- Home
- About Us
- The Doctor Is In
-
Rhinitis
Rhinitis
by Steven Verbinski, MD
Dear Doctor,
My nose runs like a faucet and is driving me crazy! I’m tempted to spray sealant up there. Any suggestions?
Dear Sniffles,
While your plight is a common one, your suggested solution is unique – let me know how that turns out. I’m kidding of course. Do not spray sealant up your nose – even if it does give you a heady feeling.
My friend, you are suffering from rhinorrhea [rhin Gr. for "nose" – like a rhino; rrhea Gr. for "profuse flow" – like…well, I"m sure you can think of your own example]. The potential causes of rhinorrhea are numerous. I'm going to presume that you did not just eat a jalepeno or hear some really sad news. By the way, the diagnostic term for a runny nose caused by spicy food is gustatory rhinitis. The treatment – avoid spicy foods. That'll be five bucks…kidding, again. If you must have those five-alarm hot wings, a couple puffs of Atrovent nasal spray ahead of time can really help. Personally, I just bring Kleenex.
I am also going to presume that you are not suffering from the most humbling of medical conditions – the common cold. For this, an over-the-counter decongestant works well but may be contraindicated if you have problems with your blood pressure or a heart condition. A nasal decongestant like Afrin does wonders for a couple of days, but after that your nasal passages may actually become dependent on the medicine to stay open – a condition called rhinitis medicamentosa. This can lead to a vicious cycle of increasing medication self-administration and worsening congestion; best to avoid this by stopping decongestants after two days.
The most common reason for an ongoing runny nose is allergic rhinitis [there's that "rhino" again, this time meaning "inflammation"]. Twenty-percent of us suffer from this condition, which in addition to runny nose, can cause nasal congestion, itchy nose and eyes, sneezing, and can be associated with asthma and eczema. It can be quite serious, interfering with sleep, leading to chronic fatigue, and impairing job-performance. Airborne allergens (particles that elicit an allergic reaction – pollen, for example) get into the nose and cause the release of inflammatory mediators (e.g. histamine – hence the use of 'antihistamines' as treatment) from immune cells (i.e. mast cells and basophils).
Triggering allergens differ from person to person. In some people, symptoms are seasonal - due to the bloom of one of a variety of trees, grasses (hence the term 'hay fever'), or outdoor mold spores. In others, the symptoms are year-round, suggesting a reaction to an indoor allergen such as dust mites, animal dander, or indoor molds. Environmental irritants like tobacco smoke, air pollution, and perfumes can provoke symptoms in some people.
The first tenant of treatment is avoidance, once the culprit allergen or irritant is identified. In some cases the cause can be obvious, such as the nose that runs every time the neighbor's cat, Oscar, jumps the fence for a friendly visit – in an unwitting act of allergenic terrorism. The solution to Oscar may be as simple as getting a dog, or turning on the sprinklers whenever he gets that social look is his eye. Many times the responsible allergen may remain mysterious. A visit to your local allergist may prove very helpful – they can perform skin-testing to identify the source of your woes, helping you take measures to reduce exposure. The tests may even exonerate poor Oscar, demonstrating that you are allergic to your neighbor’s olive tree rather than cat dander.
Contact with some allergens may be unavoidable. "Stay indoors during spring," when you allergies peak may not be practical advice. This is where medical therapy can be liberating. Saline nasal washes with bulb syringes are simple, cheap, and safe. Kits available at your local pharmacy literally wash allergens out of the nose. It may seem counterintuitive to flush more fluid into a nose that is "profusely flowing," but it can cut down on symptoms, and is especially useful for those who do not like to take medications. Cromolyn sodium nasal spray is a preventative treatment that stabilizes mast cells, cutting down on histamine release. It must be started several days before histamine-release, well before symptoms occur. This may not be possible if symptoms occur in an unpredictable fashion. It is a generally safe therapy, available over-the-counter, but in my experience results are often suboptimal.
The mainstays of medical treatment for allergic rhinitis are nasal steroids and antihistamines. Nasal steroids, available by prescription, work well but take a couple of weeks to reach their maximal effect. Many people stop them after a couple of days, observing no benefit, before the medicine has had a chance to really "kick in."
Antihistamines are distinguished from one another more on the basis of their side-effects than their effectiveness. Over-the-counter antihistamines such as Benedryl, Dimetapp, and Chlor-Trimeton, may be very effective in treating a runny nose, but can be quite sedating and should not be used while driving or operating machinery. The less-sedating varieties include loratadine (Claritin/Alavert), available over the counter, or the prescription-requiring Allegra and Zyrtec. The major draw-back to the less-sedating antihistamines is higher cost. For individuals who prefer not to take pills, an antihistamine nasal spray (Astelin) is available.
For those who prefer not to take medicines of any kind, or for those in whom nasal steroids and antihistamines do not adequately control their symptoms, immunotherapy is an option. Prescribed by an allergist, immunotherapy ("allergy shots") can desensitize the immune system over time to the culprit allergen, gradually improving symptoms.
The above is meant as general information and should not be taken as medical advice. For specific medical recommendations consult your physician.
For more information about allergic rhinitis please visit www.aaaai.org.
Dr. Steven Verbinski is a board certified in Internal Medicine and is the Co-Director of the Hospitalist Program St. Rose Hospital.
We welcome your questions!
Physicians on staff at St. Rose Hospital are interested in responding to your questions about health care and related topics such as health education and prevention.
Please send any questions to: TheDoctor@strosehospital.org