A sneezy, stuffy, runny nose makes it hard to concentrate and get a good night’s sleep. Nasal sprays, which are sprayed directly into the nose, can provide relief for your nasal allergy symptoms by targeting the mechanisms leading to them.

To make an appointment with Anthony G. Del Signore, MD, PharmD, call 212-844-8450

Many prescription and over-the-counter nasal spray options are available that reduce or eliminate nasal allergy symptoms, but each contains different medications that target different symptoms. In this Q&A, Anthony G. Del Signore, MD, PharmD, Director, Rhinology and Endoscopic Skull Base Surgery, Mount Sinai Beth Israel, and Assistant Professor of Otolaryngology, Icahn School of Medicine at Mount Sinai, explains what nasal sprays are available and how to choose the best one for you.

What nasal sprays are available to treat my allergy symptoms?

The following is a guide to some of the most popular nasal spray options. It provides details on how these sprays work, what they treat, and their potential side effects. However, you should consult your physician or otolaryngologist before using them.

Saline Spray or Gel:

These sprays help to lubricate dry nasal passages, and are often recommended for patients with epistaxis, or nosebleeds. However, they may not relieve nasal congestion.

Examples: Simply Saline™, Xlear®, A&H, Ayr®

Saline Irrigations:
These treatments, which mix purified, distilled or boiled tap water with salt and baking soda, help flush mucus from the nasal passages, thins nasal secretions and thus pair well with nasal sprays for relieving congestion.  These are often first line and the backbone of nasal regimens when treating allergies to viral and bacterial infections.

Tips: It is important to regularly clean your irrigation device and to use purified water. Depending on your symptoms, your physician or otolaryngologist may recommend using steroids or antibiotic ointments to achieve the best outcomes.

Examples: Neti Pot, NeilMed®, Ayr

Steroid Sprays

Nasal steroids are typically recommended as a firstline treatment of nasal allergy symptoms. These sprays help decrease inflammation in the nasal passages, which reduces symptoms such as congestion, runny nose, and sneezing.

Tips: To achieve the full benefit of these sprays, you should use them as recommended—once or twice each day for several weeks. The benefit is not immediate and must be used consistently to see adequate relief of symptoms. To minimize the risk of nasal bleeding be sure to aim away from the nasal septum and towards the side of the nose (think of pointing the bottle towards the eye).

Side effects: Although oral steroid use has associated risks, including cataracts, elevated blood sugar levels, mood changes, and disturbances of sleep, these risks are considerably lower when steroids are taken in nasal form. The more common risks include nosebleeds and nasal perforations when improperly used.

Over-the-counter examples: triamcinolone acetonide (Nasacort®), fluticasone propionate (Flonase®), mometasone (Nasonex®)

Prescription spray examples: beclomethasone (Beconase®), ciclesonide (Zetonna®)

Antihistamine Sprays

Much like oral antihistamines, these sprays block the effects of histamine, a chemical in cells responsible for many allergy symptoms, including a runny nose and sneezing.

Tips: To achieve the full benefits of these sprays, it is important to use them once or twice daily. For an additive benefit, be sure to use in conjunction with the nasal steroid spray.

Side effects: Some patients have reported drowsiness when taking these sprays. If you experience drowsiness, consider taking them before bed. Other patients have reported a bitter taste, dry mouth, and dizziness.

Examples: Azelastine (Astelin®, Astepro®), olopatadine (Patanase®)

Steroid and Antihistamine Sprays

This combination spray (azelastine and fluticasone) is only available by prescription. It can provide relief from nasal allergies in cases where using a steroid spray is not fully effective.

Tips: Use consistently to see maximum benefits. Often prescribed up to two times in each nostril once or twice daily. To minimize the risk of nasal bleeding, be sure to aim away from the nasal septum and towards the side of the nose (think of pointing the bottle towards the eye).

Example: The only branded combination spray currently available is Dymista®.

Anticholinergic Sprays

Available only by prescription, these sprays help to block a neurochemical that increases mucus secretions in the nose. They mainly provide relief from nasal drip .

Tips: This spray can be added to other nasal spray regimens to control nasal drip. The spray can be used up to four times a day. Best results seen when a known trigger is identified, i.e., cold weather, eating, consuming hot beverages, and typically can be pre-treated prior to the inciting factor.

Side effects: Some patients have reported dryness, nosebleeds, bitter taste, headaches, and irritation when using these sprays.

Example: The only spray currently available is ipratropium bromide (Atrovent®)

Cromolyn Sodium Sprays

These over-the-counter sprays work by blocking mast cell release, which induce inflammation and lead to nasal congestion, runny nose, and sneezing.

Tips: To achieve the best possible results, you should use them one to two times a day, starting at least several weeks before allergy season begins.

Side effects: Some patients have reported a burning sensation in their nose and a bitter taste in their mouth when using this spray.

Example: There is only one branded cromolyn nasal spray: NasalCrom®.

Decongestant Sprays
These over-the-counter treatments work by reducing swelling of blood vessels in the nose, which helps to relieve nasal swelling and congestion.

Tips: Although decongestants are effective for short-term relief, prolonged use—seven or more days—can result in rebound nasal congestion, also known as rhinitis medicamentosa, with inflammation of the nasal passages. They are also not recommended if you have glaucoma or high blood pressure as they can make these conditions worse.

Side effects: In addition to rebound nasal congestion, some patients have reported dryness, stinging, rapid heartbeat, and higher blood pressure when using these sprays, particularly during prolonged use.

Examples: Oxymetazoline hydrochloride (Afrin®, Sinex™, Dristan®), phenylephrine hydrochloride (Sudafed®)

Remember, nasal sprays can provide effective relief from the allergy symptoms you experience. If you have tried one and it did not work, there are other options you can try. The key is to see an otolaryngologist and discuss your symptoms. Based on that, they will be able to recommend one that does work for you.

A corneal transplant is sight-saving surgery that allows a patient with eyesight compromised by cornea damage to have their vision restored, in some cases to 20/20. More than 44,000 corneal transplants are performed in the United States every year, making it one of the most common and successful procedures of its kind.

Advances have been made in technique and recovery, giving patients new hope in vision improvements.

New York Eye and Ear Infirmary of Mount Sinai (NYEE) is a leader in corneal transplants and, in recent years, has had great success with the latest technique called Descemet’s membrane endothelial keratoplasty (DMEK). By selectively replacing only the damaged portion of the cornea with ultra-fine donor tissue, surgeons are able to produce much better patient outcomes than other endothelial keratoplasty techniques.

Click here to make an appointment with Angie E. Wen, MD

In this Q&A, Angie E. Wen, MD, a cornea specialist at NYEE, explains why this procedure is becoming more popular.

“DMEK is the latest cutting-edge surgical technique, and at NYEE, patients get the best surgical and post-operative care, not only by our surgeons but the entire OR and post-op team,” she says.

What are the benefits of DMEK corneal transplant?

The DMEK technique is revolutionary. The technique offers a low rejection rate (1 percent), faster recovery, faster and more significant improvement in vision, and less reliance on long-term use of eye drops that can cause immunosuppressive side effects. Clear vision of many patients is restored in a few months.

What is the cornea and how does it get damaged?

The cornea is the clear outer layer of your eye that is directly in front of the iris (the colored part) and the pupil. It allows light to enter your eye. The cornea provides approximately 65 to 75 percent of the focusing power of the eye. It must remain clear for there to be good vision. If it is scarred or swollen, it may result in glare or blurry vision. Cornea damage may be caused by an infection, a medical condition that leads to a thinning cornea, such as keratoconus; chronic swelling following cataract surgery; or by Fuchs Dystrophy, a genetic disorder that causes swelling.

What happens during a DMEK corneal transplant?

During the DMEK procedure, the surgeon carefully strips out the damaged Descemet’s membrane and endothelium layer of the cornea and replaces it with donor tissue that has been thoroughly screened, processed, certified, and prepared by the eye bank. The surgeon replaces the damaged corneal layer with the new micro-thin tissue that, at 10 microns, is the thickness of a strand of hair. It is then secured with a gas bubble. The outpatient procedure typically lasts approximately 30-45 minutes. Although it is a highly effective procedure, it requires a steep learning curve for the surgeon to master who must work with tissue that is so thin and delicate. Consequently, only 30-40 percent of surgeons nationwide feel comfortable performing it.

Is anyone a candidate for DMEK?

Not all patients are candidates for DMEK, including those with complex anterior segment anatomy, a previous history of retinal detachment repair, or glaucoma surgeries. In these cases, a Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) may be a better option. Surgeons at New York Eye and Ear Infirmary are able to apply both the latest technologies of endothelial keratoplasties customized to patients’ individual anatomy and specific needs.

The changing seasons can bring on many changes in your health, including fatigue, seasonal depression, irritability, and colds. One of the more bothersome changes is seasonal hair loss. While it is normal to shed around 100 hairs a day, the loss of more hair can feel alarming.

However, seasonal hair loss shouldn’t be cause for alarm. In this Q&A, Brian Abittan, MD, Director of Skin and Hair Rejuvenation and Director of Hair Transplantation at the Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai, discusses seasonal hair loss and how to keep your hair healthy during changing weather conditions.

Brian Abittan, MD

What is seasonal hair loss? Is it a real thing?

Yes. Seasonal hair loss does appear to be a real thing. While we do not fully understand why it happens, there are multiple theories that have been suggested. One theory is that seasonal changes, possibly due to hormonal fluctuations or variation in nutrition, can cause a spike in the resting phase of hair growth, also known as the telogen phase. Shortly after, many of these hairs will shed. Additionally, seasonal stresses in patient’s lives may cause a hair shedding, called telogen effluvium.

How does seasonal hair loss differ from traditional hair loss?

Seasonal hair loss is different from other causes of hair loss. Patients can have medical hair loss disorders, like alopecia areata, which is a completely different form of hair loss. Also, patients can have a component of androgenetic alopecia, known as pattern hair loss, which generally develops over time. This, when accompanied with a seasonal hair loss or a telogen effluvium, can make the hair shedding appear to be worse. It is important to first identify the type of hair loss you are dealing with. Each specific type of hair loss can have a variety of unique treatments.

Is there a way to prevent temporary hair loss?

The best way to try to avoid seasonal hair loss is to maintain healthy, scalp and hair habits. Ensuring proper moisturizing during dryer months, using gentle grooming techniques, and maintaining a balanced nutrition are the most basic ways to help. If the seasonal hair loss becomes a consistent issue, more aggressive topical and oral medications can be considered as longer-term treatments.

Are there any lifestyle changes that help with retaining hair?

Balanced diets rich in vitamins, healthy lifestyle choices, and gentle hair practices are beneficial to hair health and growth.

Is vitamin D and biotin effective in helping to retain hair?

There is evidence that vitamin supplements, such as vitamin D and biotin, a water-soluble B vitamin, can be helpful in hair growth and maintaining healthy hair. Certainly, if someone has a vitamin deficiency, that can affect hair growth as well. More, in-depth studies are needed to fully understand the impact of vitamins on hair growth.

Food labels are supposed to help you understand what’s in your food, but deciphering endless lists of ingredients, nutrition facts, and marketing claims can often feel impossible—especially when you’re on the go.

Taylor Stein, RD

“Knowing how to read food labels is key to making good food choices,” says Taylor Stein, Associate Researcher and Registered Dietitian at The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai. “But keep in mind that food labels don’t tell you how the food will make you feel. You might eat a protein bar that says ‘20 grams of protein’ but still feel hungry afterward. This is important to consider, since foods that don’t fill you may trigger you to overeat later.”

In this Q&A, Ms. Stein explains why it’s so important to read the labels and offers seven tips to help you separate the good from the bad.

Check the Nutrition Facts

Most people only look at the marketing copy on the front of the product (for example, “25 percent less sugar,” “gluten-free,” or “fat free”). Marketing claims are often misleading. A bag of potato chips may claim to be 25 percent less fat, but compared to what? If the comparison is to potato chips in general, 25 percent is still a lot of fat. The Nutrition Facts on the back of the product gives you the actual breakdown of nutrition. People also often overlook the subsections under the Nutrition Facts—added sugar, saturated fat, carbohydrates, dietary fiber, etc., which are just as important as the totals. Fiber, for example, helps you feel full and is essential for gut, heart, and brain health.

Pay Attention to Serving Size

People often misunderstand “Serving Size” and “Percent Daily Value” on the Nutrition Facts panel. They think serving size is how much of a product they should eat. A serving size is simply the amount of nutrition that is in a specific amount of the product. If the number of calories is 100 and the serving size is one cup, then you are consuming 100 calories if you eat one cup. It does not mean that you should only eat one cup. The “Percent Daily Value” is based on a standardized 2,000-calorie diet or the recommended daily allowance of that nutrient, and is not representative of what you as an individual should consume.

Some Added Ingredients Are Good for You

Many people assume added ingredients are bad for them, but some products, such as cereals, are fortified with ingredients that are good for you. Unless you have a food allergy or intolerance, you don’t need to avoid any ingredients. The Food and Drug Administration regulates food, so anything truly hazardous is not sold. People may also not realize the ingredients list is ordered by weight. The first ingredient is the primary ingredient. As you go down the list, the amount of the ingredient gets smaller—the last ingredient is the smallest amount. If the first ingredient is sugar, that tells you the product is predominantly sugar.

Be Mindful of Foods Without Labels

Some people assume food products that don’t have labels, such as fresh vegetables and meat, are healthier than packaged foods. This is generally true of produce, whole grains, fish, and lean meats; however, red meats and certain cheeses, for example, may be high in saturated fat, and should be limited.

Look Out for Ultraprocessed Foods

Processed foods are foods made from whole foods that have been broken down into their basic components (sugars, starches, fats, etc.) and reassembled to make packaged foods. There’s a spectrum of how processed a food could be—anywhere from not processed at all (whole foods, including those with minimal processing, such as frozen fruit) to foods that are extremely processed (ultraprocessed). These include chips, sodas, lunchmeats, ice cream, sweetened cereals, etc. One example is protein bars made from soybeans that have been turned into a powder. The manufacturer adds fats and sugars to make it tasty, which adds calories but not substance. The food is so processed that your body cannot tell when it should be full. For example, you can eat 500 calories of corn chips and not feel full, versus eating a whole corncob filled with fiber and water that satisfies you. For this reason, consuming too much ultraprocessed food can lead to chronic health conditions, such as obesity and diabetes.

How can you know how processed a product is? Look at the food—does it look like what is supposed to be in it? Applesauce has been ground down, but you can still tell it comes from apples. It’s processed, but not very. A bag of snacks claiming to be made from vegetables features images of carrots and onions, but the product does not look anything like vegetables—it’s actually made from potato flour and starch (with a little added carrot and onion flavoring).

Look at the Number of Ingredients

The number of ingredients, and the breakdown of ingredients, is another way to tell how processed a food is. Generally, the more ingredients, the more processed, though this is not always the case (trail mix, for example). Applesauce has a few ingredients, but it’s not been radically changed from its original form. In comparison, the bag of ultraprocessed “veggie” snacks contains a long list of ingredients.

Limit Your Sugar

The American Heart Association recommends no more than six teaspoons of added sugar per day for women and nine for men. We all know what a teaspoon looks like. But the Nutrition Facts panel lists ingredients by weight, in grams. In the Nutrition Facts panel, added sugar is listed separately under the total amount of sugar. An easy way to know how much sugar has been added is to divide the added sugar by four, which gives you the exact number of teaspoons. For example, if the added sugar is 12 grams per serving, divide that by four, which gives you three added teaspoons of sugar per serving.