Nikhil Prasad Fact checked by:Thailand Medical News Team May 11, 2026 1 hour, 4 minutes ago
Medical News: Millions of people around the world rely on allergy medications every day to control sneezing, blocked noses, itching, and watery eyes. But a major new analysis is now shedding light on which treatments appear safest and which may cause more side effects than previously believed.
Massive clinical review finds steroid nasal sprays safer than many other allergy treatments while immunotherapy
shows higher side effect rates
Researchers from the Department of ENT and Head and Neck Surgery at University Hospital of Split in Croatia, and the Department of Public Health at the University of Split School of Medicine in Croatia, reviewed data from 216 randomized clinical trials involving more than 88,000 participants to compare the safety profiles of popular allergic rhinitis treatments.
The study focused on therapies commonly used for allergic rhinitis, also known as hay fever, including nasal steroid sprays, antihistamine sprays, oral allergy pills, and allergy immunotherapy treatments.
Nasal Steroid Sprays Emerged as the Safest Option
The researchers found that intranasal corticosteroids, commonly known as steroid nasal sprays, showed the most favorable safety profile overall. These medications had lower rates of side effects compared to many other allergy treatments studied.
Only about 16 percent of users experienced non-serious adverse effects, and most reactions were mild. The most commonly reported issues included irritation inside the nose and minor application-site reactions. Importantly, the researchers did not find a major increase in serious complications linked to these sprays.
This finding is significant because nasal steroid sprays are already considered first-line therapy for moderate and severe allergies. The new data strengthens confidence in their long-term use for many patients.
However, the study did detect a possible increase in urinary tract infections in people receiving very high doses of nasal steroids, though researchers cautioned that the evidence remains limited and uncertain.
Antihistamine Nasal Sprays Caused More Complaints
Intranasal antihistamine sprays showed noticeably higher rates of side effects compared to steroid sprays.
Nearly 30 percent of users experienced adverse reactions. The most common complaints included dysgeusia, a strange or bitter taste in the mouth, nasal discomfort, sneezing, and oral tingling sensations.
Researchers believe these side effects occur because the medication can drip into the throat and stimulate taste receptors directly.
Interestingly, higher doses of antihistamine sprays appeared to increase the risk of taste disturbances even further, especially in older adults.
This
Medical News report highlights how side effects that may appear minor can still significantly affect patient comfort and treatment adherence over time.
<
;strong>Allergy Immunotherapy Showed the Highest Side Effect Rates
One of the most striking findings involved allergen immunotherapy, treatments designed to gradually retrain the immune system to tolerate allergens.
Sublingual immunotherapy, in which allergen tablets or drops dissolve under the tongue, produced the highest rate of non-serious side effects among all major treatment groups. Almost 65 percent of participants experienced some form of adverse event.
Many of these reactions affected the mouth and throat. Patients frequently reported mouth itching, oral swelling, throat irritation, swallowing discomfort, nausea, and ear itching.
The researchers explained that these reactions likely occur because allergens directly contact sensitive tissues in the mouth and throat, triggering local immune responses.
Subcutaneous immunotherapy, commonly known as allergy shots, showed fewer overall side effects than sublingual therapy but carried a higher risk of serious adverse events. Injection-site reactions and skin redness were among the most common complaints.
Meanwhile, intralymphatic immunotherapy, a newer and less widely used approach, also demonstrated elevated side effect risks, although the number of studies was small.
Oral Allergy Medicines Performed Better Than Expected
Traditional oral antihistamines and leukotriene receptor antagonists generally showed relatively low side effect rates.
Oral antihistamines were linked to a slightly increased risk of upper respiratory tract infections, while combination therapy using oral antihistamines together with leukotriene receptor antagonists appeared to be among the safest treatment options overall.
The researchers noted that oral therapies had shorter trial durations compared to immunotherapy studies, which may partly explain their lower rates of reported adverse events.
Conclusions
The findings suggest that nasal steroid sprays remain the safest and most balanced treatment option for most people suffering from allergic rhinitis. While allergy immunotherapy can provide long-term symptom relief and may even alter the course of allergic disease, patients should understand that these treatments are associated with significantly higher rates of local side effects, particularly in the mouth and throat. The study also reinforces the importance of tailoring allergy treatment choices according to patient age, symptom severity, treatment goals, and tolerance for side effects. Researchers emphasized that additional large-scale studies are still needed to better understand long-term risks and to refine safety comparisons between newer allergy therapies.
The study findings were published in the peer reviewed journal: Pharmaceutics.
https://www.mdpi.com/1999-4923/18/5/581
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