Septal perforation was an occasional side effect noted with very early corticosteroid nasal sprays, primarily from the 1980s, that were considerably more caustic to the nasal lining, were formulated in an irritating and over-drying alcohol-based solvent and alcohol-based preservative solution, and were delivered to the nasal passages in high-velocity aerosolized form from dispensers that could easily and readily direct their aerosol jet to the septum, which is comprised of cartilage. These nasal sprays are no longer available. In contrast, we use an alcohol-free, aqueous formulation in a bottle that delivers a gentle, broad spray-mist.
Thankfully we are happy to report that we have not seen one single instance - not one - of septal perforation in our 38 years of using the Allermi formulation and method.