The medications work locally on the mucosa and are not readily absorbed. Using Flonase as an example 50mcg are delivered with each spray. The usual dose is two sprays into each nostril one time a day. The total dose is 200 mcg. Only two percent or 4 mcg are absorbed. Compared to a dose of ten mg of prednisone this is roughly 1/25000 as much. Just as you would be unable to hold 25000 pounds out at arms length; you could hold one pound. Steroid side effects tend to be dose dependant and therefore the dose is minimal. In other words, you could take the nasal steroid spray medication for over one half a year to equal one average oral dose.
Most people who take nasal steroid spray have allergies. Allergies are chronic conditions that only change over very long periods of time. Patients have been on nasal steroids for 20 years in Europe and have had biopsies that reveal no damage.
Oral antihistamines have come a long way in recent years. (Allegra, Clarinex and Zyrtec) These medications are absorbed and therefore tend to have more side effects such as sedation and urinary retention, especially in the elderly.
Nasal steroids are not like the “over the counter” nasal sprays. You cannot become addicted to a nasal steroid spray.