When many people think of the word “allergies”, they typically think about nasal allergies. However, allergies can actually impact most areas of the body. Nasal allergies, frequently called hay fever, can cause a host of symptoms and lead to wide variety of complications such as ear infections and sinus infections. Many medications are available to control symptoms, but there is actually a BEST way to start nasal allergy treatment.
What are nasal allergies?
Allergies are symptoms that are caused by our immune system in response to specific foreign bodies that are either inhaled, eaten or come into contact with our bodies. Once the foreign body is found, the body releases chemicals that start the allergic reaction. I have detailed what goes on in the body during this reaction in a previous post.
Although allergies can affect many parts of the body, this post will be limited to allergic reactions that lead to nasal symptoms.
The CDC reports that over 20 million adults have been diagnosed with nasal allergies in the past year, while over 6 million children received the same diagnosis.
Nasal allergies are called hay fever even though there is rarely an associated fever, and the person may not be reacting to hay! Typically, the reactions occur due to pollens from trees, grasses, or weeds, to airborne mold spores, dust or animal/insect proteins.
I think most people associate nasal allergies with classic symptoms, such as:
- a runny nose
- sneezing or itchy nose
- itchy or watery eyes
- postnasal drip
However, in my Pediatric ENT (Ear, Nose, and Throat) practice, I have found the number one symptom of nasal allergies is…A STUFFY NOSE! That’s right. When my young patients do not have classic symptoms, parents assume it is a cold and just wait it out. Many of my patients come to see me due to chronic mouth breathing and complications of a chronic stuffy nose.
Nasal allergy treatment options
Over-the-counter nasal allergy treatment options are available…well…nearly everywhere! Yes, there are also prescriptions available; however, most patients self-treat.
Pediatrician Dr. Kristen Stuppy has written an excellent post about a wide range of allergy treatments, including medications and non-medications. Check out her post for a great summary of allergy management options.
I will discuss the different categories for nasal allergy treatment in greater detail, but I wanted to take a minute to remind you that salt water nasal washes are incredibly helpful!
Every day I explain to my patients that we brush our teeth daily to reduce the number of bacteria and contaminants that are ready to erode our teeth. Brushing our teeth is preventative.
This exact same preventative concept applies to saline nose rinses. Cleansing the nose to reduce the number of allergens, bacteria, and viruses is a great way to prevent inflammation which leads to complications.
Nasal mucus has many protective properties, and one of them is to trap foreign substances. Blowing your nose is helpful at removing these particles, but keep salt water sprays available to get a better clean!
Most people think this group of medications is the hallmark of nasal allergy treatment. As soon as symptoms appear, people run out to purchase many types of antihistamines. To be fair, they do work well.
When the allergy reaction is triggered, the body releases a chemical called histamine, which then causes the symptoms we all hate. This group of medications block histamine from causing the symptoms.
Antihistamines are grouped into two categories: 1st generation and 2nd generation
I like to call the 1st generation ones the “OG antihistamines”! They were the old-school medications I grew up with. Some classics include Benedryl and Dimetapp. These medications typically last 4-6 hours, so they must be taken at least 3-4 times each day for best symptom control. Plus, they have a lot of the most common side effect, sleepiness. However, there are many other complications that could also occur with an antihistamine.
I like to recommend these 1st generation medications for short-term problems where sleepiness is not a bad thing! Examples include chicken pox and poison ivy itching. No one wants to watch their child scratch their skin off, so a little nap here and there can be a good thing while waiting for the problem to resolve. I’m just saying….side effects are not bad all of the time!
The 2nd generation antihistamines are my preference for chronic illnesses such as nasal allergies. The most common ones used include Claritin, Zyrtec, and Allegra. Not only does this class of medication last longer (12-24 hours), but there is much less sleepiness.
Antihistamines work best to control sneezing, itching and a runny nose.
Regardless of which class of medication you choose, you should understand how it works, the potential side effects and problems when mixed with other medications.
Antihistamines are not helpful for a stuffy nose, so many people turn to decongestants. They work fabulously but are not a good long-term option for nasal allergy treatment.
Remember all the detail I shared about how the nose works? Well, swelling inside the nose is a common problem. The nose could be swollen due to allergies, viral infections, bacterial infections or a foreign body stuck up a child’s nose.
Decongestants work by simply shrinking the blood vessels inside the nose! As soon as they wear off, the symptoms recur.
While antihistamines may make you sleepy, decongestants tend to make you jittery and nervous. There can be an increase in heart rate and blood pressure in addition to a variety of other unpleasant side effects. It is often recommended to avoid this group of medications in children less than 6 years old, but I prefer to wait until 12 years of age.
When I do use these medications, I recommend them for an extremely short period of time while beginning treatments for the underlying problem. These medications can be used directly in the nose (Afrin) or taken by mouth (Sudafed). Afrin works so effectively that many people use it regularly; however, the effectiveness wears off and they develop an “Afrin Addiction“. So, don’t do that!
Also please note that if you are taking Zyrtec-D, Claritin-D or Allegra-D, you are taking a daily dose of a decongestant. I recommend you spend time talking with your physician to treat the underlying cause of the swollen nose and not just repeatedly shrink it down.
Singulair, or the generic form called Monteleukast, is not an antihistamine. It has been used with greater frequency for respiratory problems but it belongs to the category medications that block leukotrienes.
As mentioned earlier, histamine is known for triggering allergy symptoms, but leukotrienes are chemicals that are also released during an allergic reaction. Leukotrienes are 3-4 times more powerful than histamine in causing symptoms!
Because leukotrienes are released in a variety of different immune system reactions, Singulair works well for allergy and non-allergy related problems. It is commonly prescribed for asthma, allergies or both!
Currently, this medication requires a prescription. Most people can take this medication with no problems however potential side effects are significant.
In my patients. the most common reasons I have had to stop this medication is due to behavior changes, such as aggressiveness, mood instability, and forgetfulness. I also have seen quite a few patients with headaches and cough that resolved as soon as the medication was stopped.
However, Singulair has been a game changer over the past 20 years in my ability to control allergic diseases.
Nasal allergies often lead to the production of excess mucus. I cannot repeat enough how helpful saline nasal washes are in clearing this excess mucus! If your chest has thick excess mucus, facial steamers and inhaled saline mists may be helpful.
However, some people prefer a medication to thin mucus. The most common medication for this purpose is called Guaifenesin, which is often added to cough and cold mixtures.
I am not a big fan of these medications, but they are used a lot I prefer to focus on treating why the problem is present and use medications until I can fix the underlying issue.
Nasal Antihistamine Sprays
Because nasal allergies often begin after a substance enters the nose, treating the nose directly is a great approach. Besides my best friend, nasal saline washes, another good treatment is an antihistamine sprayed directly into the nose.
On a local level, the allergy reaction can be interrupted with these medications. Some of the most commonly used medications in this category include Patanase and AstePro.
Because the medication is not taken by mouth, the impact on the entire body is less. However, the nasal antihistamine spray side effects are real. The big one….nasty bitter taste! Might need to suck a tic-tac or mint when using.
Nasal Steroid Sprays
Now, it is time for what you have been waiting for. The NUMBER ONE BEST method for nasal allergy treatment is using NASAL STEROID SPRAYS!
WooHoo! This is a true fact that most people do not know. Most of you have antihistamines at home, but where is your nasal steroid? Many are over the counter and Costco lets you stock up at great prices. Go get some now, and you may thank me later!
These nasal sprays work well for nasal congestion (stuffy nose) AND the classic allergy symptoms often treated with antihistamines.
1st generation nasal steroid sprays are more easily absorbed into the bloodstream which can be associated with more side effects. The newer generation nasal sprays do not absorb as much, so they have fewer side effects.
The most common 2nd generation nasal steroids used are Flonase and Nasonex. Other popular sprays include Rhinocort and Nasocort, but these are 1st generation which allow more steroid to absorb into the body.
Many studies show that all nasal steroids are effective but their taste, smell and side effects can vary. The nasal steroids all work by reducing the inflammatory reaction occurring in the lining of the nose.
The main issue with nasal steroids is that people want them to work immediately. Sadly, this is seldom the case. Most of the time it takes 1-2 days to begin to take effect, but for severe cases, results may not be seen for weeks. It is best to start these medications 1 week before the allergy season starts.
What is the best way to treat YOUR nasal allergies?
Bottom line, it has been known for many years that nasal steroids are a great first line treatment for allergies. In 2017, a joint Allergy taskforce confirmed this treatment. However, you should be sure to discuss your treatment with your physicians because many different factors influence our final decisions.
The ultimate way to reduce the need for allergy medications is to have allergy shots. I will be adding more posts about allergies and discussing allergy shots vs allergy drops, both which alter the immune system to reduce allergy symptoms. So be sure to consider subscribing to my blog to avoid missing a post!
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