I have long since suffered from seasonal allergies – and it sucks. Unfortunately, both seasonal allergic as well as perennial non allergic rhinitis are common. Usual symptoms may include runny or itchy nose, stuffy nose, sinus pressure, headaches, cough, and mucus pooling in the throat. Some of my patients with chronic rhinitis are so used to their symptoms that they are barely aware of them. I often observe them clearing their throat, or swallowing mucus continually during their office visit, and they don’t even realize it! Some of the symptoms of rhinitis are a nuisance, but others can be problematic, and are best treated under the guidance of your doctor.
In their evaluation, I usually divide my patients symptoms into the itchy, runny symptoms, associated with profuse thin discharge, and congested, pressure symptoms associated with thick discharge.
Itchy, runny and… annoying
The itchy, runny symptoms, typically respond very well to antihistamines. Three once daily antihistamines, loratadine, cetirizine and fexofenadine, can be found over the counter as generic and inexpensive store brands in most pharmacies and supermarkets. These were initially introduced to the market under the brand names Claritin, Zyrtec and Allegra respectively. Like with most drugs, every patient will respond differently – I have patients who have tried all three, and insist one works better than the others. The one that is recommended the most to my patients, is cetirizine. It’s rapid onset of action is comparable to diphenhydramine (known commonly Benadryl), not nearly as sedative, and it lasts all day – diphenhydramine lasts about 6 very groggy hours and is almost never recommended to my patients. I am biased as by the time patients are discussing their allergies with me, they have likely failed treatment with loratadine.
For those of you who are lucky enough to have allergic conjunctivitis – itchy, scratchy eyes – associated with their allergic rhinitis, these antihistamines may help. As always, discuss therapeutic options with your doctor.
Congestion, sinus pressure, and thick, nasty mucus…
Sinuses are cavities of varying sizes which communicate with the nasal passages through narrow openings. The lining of the sinuses is similar to the rest of the nares, and get equally inflamed as do the nasal passages with allergies, and colds etc. Like a sprained ankle, as anyone with my athletic ability who attempted to play basket ball can attest to, when there is any inflammation, there is swelling. This results in narrowing of the nasal passages, and often narrowing of the sinus openings which now do not allow the sinuses to drain freely. The accumulation of mucus within the sinuses is often responsible for the pressure, and sometimes painful symptoms associated with sinusitis. As the mucus within the sinus cavities collect, it gets thicker, and either squeeze out under pressure, or drain by gravity with changes in position. This “post nasal drip” usually drains down the back of the throat, often causes a cough which tends to be worse at night.
Unlike the itchy runny symptoms, which are mostly a nuisance, these symptoms can be far more troublesome. Firstly, the symptoms can be more severe. Headaches and facial pain can be very intense; the associated cough disturbs sleep, and can often result in being kicked out of the bedroom by an unsympathetic partner; and severe nasal congestion. Secondly, it can predispose to infections. We don’t drink a glass of water which has been standing on the counter for a few days, so we can only imagine what is brewing in the mucus collecting within the impacted sinuses – nasty. Even in the case of a sinus infection, antibiotics will be relatively ineffective in treating these patients if the sinuses can not drain. This is analogous to the benefit of draining a large abscess as antibiotics will have a hard time penetrating the entire cavity.
Acutely, as in the case of infection or intense symptoms, decongestants can help, but some of the topical ones, although very effective, can be harmful long term – never to be used for more than 1 week. The oral decongestants also can lose their effect over time as the tissue in the nasal lining grows thicker, and are also associated with increasing blood pressure and other side effects.
Usually, these symptoms are best treated with a nasal spray containing steroid anti-inflammatory medications which are available by prescription. Don’t worry, these nasal corticosteroids are not related to the steroids being peddled to gym members looking to buff up. The most common side effect of these are irritation of the nares and rarely nose bleeds. These are often prevented by using the spray correctly – always have your doctor demonstrate the correct use in the office. These have also been shown to be effective in bacterial infections, hence have become part of my regimen in treating acute infections as well.
Other over the counter treatments which are useful are nasal saline and flushes. Remember, that if using flushes, always use either boiled or bottled distilled water. Rarely, deadly sinus infections can occur from using the tap or well water – even if it is considered safe for drinking.
“Poetry is thoughts that breath, and words that burn.” – Thomas Gray.
If you find that you often seek treatment of sinusitis, requiring frequent antibiotics, or have been diagnosed with chronic sinusitis, talk to your doctor about possible chronic allergic or perennial rhinitis. Most of my patients notice improved breathing, and a significant reduction in their need for antibiotics.
As always, if you have any stories to share of how you dealt with rhinitis, please share in the comments below. I would love to hear your experiences.
Disclosure: Any information in this blog is for informative purposes only, and is not intended to establish a physician patient relationship. The writer of this blog believes in sharing his experiences for none other than educational purposes. Please discuss individual management of your symptoms with your doctor.