Blood-Tinged Nasal Secretions After Azelastine-Fluticasone Spray
A tinge of blood in nasal secretions a few hours after using azelastine-fluticasone nasal spray is a known, minor local side effect that typically does not require discontinuation of the medication. This represents mild nasal irritation rather than a serious adverse event.
What This Represents
- Nasal bleeding with intranasal corticosteroids typically manifests as blown blood-tinged secretions, which is exactly what you're experiencing 1
- This is one of the most common local side effects of intranasal corticosteroid use and occurs due to local irritation of the nasal mucosa 1
- The combination therapy has a low rate of adverse events overall, with epistaxis rates similar to or lower than placebo in clinical trials 2, 3
Immediate Management Steps
Continue using the medication but modify your spray technique immediately:
- Direct the spray away from the nasal septum to prevent repetitive direct application to the same area 1
- For the right nostril, use your right hand and aim the spray laterally (toward the outer wall of the nose)
- For the left nostril, use your left hand and aim laterally
- Avoid pointing the spray directly at the center dividing wall between nostrils 1
When to Monitor More Closely
- The nasal septum should be periodically examined to ensure no mucosal erosions are present, as these may precede the development of nasal septal perforations 1
- While nasal septal perforation has been rarely reported with long-term intranasal corticosteroid use, it remains an uncommon complication 1
- If blood-tinged secretions persist despite proper technique or worsen in frequency/amount, seek medical evaluation 1
Important Caveats
- Do not discontinue the medication based on minor blood-tinged secretions alone, as the therapeutic benefits typically outweigh this minor local side effect 1
- Nasal biopsies in patients using intranasal corticosteroids for 1-5 years show no evidence of atrophy or other tissue damage 1
- Burning or stinging is most often associated with propylene glycol-containing solutions, but blood-tinged secretions specifically relate to mechanical irritation 1
Red Flags Requiring Medical Attention
Seek immediate medical evaluation if you experience:
- Frank bleeding (not just tinged secretions) that doesn't stop with pressure
- Recurrent significant nosebleeds
- Visible ulceration or crusting inside the nose
- Pain or tenderness over the nasal bridge
- Any signs of septal perforation (whistling sounds, crusting, or visible hole when looking in the nose) 1