Chronic Rhinitis (cont.)
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Chronic rhinitis and post-nasal drip definition and facts
- Where are the sinuses, and what do they look like?
- What are rhinitis and post-nasal drip?
- What causes rhinitis?
- Is rhinitis always related to allergies?
- What conditions cause an abnormal production of nasal secretions?
- What conditions cause an impaired clearance of nasal secretions?
- Which specialties of doctors treat chronic rhinitis and post-nasal drip?
- How can chronic rhinitis and post-nasal drip be treated?
- What medications can be used to treat rhinitis and post-nasal drip?
- What can be used to treat non-allergic rhinitis?
- Does salt water or nasal irrigation have any role in the treatment of rhinitis and post-nasal drip?
- What are other options for the treatment of rhinitis and post-nasal drip?
- Find a local Ear, Nose, & Throat Doctor in your town
What medications can be used to treat rhinitis and post-nasal drip?
In addition to measures noted above, medications may also be used for the treatment and relief of rhinitis and post-nasal drip.
For allergic rhinitis and post-nasal drip many medications are used. It also is essential to attempt to avoid the offending allergic particles.
Steroid nasal sprays
Intra-nasal glucocorticoids (steroid sprays applied directly into the nose) are often recommended as the first line of treatment. Steroids are potent anti-inflammatory and anti-allergic agents and may relieve most of the associated symptoms of runny and itchy nose, nasal congestion, sneezing, and post-nasal drip.
Their use must be monitored and tapered by the prescribing physician as long-term use may have significant side effects. Examples of the nasal steroids include:
- beclomethasone (Beconase, Beconase AQ, Vancenase, Vancenase AQ)
- flunisolide (Nasarel, Nasalide)
- budesonide (Rhinocort)
- fluticasone propionate (Flonase)
- mometasone furoate (Nasonex)
- fluticasone furoate (Veramyst)
- triamcincolone (Nasocort)
- Ciclesonide (Omnaris, Zetonna)
- Acetonide (Tri-Nasal)
These are generally used once or twice daily. It is recommended to tilt the head forward during the administration to avoid from spraying the back of the throat instead of the nose.
These drugs, for example, prednisone, methylprednisolone (Medrol), and hydrocortisone (Hydrocortone, Cortef) are highly effective in allergic patients. They are best used for short-term management of allergic problems, and a health-care professional must always monitor their use, as there are potential serious side effects when using these medications for extended periods. These are reserved only for very severe cases that do not respond to the usual treatment with nasal steroids and antihistamines.
Learn more about: hydrocortisone
Allergy medications such as antihistamines are also frequently used to allergic rhinitis and post-nasal drip. These are generally used as the second line of treatment after the nasal steroids or in combination with them. Histamines are naturally occurring chemicals released in response to an exposure to an allergen, which are responsible for the congestion, sneezing, and runny nose typical of an allergic reaction. Antihistamines are drugs that block the histamine reaction. These medications work best when given prior to exposure.
Antihistamines can be divided into two groups:
- Sedating, or first generation, for example, diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist). Sedating antihistamines should be avoided in those patients who need to drive or use dangerous equipment.
- Non-sedating or second generation, for example, loratadine (Claritin), cetirizine (Zyrtec),fexofenadine (Allegra). Non-sedating antihistamines can have serious drug interactions. Most of these are found over the counter.
There is a nasal antihistamine preparation that has been shown to be very effective in treating allergic rhinitis, called azelastine nasal (Astelin).
Examples of decongestant sprays include:
- oxymetazoline (Afrin, Dristan)
- phenylephrine (Neo-Synephrine)
Learn more about: Neo-Synephrine
Decongestant sprays quickly reduce swelling of nasal tissues by shrinking the blood vessels. They improve breathing and drainage over the short-term, and their use should be limited to 3 to 5 days because of the potential for rebound addiction. If they are used for more than a few days they can become highly addictive (rhinitis medicamentosa). Long-term use can lead to serious damage.
Oral decongestants temporarily reduce swelling of sinus and nasal tissues leading to an improvement of breathing and a decrease in obstruction. They may also stimulate the heart and raise the blood pressure and should be avoided by patients who have high blood pressure, heart irregularities, glaucoma, thyroid problems, or difficulty in urination. The most common decongestant is pseudoephedrine (Sudafed).
Cromolyn sodium (Nasalcrom)
Learn more about: Nasalcrom
Cromolyn sodium (Nasalcrom) is a spray helps to stabilize allergy cells (mast cells) by preventing release of allergy mediators, like histamine. They are most effective if used before the start of allergy season or prior to exposure to a known allergen.
Learn more about: Singulair
Montelukast (Singulair) is an agent that acts similar to antihistamine, although it is involved in another pathway in allergic response. It has been shown to be less beneficial than the steroid nasal sprays, but equally as effective as some of the antihistamines. It may be useful in patients who do not wish to use nasal sprays or those who have co-existing asthma.
Ipratropium (Atrovent nasal)
Ipratropium (Atrovent nasal) is used as a nasal spray and helps to control nasal drainage mediated by neural pathways. It will not treat an allergy, but it does decrease nasal drainage.
Mucus thinning agents
Mucus thinning agents are utilized to make secretions thinner and less sticky. They help to prevent pooling of secretions in the back of the nose and throat where they often cause choking. The thinner secretions pass more easily. Guaifenesin (Humibid, Fenesin, Organidin) is a commonly used formulation. If a rash develops or there is swelling of the salivary glands, they should be discontinued. Inadequate fluid intake will also thicken secretions. Increasing the amount of water consumed, and eliminating caffeine from the diet and the use of diuretics are also helpful.
Immunotherapy treatment has a goal of reducing a person's response to an allergen. After identification of an allergen, small amounts are given back to the sensitive patient. Over time, the patient will develop blocking antibodies to the allergen and they become less sensitive and less reactive to the substance causing allergic symptoms. The allergens are given in the form of allergy shots or by delivery of the allergen under the tongue (sub-lingual therapy). Sublingual therapy has been more common in Europe. In either method, the goal is to interfere with the allergic response to specific allergens to which the patient is sensitive
These drugs are made up of one or more anti-allergy medications. They are usually a combination of an antihistamine and a decongestant. Other common combinations include mucus thinning agents, anti-cough agents, aspirin, ibuprofen (Advil), or acetaminophen (Tylenol). They help to simplify dosing and often will work either together for even more benefit or have counteracting side effects that eliminate or reduce total side effects.
There are some combination nasal preparations available as well to target the tissue of the nose. The combination of azelastine and fluticasone (Dymista) combines a nasal antihistamine and steroid to help provide relief of seasonal allergic rhinitis symptoms.
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