Over-the-Counter Allergy Nasal Spray Triamcinolone – What Does It Mean for Patients?

This article has been reviewed by Thanai Pongdee, MD, FAAAAI

The U.S. Food and Drug Administration (FDA) recently approved nasal triamcinolone for over-the-counter use. This means that consumers will soon be able to go to their local drugstore and purchase a nasal steroid spray. Other brands will still be available by prescription. Previously, all nasal steroids were available only with a prescription so they required occasional monitoring by a medical provider.

There are benefits and risks that come along with the decision to allow access to over-the-counter corticosteroids. To help you make an informed decision, this article will describe the pros and cons. It will also explain the importance of working with your doctor even if the medicines may be obtained without a prescription.

What Are Nasal Steroids?
Nasal steroids are important medicines to help treat allergic rhinitis (hay fever). They are helpful in reducing nasal inflammation, nasal congestion, runny nose and sneezing.

Other medicines that are available to treat allergic rhinitis include oral antihistamines, nasal antihistamines, anti-leukotriene modifiers and nasal saline. Allergy immunotherapy (allergy shots) can also be given to improve the immune system to not react or desensitize itself to the allergens.

If you’re wondering which medicines and treatment strategies will work for you, your doctor will help you navigate the many options and will work with you to decide the best treatment plan.

What Are the Concerns with Using Nasal Steroids?
Although these medicines are safe under a medical provider’s care, they do have some potential risks and concerns:

1. Symptoms of allergic rhinitis can be similar to other ailments like sinus infections, viral colds, chronic sinus inflammation, sinus polyps, and in rare cases certain cancers and other serious problems. It is possible that consumers may treat the wrong condition and a more serious problem could go unnoticed.
2. Nasal steroids can lead to nose bleeds that can be very concerning to patients, which is why proper usage and technique are important. Your doctor can examine the nasal tissues to make sure no damage is occurring. A rare complication that can occur is a hole, or perforation, in the nasal septum (bone separating each nostril). To make sure this does not happen, individuals should be monitored and receive nasal exams.
3. Growth restriction is a well-known risk of using steroids, although topical steroids like nose sprays are less much risky than oral corticosteroids. Even so, every person is different and some are more sensitive than others. For that reason, height and weight should always be monitored.
4. Side effects involving the eyes, which include glaucoma and cataracts, are potential yet uncommon risk factors of topical steroids. Those at risk for these conditions should talk with their physician.
5. Since the medicine will be over-the-counter, you will likely have to purchase it “out of pocket,” which is the case with many antihistamines and heartburn medications. This could increase the amount of money you pay each year for health costs.

Unlike taking a pill, the way you use the nasal spray is important. As mentioned above, it is important to avoid spraying the medicine into the middle of the nose, the septum bone that separates the nostrils. Sometimes it helps to use a mirror, or have another person or doctor make sure this is being done correctly. If you do not use the medicine correctly, it may not work, or worse, could cause serious side effects.

As with all medications, the benefits and risks should be weighed before deciding on a treatment plan. When used properly, nasal steroid sprays can be very effective at treating allergies. It is just important to recognize that steroid nose sprays can create risks if not monitored or used correctly.

Your allergist is trained to help you navigate the best treatment course and monitor your health. He or she can explain the benefits and risks of these treatments and answer any concerns you may have. Together, you and your allergist can decide the best treatment plan.

Carbs: Beyond The Basics

The pros and cons of using the glycemic index for carb counting and meal planning

By Tracey Neithercott
February 2014

Carbs count. Eat too many and your blood glucose can spike. It’s the first lesson people with diabetes learn at diagnosis: Watch the number of carbohydrate grams you eat at each meal or snack. That’s all well and good, but what about the type of carbohydrate you choose to eat? Increasingly, researchers are asking that question. Their answer may surprise you.

The GI Revolution

Back in 1980, most people with diabetes were using carbohydrate exchange lists, and “glycemic index” was a term foreign to researchers, doctors, and patients alike. Scientists at the University of Toronto, led by David Jenkins, MD, PhD, DSc, began digging around in the body’s glucose response to different foods, and the term came into use. In a 1981 study published in The American Journal of Clinical Nutrition, the researchers listed what they called the glycemic index for 62 common foods.

The glycemic index (GI) measures the glucose response to a given number of grams of carbohydrate. Imagine a chart with a line representing glucose levels during the first two hours after you eat 50 grams of carbohydrate. The area under that line, when compared with results from a test using 50 grams of pure glucose, indicates a food’s glycemic index (graph, opposite). Foods with a high glycemic index have higher peaks and more area under the line than those with a low GI. The glycemic index, then, is a ranking of foods from zero to 100 based on blood glucose levels after eating. So 50 grams of a plain white baguette has a GI of 95 (and a taller graphed line) while 50 grams of an apple has a GI of 39 (and a shorter line).

“If you’re carb counting and if you have 20 grams of carbohydrate from an apple or a banana or rice, it’s [as if it’s] all the same,” says Thomas Wolever, BM, BCh, DM, PhD, coauthor of The New Glucose Revolution: The Authoritative Guide to the Glycemic Index—the Dietary Solution for Lifelong Health, professor in the Department of Nutritional Sciences at the University of Toronto, and coauthor of the 1981 glycemic index study. “But it’s not.”

You might imagine that the glycemic index would be useful for people with diabetes. Yet more than three decades after its discovery, the glycemic index still isn’t among the most-recommended meal-planning tools.

The Glycemic Load

Graphing Blood Glucose Response
To determine the glycemic index of foods, researchers plot glucose levels for two hours after subjects eat portions containing 50 grams of carbohydrate and compare the area under each line with that of pure glucose.

SOURCE: Adapted from The American Journal of Clinical Nutrition, January 2009

In its 2013 nutrition position statement, the American D
iabetes Association says picking low-GI foods over high-GI ones “may modestly improve glycemic control.” Yet despite the ADA’s slight encouragement, the recommendations note that while some studies showed drops in A1C (a measure of average glucose for the past two to three months) from following a low-GI diet, others found no blood glucose improvement at all.
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