The Short Answer: No, You Can Keep Using Flonase
For most individuals, the answer is no; you do not need to stop taking Flonase, or other similar nasal corticosteroid sprays, before a skin prick allergy test. This is a common point of confusion because many other allergy medications, particularly oral antihistamines, must be temporarily discontinued. The reason for this difference lies in how these two types of medications work within the body.
Understanding the Different Types of Allergy Medications
To understand why Flonase is not an issue, it's helpful to categorize common allergy treatments by their mechanism of action.
- Nasal Steroids (e.g., Flonase, Nasacort, Nasonex): These medications work by reducing inflammation in the nasal passages over a period of time. They don't block the acute, immediate-type allergic reaction (the wheal and flare) that a skin test measures. Because their effect on a skin prick test site is minimal, they do not need to be stopped.
- Oral Antihistamines (e.g., Zyrtec, Claritin, Benadryl): These are the medications that must be stopped before a skin prick test. Antihistamines block the body's natural response to histamine, the chemical responsible for the test's characteristic red, raised bump. Taking them would suppress a positive reaction, leading to a false-negative result.
- Antihistamine Nasal Sprays (e.g., Astelin, Astepro): While they are also nasal sprays, these specifically contain antihistamines and therefore should be discontinued before a skin test.
- Asthma Medications (e.g., inhalers, Singulair): In most cases, these medications do not interfere with skin testing and should be continued as prescribed to maintain control of your asthma.
Preparing for Your Allergy Skin Test
For accurate results, the preparation for a skin prick test is focused on eliminating any medication that might suppress your body's immune response to the test allergens. Here's a general guideline, but you should always follow the specific instructions from your allergist.
Medications to Stop:
- Oral Antihistamines: Stop 5 to 7 days before the test.
- Antihistamine Nasal Sprays: Stop 2 to 3 days before the test.
- Certain Antidepressants: Some, particularly older tricyclic antidepressants, can have antihistamine-like properties and need to be stopped under a doctor's guidance.
- Some Acid Reducers (H2 Blockers): Medications like Pepcid (famotidine) should be stopped 1 to 2 days prior.
Medications to Continue:
- Nasal Steroid Sprays (like Flonase): Continue as normal.
- Asthma Inhalers & Montelukast: Continue as normal.
- Standard Decongestants: Continue as normal.
Why the Distinction Matters
An allergy skin prick test works by exposing a small amount of an allergen to your skin's surface to see if it triggers an immune reaction. This reaction is mediated by the release of histamine and other chemicals from mast cells in your skin. When you take an antihistamine, you are specifically blocking the effect of that histamine, which makes it impossible to accurately measure a reaction. A nasal steroid, like fluticasone, does not have this effect and thus will not skew your results.
Comparison Table: Flonase vs. Antihistamines Before Testing
| Feature | Flonase (Nasal Steroid) | Oral Antihistamine (e.g., Zyrtec, Claritin) |
|---|---|---|
| Drug Class | Corticosteroid | Antihistamine (H1 blocker) |
| Mechanism | Reduces inflammation in nasal passages. | Blocks histamine, the chemical that causes allergic reactions. |
| Action on Test | Does not block the histamine response needed for skin testing. | Suppresses the histamine response, potentially causing false negatives. |
| Pre-Test Action | Continue usage as prescribed. | Discontinue typically 5-7 days prior. |
| Area of Effect | Primarily local (nasal passages). | Systemic (whole body). |
What if I Can't Stop My Medication?
If you are unable to stop taking an antihistamine due to severe symptoms, you should still go to your appointment and inform your doctor. In this scenario, they may opt for an alternative testing method, such as a specific IgE blood test. A blood test measures the amount of specific antibodies (IgE) in your bloodstream that are associated with allergies, and the results are not affected by allergy medications.
Conclusion
In short, the key takeaway is that the type of medication is what determines if you need to stop. As a nasal corticosteroid, Flonase does not need to be stopped before an allergy skin prick test. This allows you to continue managing your symptoms while still getting accurate diagnostic results. However, you must carefully follow the instructions for any other medications you take, especially oral or nasal antihistamines, and always consult your healthcare provider with any questions about your specific medication regimen. For more comprehensive information, you can also consult resources from institutions like the American Academy of Otolaryngic Allergy (AAOA).
