During the last episode, I discussed sinusitis and how you could differentiate between a viral and a bacterial infection. Like I mentioned in that episode, I’ve been seeing a surge of patients coming in with nasal symptoms – and sometimes it’s viral, but it’s also springtime which could only mean one thing: allergy season.
Viruses, bacteria, allergies – it can get a little overwhelming to consider all the possible causes when faced with snotty, drippy conditions. But don’t despair – I’m here to dissect those nasal passages even further this week.
What is Allergic Rhinitis?
The official name for seasonal allergies is allergic rhinitis. In the episode, When Is a Sinus Infection Serious? we learned that anything that ends in “-itis” means “inflammation of.” “Sinusitis” is therefore the inflammation of the sinuses. And “rhinitis” is the inflammation of the mucous lining of the nasal passages. And allergic rhinitis is the inflammation of this lining due to an allergen, or particles in the air that trigger your immune system to react. Your immune system views these allergens as foreigners and attacks, wreaking havoc in your nose, among other places. Your immune system causes inflammatory cells to release chemicals such as “histamine,” which causes:
- Nasal congestion
- Runny nose
- Watery eyes
- Sore throat
- Hoarse voice
- Postnasal drip
- Ear pain, congestion, or popping
What Causes Allergies?
Allergies can come and go throughout life. Commonly, patients experience allergies that are seasonal (hay fever during springtime is particularly common). Some unlucky folks experience allergies all year round.
About 20% of people living in the U.S. currently suffer from allergic rhinitis. There does tend to be a hereditary component and it tends to be more common in people with a history of asthma or eczema.
Here are some common allergy culprits:
- Animal dander (most frequently cats and dogs)
Diagnosis of Allergic Rhinitis
Your doctor should be able to diagnose you with allergies simply based on your history and physical exam. Other testing is typically unnecessary. Blood tests for allergies are not deemed very “sensitive,” or accurate enough to pick up the causes of your symptoms. Skin testing is an option, but is performed though an allergy specialist, and is very rarely necessary.
Treatment of Allergies
No matter what the offending allergen is, the key thing to remember is that the treatment is really the same. If you know what you are allergic to (for instance, if your nose turns on like a faucet every time you’re around cats), well then by all means, stay away from that offending agent.
Otherwise, if it’s not as easy to stay away from trees when you live in the humid tropical climate of Del Ray Beach, Florida (although we get more allergic rhinitis than you’d think in my Southern California hometown), just know that your symptoms are treatable by your primary care doctor. Here are some of the tricks up our sleeves:
1. Intranasal steroid sprays: Prescription nasal spray containing a mild steroid is often the first-line of treatment for those with allergy-caused nasal symptoms. Don’t let the word “steroid” scare you here – it’s not the same type of oral steroids that have been associated with the negative side effects we’ve all heard about. And these doses in the nasal sprays are quite low. Nasal steroid sprays have very few side effects, and are quite effective for treating allergy symptoms. However, they are effective only when used daily, not “as needed.” They take days to even a few weeks to reach peak effectiveness.
2. Oral antihistamines: Like I previously mentioned, histamine is a chemical that is released when your immune system encounters an allergen. So it makes sense to use an anti-histamine to combat your symptoms. Over-the-counter loratadine, cetirizine, and fexofenadine are antihistamines that are non-sedating (unlike short-acting diphenhydramine) and last 24 hours. Nasal steroid sprays and one of these three oral antihistamines are usually our first line of defense, and work quite well.
3. Prescription antihistamine nasal sprays: Azelastine and olopatadine are two generic nasal spray antihistamine options that require a prescription. The benefit is that they work fast, but on the down side, they also wear off fast. They also aren’t too tasty if they drip to the back of the throat. They are really only appropriate if your symptoms are mild and infrequent.
4. Montelukast: Leukotrienes are another class of chemicals released during allergic reactions. Therefore, a medication that blocks them may be helpful. There is now a generic available as a once a day prescription pill.
5. Ipratroprium nasal spray: This is a non-steroid spray that can be helpful for those with uncontrollable runny nose that doesn’t respond to the steroid spray. It is not the first choice for allergic rhinitis, and can have some unpleasant side effects (not for those with enlarged prostate or history of glaucoma).
6. Decongestants: If a stuffy nose is your worst symptom, an OTC decongestant will help open you up. There are two forms – a pill or nasal spray. The over-the-counter pills can be used for up to one week to de-clog your nose, but really are not meant for daily, chronic, or preventative measures. They can also elevate blood pressure, and not everyone feels well on them. The nasal spray version may work well – but can cause “tolerance” (where you need more and more to get the same effect the next time) and “withdrawal” (where your congestion gets worse than it was before you used it). That’s why decongestant nasal sprays are not recommended for more than 3 days of use.
Quick and Dirty Tip: Doctors loathe OTC nasal spray decongestants because some patients use it so much, they can’t function without them. This is actually a medical condition call Rhinitis Medicamentosa. My advice: stay away!
7. Nasal Saline: OTC nasal saline can be used several times a day to help clear away those allergens lining your nasal passages.
If none of the above is effective in controlling your allergies, which is not too common, your doctor can then send a referral to an allergist for possible allergy shots. This is a potentially expensive and very time-consuming effort, however. It consists of weekly injections for 3-5 years, and is not effective for everyone, especially if you stop it mid-way.
House Call Doctor’s Advice: Try a combination of prescription intranasal steroids, along with an OTC antihistamine (#1 and #2 above) for at least 4 weeks consistently and daily. It usually works.
Do you have allergies? What treatment works for you? Share it with us in the comments below.
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
Thanks for listening to The House Call Doctor’s quick and dirty tips for taking charge of your health. If you have any suggestions for future topics you can email me at [email protected]. Hope you have another snot-free week!
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