My Twitter feed has recently been subject to a series of promoted tweets from a company that sells decongestant nasal sprays. The brand behind these advertisements shall remain nameless (other decongestant nasal sprays are available), but I have been compelled to take to the keyboard because the spray is being recommended for the relief of symptoms of hay fever – which is just bad medicine.
I must make it clear that the company is doing nothing wrong – the spray is licensed for the treatment of hay fever and it is available without prescription, so they are well within their rights to advertise it in this way. That doesn’t mean I have to agree with them, though.
On the face of it, it seems reasonable to use a decongestant for hay fever – one of the symptoms is nasal congestion, after all. The problem lies in the issue of rebound congestion – sometimes known as rhinitis medicamentosa (medical speak for your medicines made your nose run). The decongestants might make you feel dramatically better in the short-term – as they reduce the blood flow, and hence the swelling, in your nasal passages within minutes – but they don’t do anything about the underlying cause. Worse than that, within a few days your nose can start getting ‘addicted’ to these sprays so that the congestion returns with a vengeance, requiring more of the spray to relieve the symptoms, leading to further rebound congestion and so on.
For this reason all decongestants have strict warnings on them that they are not to be used for more than 7 days. They are mostly used for treating colds, and since these last only a week or so that is not too problematic. For treating acute sinus pain, or relieving earache on a flight, they are fantastic, since these are short-term problems. Hay fever, on the other hand, will last as long as the pollen you are allergic to – April and March for tree pollens, May, June and half of July for grasses. So the adverts promote something that should never be used for more than a week, to treat a condition that will usually last at least 2 months. Even for those patients who have only very intermittent symptoms on high pollen days there are more effective treatments out there, in the form of antihistamines and steroid nasal sprays.
While the ‘S’ word can cause people concern, I sometimes describe steroid nasal sprays as being the polar opposite of decongestants. The latter make you feel better straight away, but do nothing for the underlying condition and will make it worse in the long-term, while steroid sprays do absolutely nothing straight away, but treat the underlying inflammation that is the problem in hay fever and will usually solve the problem in the longer term. The steroid dose is extremely low so that there are no side effects due to absorption into the blood stream. It’s better not to use them all year round if you can help it, due to thinning of the lining of the nose and nose bleeds, but then hay fever is seasonal so most people can have prolonged breaks from treatment.
As a doctor I feel especially powerless to stop people becoming dependent on decongestant nasal sprays; and some do become truly hooked – I have had some patients rely on them for decades. I know that my pharmacy colleagues are very good at warning patients not to take them for more than 7 days, and I can’t imagine any pharmacist recommending them for hay fever, but patients don’t have to speak to any health care professional to buy these products. They are categorised under General Sales Licence, which means that you can just drop them in your basket from the shelves of a supermarket and take them to the checkout – no-one will notice that you buy them every week, or advise you that it might be causing you such a problem.
How such a product was ever made so readily available, or achieved a licence for hay fever, I shall never know. There is no prospect of changing this, but perhaps by writing about it I can steer one or two people away from turning their seasonal allergy into a year-round problem of rebound congestion.