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Nasal sprays come in a variety of forms. Medicated such as Astelin, Afrin and Nasonex and natural such as Sinusoothe and Sterimar. Although delivery methods vary, most nasal sprays function by instilling a fine mist into the nostril by action of a hand-operated pump mechanism.
Antihistamine nasal sprays 
Excessive histamine function is the primary cause of allergic reactions in people. Histamine is a chemical naturally produced by the body which creates an inflammatory effect to help the immune system remove foreign substances. Antihistamines work by competing for receptor sites to block the function of histamine, thereby reducing the inflammatory effect. These products have gained popularity with sufferers of allergic rhinitis.
Astelin (azelastin hydrocholoride) and Patanase (olopatadine hydrochloride) are the only antihistamines available as a nasal spray in the United States and are available by prescription only. In Australia Telnase (Triamcinolone acetonide) and livostin (Levocabastine hydrochloride) are the most popular products currently on the market and are available over-the-counter.
Topical decongestant nasal sprays 
Oxymetazoline hydrochloride decongestant nasal sprays such as Afrin and Vicks Sinex, along with phenylephrine hydrochloride nasal sprays such as Neo Synephrine and Dristan, which are available over-the-counter in the United States and the UK, work to very quickly open up nasal passages by constricting blood vessels in the lining of the nose.
Prolonged use of these types of sprays can damage the delicate mucous membranes in the nose. This causes increased inflammation, an effect known as rhinitis medicamentosa, or the "rebound effect". As a result, decongestant nasal sprays are advised for short-term use only, preferably 5 to 7 days at maximum however, some advise you to only use them 3 days at the max. However a recent clinical trial has shown that Flonase (fluticasone), a corticosteroid nasal spray, may be useful in reversing this condition.
Corticosteroid nasal sprays 
Corticosteroid nasal sprays such as Nasonex (Mometasone furoate) and Rhinocort (Budesonide) can be used to relieve the symptoms of sinusitis, hay fever, allergic rhinitis and non-allergic (perennial) rhinitis. They can reduce inflammation and histamine production in the nasal passages thereby relieving nasal congestion, runny nose, sneezing, sinus pain, headaches etc. They have been clinically proven however they can cause side effects such as headaches, nausea and nose bleeds.
Natural nasal sprays 
Saline sprays are also common and are typically unmedicated. A mist of saline solution is delivered to help moisturize dry or irritated nostrils. See also nasal irrigation. They can also relieve nasal congestion and remove airborne irritants such as pollen, dust etc. thereby providing sinus allergy relief. The solution can be either isotonic or hypertonic. Isotonic solutions have the same salt concentration as the human body whereas hypertonic solutions have a higher salt content. Hypertonic solutions may be more useful at drawing moisture from the mucus membrane and relieving nasal congestion.
Nasal salves have been shown to alleviate respiratory discomfort caused by the increased dryness of air in pressurized air flight and some air conditioned offices (sick building syndrome) They have been shown to reduce susceptibility to various flight related respiratory infections.
Some patients with rhinitis find nasal sprays including plant-derived chemical complexes such as Ginger, capsaicin and tea-tree oil useful. There is however, no trial-verified evidence that they have a measurable effect on symptoms.
Nasal spray flu immunization 
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Combined use 
Frequently, a doctor or allergist will prescribe several types of nasal sprays in combination with each other or with other drugs. For example, a decongestant spray is often advised for the first few days of treatment in conjunction with an antihistamine or steroidal spray. The quick-acting effects of the decongestant allow for better initial delivery of the other sprays.
- Fluticasone reverses oxymetazoline-induced tachyphylaxis of response and rebound congestion, Vaidyanathan S, Williamson P, Clearie K, Kahn F, Lipworth B, Asthma and Allergy Research Group, Centre for Cardiovascular and Lung Biology, University of Dundee, Dundee DD1 9SY, Scotland, UK.
- Onset of action of mometasone furoate nasal spray (NASONEX) in seasonal allergic rhinitis, Rb Berkowitz1, Di Bernstein2, C LaForce3, Aj Pedinoff4, Ar Rooklin5, Crv Damaraju6, B Mesarina-wicki6, Kb Nolop6, Article first published online: 9 OCT 2008