Nasal Allergy Management
Allergy is a chronic disease much like high blood pressure and diabetes and thus must be managed with daily therapy in order to improve. Allergies are rarely, "cured," and the only effective modality that offers a cure of allergies is immunotherapy, either with drops under the tongue or allergy shots. Nasal allergy management is about stopping the inflammation within the nose, and preventing future inflammation with allergen exposure. Inflammation results in obstruction of the nose as well as hypersecretion of mucous within the nose. There are several medications and over the counter additions that can help effectively manage your problems.
- Neilmed Sinurinse or saline rinses: These mechanically remove the allergy causing molecule or thick mucous from the nose. This also helps remove this mucous from the lining of the nose and allows other nasal sprays to work more effectively on the nasal lining. You cannot use this too often, and twice daily is the minimum I would recommend and up to five times daily is optimal. It is also very effective for nasal congestion and drainage due to sinusitis and viral illness.
- Nasal Steroid Sprays (Flonase, Nasonex, Veramyst, Nasocort): All these sprays effectively decrease the swelling within the nose and paranasal sinuses. If you have nasal polyps, these sprays are the key to keeping the polyps from returning. They not only decrease the swelling and inflammation within the nose, but they also help to decrease excess mucous production secondary to swelling and irritation. This spray is to be used after the saline rinses, and take 2-3 weeks until one can notice a significant effect using it every day. The steroid is not absorbed throughout the body and has no significant systemic effects.
- Oral Antihistamine (Allegra, Zyrtex, Xyzal): These medications decrease the bodies inflammatory response to allergens and can be taken before or after allergy expose but are more effective before allergy exposure. Histamine is a molecule that is released by the body when exposed to something allergenic, and this medication blocks the systemic reaction to histamine. They are sometimes sedating, so I recommend taking them at night. I also do not recommend the preparations with decongestants (D) because these tend to make the nasal secretions thicker and even harder to remove.
- Topical Nasal Antihistamine (Patanase, Astelin, Astepro): These medications are antihistamine that are sprayed directly into the nose and are not absorbed systemically. These medicines decrease the nasal reaction to any allergen within the air without having the whole body side effects of an oral antihistamine.
- Leukotriene Inhibitor (Singulair): This medication blocks the effects of a second inflammatory molecule, leukotrienes, that are released as a result of allergen exposure. This medication prevents inflammation in both the nose and lungs, so it is very effective in patients with allergies and asthma, with very few side effects.
- Mast Cell Stabilizer (Cromylyn sodium): This prevents another allergy cell, a mast cell, from release histamine when you are exposed to an allergen. This must always be used before one is exposed to the allergen. Once exposed to an allergen, it is too late to use this medication.
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