Chronic Rhinitis (cont.)
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.
Next: What can be used to treat non-allergic rhinitis? »
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