic rhinitis year-round. He’d look up my nose and say, “Allergies,” when I didn’t think I had symptoms. Will try a drug holiday before allergy season starts in the fall.

    • Kat
      Reply

      I switched to Nasalcrom after reading about corticosteroid side effects, but developed a worse dry cough than I’ve ever had with anything else. I’m allergic to Florida, where I live, but other than moving what can I do now? I’m baffled and frustrated.

  16. Allison
    Reply

    Have been told, by two different medical providers, to try Flonase or Nasocort in order to see if that would decrease sporadic hoarseness/need for throat-clearing that may (or may not) be due to non-allergic rhinitis. Though the trial is only for a few weeks, if the spray happens to be effective it would presumably be recommended as ongoing treatment. Any thoughts on whether such trials of meds should be skipped if ongoing use wouldn’t be acceptable? (I expect others, like myself, have been told symptoms such as mine are due to “silent GERD”; I’m skeptical of that, as it suddenly seems to be an “epidemic” that benefits — whom else? — the makers of PPIs, which are starting to get a lot of bad press — probably deservedly so — due to links to some very serious side-effects).

  17. Sha
    TX
    Reply

    I have feelings of love and hate towards this article lol. (Genuine gratitude though; thank you People’s Pharmacy!) I had finally accepted that my 7 year old’s asthma meds (that includes 2 different off-brand alternatives to Flonaze) over the last year *have* helped us all be able to sleep and not worry about ER visits as frequently….. His allergies are almost non-existent now! This is a reminder about those lovely side effects I have purposely tried to forget about. Back to trying more natural remedies for allergies!

  18. Paulis
    Reply

    I never got my sense of smell back after losing it to a nasal spray years ago. Really miss the smell of the ocean and other wonderful smells. Also feel vulnerable I can’t smell burning or gas.

    I talked to my excellent ent doctor at length about risk of spray to eyes and she never mentioned this risk. My internist sort of shrugged when I mentioned it later. She was aware of this issue and knew what I was on but these sprays are totally common and I doubt most doctors flag this possible side effect.

    For months before I had smelled an odd odor but thought it was in the ventilation. If I had been aware of this possible side effect I might have stopped the spray much sooner.

  19. Anne
    Uk
    Reply

    Should we take antihistamine instead of using steroid nasal sprays? Thanks.

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