For allergic rhinitis and postnasal drip many medications are used.
Steroid Nasal Sprays
The experts recommend using intranasal glucocorticoids (steroid sprays applied directly into the nose) as the intial treatment. Steroids are known to be potent anti-inflammatory and anti-allergic agents, and they are known to relieve most of the associated symptoms of runny and itchy nose, nasal congestion, sneezing, and postnasal drip.
Their use must be monitored and tapered by the prescribing physician as long-term use may have significant side effects.
These drugs are highly effective in allergic patients; however, there is a potential for serious side effects when used for extended periods. They are best used for the short-term management of allergic problems, and a physician must always monitor their use. These are reserved only for very severe cases that do not respond to the usual treatment with nasal steroids and antihistamines.
Allergy medications, such as antihistamines, are also frequently used to treat allergic rhinitis and postnasal 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.
Decongestant sprays quickly reduce swelling of nasal tissues by shrinking the blood vessels. They improve breathing and drainage over the short-term. Unfortunately, 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. Therefore, their use should limited to only three to seven days.
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.
Cromolyn Sodium (Nasalcrom)
Cromolyn sodium (Nasalcrom) is a spray that helps to stabilize allergy cells (mast cells) by preventing release of allergy mediators, such as histamine. They are most effective if used before the start of allergy season or prior to exposure to a known allergen.
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 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 is a commonly used formulation.
Allergy Shots (Immunotherapy)
Allergy shots interfere with the allergic response. 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.
These drugs are made up of one or more antiallergy medications. They are usually a combination of an antihistamine and a decongestant. Other common combinations include mucus-thinning agents, anticough 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.
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