Treatment of Nasal Allergies

This video explains the first three things to do if you have nasal allergies. It also explains when to use oral or topical decongestants and how they work.

Video Transcript

Hello, I’m doctor James Ludwick, and I’m going to teach you how to treat your nasal allergies. 


So, what are nasal allergies? Nasal allergies are when things like pollen and dust land inside your nose and create inflammation. And this inflammation creates lots of symptoms — like itching, sneezing, postnasal drip, and problems breathing through your nose. 


Patients are always asking me what medications they should use to treat their nasal allergies. Let’s look at the different medications and figure out which one you should be using for which symptoms. 


There are four main types of allergy medication you can use to treat your allergy symptoms, and everything else is just a combination of those products.


First, we have saltwater irrigation products, then there are topical steroids, antihistamines, and then decongestants. Then other products are just a combination of these different things.


The first thing you should do is wash your nose with a good saltwater product. Make sure you use distilled water, so you don’t have a lot of heavy metals and ions and things that would irritate your nasal cavity. 


Probably the most important product to use when treating your nasal allergies on a daily basis are topical steroids, such as Qnasl, Flonase, or Nasonex. Topical steroids work by blocking the inflammatory reaction that incites all the symptoms that you’re suffering from because of nasal allergies. That’s why you have to use it every day. 


If your symptoms are just in your nose, that’s where you have your allergy. Sneezing, postnasal drip, itchy nose, you want to put the medicine where the problem is. 


The best choice for nasal allergies is topical antihistamines. So when you have this inflammatory reaction in your nose, it causes the release of histamine. And histamine causes lots of itching and sneezing that you experience with nasal allergies. 


The nice thing about antihistamines is that you can use them as needed. You don’t necessarily need to use them every day unless you have symptoms every day. 


If your symptoms are mainly in your nose and you’re not having lots of hives or rashes — just nasal symptoms, you’re better off using a topical antihistamine, as needed, to help stop the symptoms of histamine — which is itching and sneezing and postnasal drain. 


Probably one of the most confusing medications is decongestants. Patients just don’t know when to use nasal decongestants. 


When it comes to allergies when you have lots of inflammation inside your nose, and there’s not a lot of room for the air to move through your nose, you’re probably going to benefit from a decongestant. 


Even though you’re taking your topical steroids, you’re washing your nose and using an antihistamine, sometimes it’s just not enough to help you get the air you need through your nose, and that’s where decongestants come into play. 


There are two types of decongestants in general that you can use to help improve the air-flow through your nose. 


Topical decongestants are like Afrin or Neo-Synephrine, and then oral decongestants like Sudafed. So if you have heart trouble, if you have high blood pressure, you should NOT be using decongestants. If not, they are great to use on a temporary basis to help improve the amount of space inside your nose so that you can breathe better. 


The last product that patients often grab off the shelf Mucinex. Mucinex is an expectorant, which means it breaks up mucus. The last thing you want to do is grab a product off the shelf that makes your secretions even more watery and runnier. 


Mucinex is great when you have a sinus infection or bronchitis. In those cases, you have thick secretions that you’re trying to cough up, and that’s exactly what Mucinex does. It helps break up those secretions so you can get them out. 


If you have just nasal allergies, stay away from Mucinex. 


Up to this point, everything we’ve talked about are medications to treat your allergy symptoms. But unfortunately, they don’t cure your allergies. The good news is, we have a way to potentially cure nasal allergies. This is called immunotherapy. 


To do immunotherapy, you first have to be allergy tested. We don’t test you because we don’t believe you really have allergies — of course you do, you’re sneezing and having drainage and postnasal drip — we test you because we have to find out what you’re body is reacting to, in order to give you those allergens in high doses over a long period of time. By doing this, immunotherapy reprograms your immune system to not react to all those things it’s currently reacting to, and therefore, it alleviates the symptoms. 


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