Nasal Allergy Medications (cont.)

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What are decongestants?

Nasal stuffiness or congestion occurs as a result of swelling of the nasal membranes. Histamine opens the blood vessels and encourages fluid leakage from them, thereby causing the tissues to become "congested." This reaction reduces the space inside the nose through which we breathe and results in the typical "blocked" or stuffy nose. While antihistamines can control many symptoms of allergic rhinitis, they are not very helpful for treating nasal congestion once it has already occurred. At this point, decongestants can be a very useful addition (see next section).

How do decongestants work?

Decongestants act on a receptor on the blood vessels. When the decongestants act on the receptors, the blood vessels shrink which in turn reduces the blood flow to the area and lessens the leakage of fluid into the tissues. The result is a nasal passage that feels more "open." It is important to remember that decongestants do NOT help with an itchy, sneezing, and runny nose.

Two forms of decongestants, oral and topical, are currently available. They are probably equally effective, although the topical nasal sprays or drops work more quickly (a few minutes compared to thirty minutes). Most preparations are OTC and are relatively inexpensive. Decongestants are frequently combined with antihistamines and are sometimes combined with mucous thinners (mucolytics).

Common Decongestants
Generic Name Brand Name
pseudoephedrine (oral: liquid, tablets) Sudafed (Novafed)
phenylephrine (topical: drops, spray) Neosynephrine
oxymetazoline (topical: drops, spray) Afrin

When should I use topical decongestants?

The best use for topical decongestants, the nose drops and sprays, is for the quick, temporary relief of nasal stuffiness due to either allergic or non-allergic causes. They are helpful for relieving congestion in the Eustachian tubes, which equalize pressure between the inner ear and the nasopharynx. Decongestants are frequently used before air flights to prevent ear symptoms such as ear pressure during flight. They may also be useful in treating or preventing ear infections. It is important, however, not to use these topical agents for longer than 3 to 5 days, since this may cause rebound congestion. Also, be careful to follow the daily use instructions - some decongestants need to be taken only twice a day while others may need to be used 3 to 4 times a day.

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