Allergic rhinitis, commonly known as “hay fever”, is one of the common urban diseases that has deeply disturbed the lives of many Hong Kong people. Patients inhaling or in contact with allergens will induce nasal allergic symptoms, such as runny nose, post-nasal drip, nasal congestion, itchiness, sneezing, etc. Many sprays for soothing allergic rhinitis or nasal congestion contain pharmaceutical ingredients, and some are even classified as prescription drugs. A recent survey conducted by the Consumer Council found out that consumers could easily purchase various prescribed nasal sprays. The Council reminds that the ingredients in nasal sprays may not be suitable for everyone. Not only will spraying cause increased stuffiness, but it will also affect the efficacy of other medication, or even affect children’s growth, people with hypertension, heart diseases, diabetes, and the elderly, and cause severe adverse health effects. Consumers are advised to seek doctors’ diagnoses before use and pharmacists’ advice when purchasing. Do not decide to buy or use on one’s own to prevent potential health hazards caused by misuse. The Council also urges traders to stop illegal selling of prescription drugs or drugs under supervised sales which could lead to legal consequences.
The 20 nasal spray models collected for the survey could be classified into 3 categories: corticosteroid nasal sprays, vasoconstrictor nasal sprays (also known as “decongestants”), and saline nasal sprays, ranging from $40 to $180 per bottle. Corticosteroid nasal sprays are suitable for patients with moderate to severe nasal allergies. These sprays are mostly prescription drugs that require doctors’ diagnosis and prescription. Some are listed as drugs under supervised sales which can only be sold in registered drugstores with the assessment and supervision of registered pharmacists. Nevertheless, Council staff tried to purchase corticosteroid nasal sprays without doctors’ prescription at various drugstores for this survey and successfully purchased 6 models labelled as “Prescription Drugs” and 1 model labelled as “Drug under Supervised Sales”. The relevant information has been submitted to the Department of Health for follow-up.
Misuse and Abuse of Different Categories of Nasal Sprays May Cause Extra Stuffiness; Severe Cases May Lead to Increased Intraocular Pressure and Impact Children’s Growth
Corticosteroid nasal spray can relieve the symptoms of allergic rhinitis to a certain extent. However, if it is not diagnosed by doctors or assessed by pharmacists, consumers increasing or decreasing the dosage or prolonging the use time by themselves may lead to severe adverse effects. Common side effects include a stinging or burning sensation in the nose, dryness and scabs, nosebleeds, dry throat, itchy nose, redness, and swelling. Consumers should know that long-term use may even lead to an increase in intraocular pressure. Therefore, regular eye examinations should be taken during drug treatment to pre-empt severe adverse effects such as glaucoma.
Moreover, older models contain a higher concentration of pharmaceuticals, and the continuous use may also hinder children’s or adolescent's growth. Though the 6 models of prescription drugs successfully purchased in this survey were all labelled as suitable for use by children, yet, for prudence’s sake, parents should never buy corticosteroid nasal sprays for children without consulting a doctor.
Another common type is the vasoconstrictor nasal spray, which contains alpha agonist, and has the advantage of quickly clearing nasal congestion. In recent years, many patients with allergic rhinitis have purchased large quantities of vasoconstrictors from overseas drugstores or cosmeceutical stores for long-term use, yet their nasal congestion worsened with use and they eventually had to seek medical help. In fact, the related vasoconstrictor is not a targeted treatment for allergies. At the beginning, blood vessels would show a stronger reaction and contract immediately, so patients would think that the nasal spray is effective and continue using it. However, vasoconstrictors are not suitable for long-term continuous use. Side effects may occur if the spray is used consecutively for more than 1 week. Patients would require constant application to alleviate nasal congestion, resulting in increasingly frequent application, yet the congestion may get even worse. From the 7 models collected, 6 mentioned the duration of continuous use or provided warnings. Consumers should pay special attention in using.
In addition, as vasoconstrictor nasal sprays can increase blood pressure, it is not suitable for patients with hypertension, heart diseases, diabetes, and the elderly. Men with prostate gland enlargement should know the risk of ureteral constriction after using this type of nasal sprays which are not suitable for them.
Nasal Sprays Could Interact with Other Drugs Affecting Efficacy
Allergic rhinitis patients who are also on other medication should beware that different nasal sprays could interact with other medications, affecting each other’s efficacy. Among them, CYP3A4 inhibitors in antifungal medications and antibiotics erythromycin could have drug interaction with corticosteroid nasal sprays, affecting each other’s efficacy; while tricyclic antidepressants (TCA) or monoamine oxidase inhibitors (MAOI), when used together with vasoconstrictors may cause a rise in blood pressure. As such, before using nasal sprays, patients should let medical professionals know the medications they are using for assessment of possible interactions.
Insufficient Labelling of Various Models Increases the Risk of Use
Consumers are strongly advised to read the product labels carefully before using nasal sprays. However, the survey revealed that some models lacked sufficient detail on their labelling and should be improved immediately. Upon reviewing the 7 decongestant nasal sprays collected, 3 models did not mention the possible drug interaction with TCA or MAOI, 2 models did not mention the risk of elevation of blood pressure while 1 was not labelled with the time limit for continuous use of the nasal spray or provide relevant warnings.
Before purchasing nasal sprays, patients with allergic rhinitis should receive proper diagnosis and prescription while paying heed to the following:
- Pay attention to the correct usage, dosage, frequency and duration of continuous use of each drug;
- Read product labels and instructions carefully to learn the proper techniques of using nasal sprays;
- Be mindful of the storage method indicated on the product. Most corticosteroid nasal sprays and vasoconstrictors should be stored at below 30°C to below 25°C, but should also not be stored below 0°C or refrigerated. Some saline nasal sprays use compressed gas for discharging saline and should be kept away from high temperature environments and store them according to user instructions;
- Patients with allergic rhinitis can choose non-medicated saline nasal sprays to relieve symptoms;
- When using nasal sprays or during saline nasal irrigation, it might produce a fine mist. Ensure the space is well-ventilated when using the spray and stay away from other people to reduce the risk of spreading diseases;
- Be mindful of the hygiene of nasal sprays, and clean the nozzle and other parts as instructed; Users should not share their nasal sprays with other people. If the nozzle of a nasal spray or any other parts are for single use only, users should follow the user instructions and use them once only and should not reuse them to avoid infection or risk incurred due to improper cleaning;
- Adults should accompany children when using nasal sprays;
- Refrain from using expired products even if there is still medication or saline in the bottle.
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