Treating Allergic Rhinitis
By Dr I. Abrahams (MBChB, UCT)
What is Allergic Rhinitis or hayfever (aka “Sinus”)
Allergic rhinitis is an allergic condition that is characterised by clear thin mucus, itchy eyes and nose, postnasal drip, runny nose, sneezing and even cough. The condition can either be seasonal or all year round and is normally triggered by pollen, pet dander, cockroaches, fabric and dust.
Allergic rhinitis is commonly associated with chronic throat clearing, cough and feeling of mucous dripping. This condition is known as upper airway cough syndrome/ post nasal drip.
Medical Treatment
Please refer to the How to use Nasal Spray Article prior to using your meds
Intranasal steroids ( intranasal refers to going directly into the nose usually via a spray)
These are used to prevent a flare up of allergic symptoms in the first place. They usually take up to 1-2 weeks to work fully. They can be combined with antihistamines to tide you over until you feel better. Examples include Flomist®, Genemist/Avamyst®, Beclate® . They come in nasal spray form because doses are targeted to the affected area (i.e your nose) so they don’t usually have the side effects of oral steroids like prednisone. These, when used correctly, can significantly help a chronically blocked nose, runny nose and sneezing, however, antihistamines often provide better relief for itching and sneezing. Always follow your healthcare provider’s advice when taking this medication as overuse can cause steroid related side effects or sometimes nosebleeds. They can be used with oral or intranasal antihistamines.
Tip: Never use these medications “as needed” as they take long to work. People usually say these don’t work because they aren’t patient and stop using the medication before they start working.
Antihistamines (oral or intranasal)
They are “relievers” and work much faster than steroids. They come in either tablet form or as a nasal spray which can sometimes include a steroid. They aren’t as good as “preventers” when it comes to keeping symptoms at bay but work very well at relieving symptoms fast, especially sneezing and nasal itching. It is important to note that many flu medications contain some sort of antihistamine already e.g. Flustat, Sinutab, Coryx, Sinucon, Sinuend, flutex and Histacon all contain the same antihistamine found in Allergex ® namely Chlorpheniramine/ Chlorphenamine. Antihistamine nasal sprays work faster and have less side effects than oral ones.
Oral | Intranasal | |
Sedating (drowsy) | Non -drowsy | |
Promethazine (Phenergan) | Cetirizine (Texa; Zyrtec) | Azelastine (Rhinolast) |
Chlorpheniramine (allergex or rhineton. Sometimes found in flu medication such as flustat) | Fexofenidine (fenofex or Fexogen) | Levocabastine (Sinumax allergy nasal spray) |
Doxylamine (usually in combination tablets like Adco-dol or Codoxol and not usually for rhinitis) | Loratadine (Allergex non drowsy/ Rhineton non drowsy) | |
Diphenhydramine (Benylin or Expectalin) | Rupatadine (Rupanase) | |
Desloratadine (Deselex) |
Combination nasal sprays (combining steroid + antihistamine)
These nasal sprays are a combination of steroid nasal steroids and antihistamines. They target all the symptoms of allergic rhinitis including nasal itching, sneezing, blocked nose and post nasal drip. These usually work better than either ingredient alone but can be prohibitively expensive and may not be necessary if you can control your symptoms with an alternative option. Examples include: Dymista ® (Azelastine and fluticasone propionate) or Ryaltris ® (olopatadine and Mometasone).
Saline nasal rinse/ sprays
These help relieve nasal congestion and irritation, and remove any allergens stuck in your nose while being quite safe to use. They can sometimes be used to relieve congestion prior to using your other nasal sprays so they work better. A typical example is Salex®/ Iliadin saline nasal spray or Salex nasal rinse. These don’t usually have a dosage limit but check with your doctor and pharmacist first.
Tip: if your nose is dry from using nasal steroids, nasal saline is very effective to give you immediate relief.
Topical decongestants
These are immediate acting relievers. Ever blown your nose and nothing comes out? This is because your nose is swollen and not necessarily blocked by mucus. Decongestants quickly stop the swelling by reducing the blood flow to your nose i.e the source of the mucus and swelling. They work rapidly (usually within minutes) but cannot be used for more than 3- 5 days as they can cause rebound swelling or rhinitis that makes you dependent on these sprays to even keep your nostril open. This condition is called rhinitis medicamentosa. These should never be used to control hayfever in the long term but can be used to help other nasal sprays to enter your nose. Examples include Oxymetazoline (Iliadin ®, Oxymist ®, Nazene ®) and Xylometazoline ( Otrivin ®, Sinutab ® nasal spray). For severe allergic rhinitis, where your other nasal sprays don’t work, saline or a topical decongestant can be used temporarily to pave the way for the other medication.
Tip: If using more than one nasal spray, the order should be as follows:
Saline → Topical decongestant→ antihistamine/ Combo spray→ steroid/ Combo spray
Allow the previous medications +- 10 minutes to work.
Stop the topical decongestant after 3-5 days of use
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