Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
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, 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.
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 of rhinitis and post-nasal drip.
For allergic rhinitis and post-nasal drip many medications are used.
Steroid nasal sprays
The experts recommend using intra-nasal glucocorticoids
(steroid sprays applied directly into the nose) as the first line of 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 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:
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.
Oral steroids
These drugs [prednisone, methylprednisolone (Medrol),
hydrocortisone (Hydrocortone, Cortef)] 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.
Antihistamines
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 [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 [loratadine
(Claritin), cetirizine (Zyrtec)].
Non-sedating antihistamines can have serious drug interactions. Most of
these are found over the counter.
There is also a nasal antihistamine preparation that has been shown
to be very effective in treating allergic rhinitis, called
azelastine nasal (Astelin).
Decongestant sprays
Examples of decongestant sprays include:
oxymetazoline (Afrin), and
phenylephrine (Neo-Synephrine)
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 3 to 7 days.
Oral decongestants
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)
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.
Montelukast (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.
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.
Combinations
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.
Most sore throats are caused by viruses or mechanical causes (such as mouth breathing) and can be treated successfully at home. However, a person should be seen by a health care professional if they have a sore throat that has a rapid onset, and is associated with a fever or tenderness of the front of the neck; a sore throat that causes the person to have difficulty swallowing (not just pain swallowing) or breathing; or if a sore throat lasts for more than a week.
Eczema, also known as dermatitis, is a general term for many types of skin inflammation. The most common form of eczema is atopic dermatitis. The other forms of eczema include: contact eczema, seborrheic eczema, Nummular eczema, Neurodermatitis, stasis dermatitis, and dyshidrotic eczema. Symptoms, diagnosis, and treatment of eczema may vary from person to person and may depend on the type of eczema.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Sinus infection (sinusitis) signs and symptoms include headache, fever, and facial tenderness, pressure, or pain. Treatments of sinus infections are generally with antibiotics and at times, home remedies.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
The Eustachian tube is a membrane lined tube that connects the middle ear space to the back of the nose. Problems include partial or complete blockage which can cause popping, clicking, and ear fullness. Allergies, sinus and ear infections, or the common cold can cause this blockage, while altitude changes can cause symptoms in those persons with Eustachian tube problems. Treatment includes several maneuvers (swallowing, chewing gum, yawning etc.), which can be done to improve Eustachian tube function.
Impotence, also known as erectile dysfunction, is a common
problem among men characterized by the consistent inability to sustain an
erection sufficient for sexual intercourse or the inability to achieve
ejaculation, or both. Impotence can have emotional causes but most often it is
due to a physical problem.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Keratosis pilaris (KP) is a common skin disorder in which small white or red bumps appear around hair follicles on the upper arms, thighs, buttocks, and cheeks. The cause of KP is unknown. There is no cure for keratosis pilaris, and the condition may resolve on its own. Gentle exfoliation, professional manual extraction, chemical peels, and microdermabrasion, along with topical products, are the best treatments for this condition.
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished, bulky and fouls smelling stools, vitamin insufficiency, gas, painful or swollen abdomen, infertility, susceptible to heat emergencies, and respiratory failure. There is no cure for cystic fibrosis, treatment of symptoms is used to manage the disease.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Wegener's granulomatosis, a condition that usually affects young or middle-aged adults, is an inflammation of the arteries supplying blood to the sinuses, lungs, and kidneys. Symptoms of Wegener's granulomatosis include bloody sputum, fatigue, weight loss, joint pain, sinusitis, shortness of breath, and fever. Wegener's granulomatosis may be fatal within months without treatment. Treatment aims to stop inflammation with high doses of prednisone and cyclophosphamide.
Hay fever (allergic rhinitis) is an irritation of the nose caused by pollen and is associated with the following allergic symptoms: nasal congestion, runny nose, sneezing, eye and nose itching, and tearing eyes. Avoidance of known allergens is the recommended treatment, but if this is not possible, antihistamines, decongestants, and nasal sprays may help alleviate symptoms.
A deviate septum is a condition in which the bone and cartilage that divide the nasal cavity of the nose in half (nasal septum) is significantly off center or crooked. The causes of a deviated septum can be congenital, or develop after a trauma or injury to the nose. Symptoms of a deviated septum include nasal congestion, recurrent sinus infections, nosebleeds, headache, facial pain, postnasal drip, snoring, and loud breathing. A deviated septum can be relieved with medications, and if necessary surgery, called a septoplasty.
Common sources of indoor allergens include dust mites, cockroaches, molds, pets, and plants. Managing allergies caused by indoor allergens means reducing your exposure to them.
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