Nosebleeds can happen and certainly do for some. Nasal hydration helps (for instance, ayr gel in combination with saline spray or irrigations). Ultimately, a good portion of patients that don’t tolerate or fail nasal steroids get surgery.

Azelaetine is fantastic - there’s a lot of patients I prescribe it in conjunction with Flonase. Allergic rhinitis or even just excessive secretions is common in patients with inferior turbinate hypertroph/nasal obstruction, and both meds have a function. They sell it as a combination, actually, but often insurance doesn’t cover the combo.