ALLERGIES AND SINUS

• Nasal Steroids Sprays - Out of all the allergy medications to help manage symptoms, nasal steroids are the most effective.  Inflammation in the nose and sinuses causes the majority of symptoms our patients complain about such as sinus congestion, pressure, trouble breathing through the nose, and sinus headaches. Medications that can target as many of the inflammatory hormones as possible will offer the best relief of symptoms, in this case it is a nasal steroid.  Nasal steroids act on the following inflammatory hormones: histamine, prostaglandins, cytokines, tryptases, chemokines, and leukotrienes (13). Because nasal steroids can take up to a week for peak effectiveness, they are best used on a daily basis as a preventative measure, as opposed to only using one when you have symptoms.  They are safe to take long-term and have little to no side effects if used as directed.  They are also now very easy to obtain because they are over-the-counter and can be found at your local pharmacy or drugstore.  Examples of these sprays are Flonase™, Nasacort™, Sensimist™, and Rhinocort™. (14)

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• Antihistamines (9) - Histamine is the major hormone responsible for allergic reactions.  When someone with allergies comes into contact with their allergen, such as Mountain Cedar, histamine is released by cells in your body called mast cells (10).  This is done to activate the immune system because your body thinks your allergen is trying to harm you so it initiates an immune response to fight the allergen.  This histamine release is responsible for the itchy, sneezing, runny nose and watery eyes symptoms. Antihistamines, such as Claritin™, Allegra™, Zyrtec™, Xyzal™, Benadryl™, etc., reduce symptoms by blocking histamine from binding to its receptor.  

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• Antileukotrienes - A leukotriene is another hormone that causes symptoms in patients with allergies.  It is usually more of a problem in patients with chronic allergies and asthma. Leukotrienes are released from mast cells, basophils and eosinophils. The release of leukotrienes cause airway constriction (a narrowing of the airways), increased mucus production, swelling and inflammation in the lungs. This causes symptoms such as wheezing, cough, post nasal drip and shortness of breath. An example of an antileukotriene is Singulair™ or montelukast. (11, 12)

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• Nasal Antihistamine Sprays and Antihistamine Eye Drops - Like oral antihistamines, these spray/drops target histamine except they are directly sprayed in the nose or dropped in the eyes.  They work very well on itchy, sneezing, watery eyes, post nasal drip and runny nose symptoms. They often do not have the adverse side effects of oral antihistamines, such as drowsiness or dry mouth.  Some examples of these include Astelin™ (azelastine), Patanase™ (olopatadine), Pataday™, Pazeo™ or Patanol™. An important note, is that these medications must also be stopped prior to allergy testing. Even though their systemic effect is minimal, it may be enough to blunt your allergy response upon testing.  These sprays and drops are very effective on acute symptoms, so you may not need to take these on a daily basis to get the full effect. But remember — prevention is always a better approach.

 

• Nasal Decongestants and Oral Decongestants -  These medications work on the blood vessels in the nose if sprayed, and all over the body  if taken orally. They work by constricting (shrinking) blood vessels in an effort to make the tissue in the nose less inflamed.  This makes the swelling that occurs in an allergic reaction less noticeable. The effects of these drugs are temporary and do not help with the underlying causes of swelling like the other drugs mentioned.  It is best to reserve these medications for as-needed use when your symptoms are uncontrolled by other allergy medications. Using decongestants for more than three-to-four days may cause a nasal mucosal addiction. The most common drug to cause this is products like Afrin™ (oxymetazoline) or Neo-Synephrine™ (phenylephrine). If decongestants are used longer than four days, the nasal mucosa can become reliant (addicted) to the medication and when not in use, rebound congestion occurs that is often worse than the original symptoms.

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