Allergies and Your Sinuses: Fighting Allergic Rhinitis

A guide to the best stuff for stuffy noses, from prescription treatments to self-care.

From the WebMD Archives

One in five adults in the U.S. has nasal allergies, or allergic rhinitis. Yet as common as it is, experts say that allergic rhinitis is underdiagnosed, undertreated, and underestimated.

Allergic rhinitis is a trivialized disease,” says Jonathan A. Bernstein, MD, an allergist at the University of Cincinnati College of Medicine. “Obviously, nobody dies from it. But it does cause a tremendous amount of sickness and suffering.”

All that sneezing, congestion, and teary-eyed misery takes a toll. Allergic rhinitis can cause missed workdays, and it can detract from your performance at school or on the job. Because of this, allergic rhinitis costs the country billions of dollars every year.

Nasal allergies can also lead to other conditions such as sinus problems. But they don’t have to.

“Allergic rhinitis is a treatable problem,” Bernstein says, “and when people get diagnosed and treated properly, they do very well.” If you’ve been limping through life with nasal allergies, it’s time to get the best of them.

Nasal Allergies and Sinus Problems

Allergy symptoms are miserable enough on their own. But in many people, allergic rhinitis can cause -- or aggravate -- other complications or conditions.

What’s the connection between allergies and sinus problems?

Sinuses are hollow pockets in the skull that are connected to the nasal passages. When allergies trigger swelling in the mucous membranes, the inflamed tissue can block off the sinuses. The sinuses can’t drain, trapping mucus and air inside. That leads to pain and pressure.

Take Allergy Symptoms Seriously

Despite the misery of allergies and their complications, many people don’t take the symptoms very seriously.

They don’t realize the impact that their allergies are having on their lives, especially when added up over years and decades, says Leonard Bielory, MD, professor of allergy and immunology at Rutgers University.

They get used to the congestion, chronic sinus problems, and mouth breathing. They get used to disturbed sleep and fatigue. After a while, they just don’t remember what life was like before allergies.

When symptoms get bad, they make do. They grab over-the-counter medicines at random at the drugstore. They make guesses at the cause of their allergies and half-hearted attempts to control their exposure, but never get a diagnosis.

That’s not the way to go about it, experts say. Given the impact that nasal allergies can have on your life, you really need to get proper medical evaluation and treatment.

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Allergic Rhinitis Treatments: Over-the-Counter Medicine

For mild allergic rhinitis -- or symptoms that only strike for a few weeks a year -- over-the-counter medicines may be enough. OTC treatments for allergic rhinitis include:

Steroid nasal sprays. These drugs work by reducing the swelling in the nasal passages. Doctors recommend this as your first choice for treatment because of effectiveness and simplicity of use. Many are available by prescription, but only two, Nasacort and Flonase, are available over the counter.

Antihistamines. These drugs work by blocking histamine, a chemical that causes many allergy symptoms. They help relieve itching and sneezing. Examples include cetirizine, fexofenadine, and loratadine. The antihistamines chlorpheniramine and diphenhydramine are known to cause drowsiness. If your primary complaint is sneezing and itching, your doctor may recommend one of these.

Decongestants. Though antihistamines can control many allergy symptoms, they don’t relieve congestion. That’s where oral decongestants come in, such as phenylephrine and pseudoephedrine (Sudafed, Sudogest). They reduce swelling in the nasal passages, opening them up. Don't use nasal spray decongestants like naphazoline (Privine), oxymetazoline (Afrin, Dristan, Duramist), or phenylephrine (Neo-Synephrine, Rhinall, Sinex) for more than three days at a time. Used for too long, they can cause a rebound effect, making symptoms worse.

 

Other drugs. A few other over-the-counter drugs may help too. Many others are available by prescription, as mentioned below. Cromolyn sodium (NasalCrom) is a nasal spray that can ease a runny or itchy nose, sneezing, and a stuffy nose due to allergies. Allergy eye drops with the ingredients naphazoline (Naphcon-A, AK-Con-A) and tetrahydrozoline (OptiClear) can relieve red eyes. Other eye drops with ketotifen (Zaditor, Alaway), an antihistamine, help relieve itchy eyes.

Prescription Treatments for Allergic Rhinitis

If over-the-counter medicines aren’t giving you relief, you might need prescription drugs. Prescription treatments for allergic rhinitis include:

Steroid nasal sprays. These are the recommended prescription treatment for allergic rhinitis. “The great thing about steroid sprays is that with just one medication, you can treat the congestion, the itchiness, and the sneezing,” says Corinna Bowser, MD, an allergist in Narbeth, Pa. Examples include beclomethasone diproprionate (Qnasal, Beconase AQ), budesonide (Rhinocort), fluticasone propionate (Flonase), mometasone (Nasonex), and trimcinolone (Nasacort). Flonase, Nasacort, and Rhinocort are available without a prescription.

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If you are concerned about taking a steroid, experts stress that these are very safe drugs. One key advantage of nasal sprays is that they focus the medication on the affected area – in your nose – and deliver with minimal risk instead of circulating it throughout the body.

Prescription antihistamines and decongestants. Your doctor may also recommend a prescription antihistamine pill like desloratadine (Clarinex) or levocetirizine (Xyzal). Some prescription antihistamines also contain a decongestant. Azelastine (Astelin) is a nasal spray antihistamine that’s often used alongside steroid sprays. Antihistamines also come as prescription eye drops.

Other medications. Singulair, a medication called a "leukotriene modifier" helps relieve symptoms of allergic rhinitis, but should not be the main form of treatment. Depending on your symptoms, prescription sprays and eye drops are also options. For severe flare-ups, oral steroids can help -- prednisone is the standard.

Immunotherapy. While other treatments for allergic rhinitis are a temporary fix, immunotherapy -- in the form of allergy shots or oral tablets or drops -- can be a genuine cure. They work by regularly exposing you to tiny amounts of an allergen, so your body slowly becomes used to it. Over time, even large amounts shouldn’t provoke an allergic reaction. Allergy shots are effective in about 85% to 90% of people.

If you’re wary of long-term drug use, allergy shots might be the best approach. “What you’re getting in the injection is a tiny amount of the allergen, and your immune system does the rest,” says Bowser. “It’s really the most natural treatment we have.”

The tablets currently available include Grastek, Ragwitek, and Oralair. After an initial dose in your doctor's office, this type of treatment is usually used at home.

Allergic Rhinitis Self-Care

Medications are often the key to handling nasal allergies and sinus problems. But there’s also a lot that you can do on your own. Here are some suggestions.

Nasal irrigation . To the uninitiated, squirting salt water in your nose might seem to be a bizarre treatment for nasal allergies. But it works. “Some trials found that nasal irrigation works as well as antihistamines in reducing symptoms,” says Bowser. There’s evidence that it relieves sinus symptoms, too.

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The principle is simple. By washing out your nasal passages and sinuses with salt water, you clear out the allergens that are triggering your symptoms -- along with bacteria and excess mucus. “It’s just like cleaning your furnace filter,” says Bernstein. “If you want good air quality in your home -- or your lungs -- the filters have to be clean.” If you are irrigating, flushing, or rinsing your sinuses, use distilled, sterile, or previously boiled water to make up the irrigation solution. It’s also important to rinse the irrigation device after each use and leave open to air dry.

Experts say that simple neti pots or squeeze bottles seem to work as well as more expensive devices. Keep in mind that nasal irrigation (which flushes out the nasal passages) is different from spray bottles of saline (which merely moisten them).

Neti pots and other nasal irrigation devices are available in drugstores, supermarkets, and online. Basic neti pots cost about $10 to $15, while fancier irrigation devices can cost $100 or more.

Environmental control. If you can reduce your exposure to an allergen, you’ll help reduce your symptoms. So take some sensible precautions around the home. If you’re allergic to dust mites, buy a mattress cover to keep them out. If it’s pollen, keep the windows shut and use air conditioners to filter the air. If it’s cat dander, keep the animal out of your bedroom. Consider trying out a HEPA (high efficiency particulate air) filter. However, don’t break the bank trying to make your home allergen-free. It’s impossible. “Environmental control is a great first step,” says Bowser. “But in most cases it’s not enough to control symptoms.”

Moist air. If the air is dry and you’re having sinus problems -- like pain and pressure -- keep your nasal passages moist. Use a humidifier or vaporizer (and keep it clean). Other suggestions: Take long showers, apply warm compresses over your nose and mouth, and breathe in steam from a pot on the stove. Just make sure not to make your home too swampy. Dust mites, a common cause of allergies, thrive in humidity.

Protection. If you know you’re going to be exposed to an allergen, take some precautions. If you need to rake outside during pollen season, for example, wear a mask and goggles to protect yourself – or get someone else to do it.

Supplements. Some people want to treat their allergies without drugs and hope to find a “natural” cure instead. There is evidence that supplements such as butterbur and quercetin can help with allergy symptoms.

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Fighting Allergic Rhinitis: Where to Start

If over-the-counter allergy treatments do the trick for you, great! If not, you should see your doctor.

You might assume that you have allergies when you really have nonallergic rhinitis, which is triggered by irritants like cigarette smoke or fumes, instead of allergens. Or your symptoms could stem from colds, sinus problems, asthma, thyroid dysfunction, medication side effects, or other issues. If allergies aren’t really your problem, those allergy drugs won’t do any good.

If your doctor does say you have allergic rhinitis, it's a good idea to find the cause of your allergies. The only way to do that is to get allergy testing.

“Some people with allergic rhinitis spend a lot of time and money focusing on the wrong thing,” says Hugh H. Windom, associate clinical professor of allergy and immunology at the University of South Florida.

“They assume that they’re allergic to dust mites, so they spend thousands renovating their homes, pulling up carpets, and cleaning air ducts. But it turns out to be the oak tree outside the bedroom window.”

So get allergy testing before you do anything drastic. You don’t want to pry a beloved kitty out of your tearful child’s arms, find it a new home, and then discover that you were never allergic to cats in the first place.

WebMD Feature Reviewed by Jennifer Robinson, MD on June 08, 2016

Sources

SOURCES: 

News release, Sanofi-aventis U.S. 

Jonathan A. Bernstein, MD, allergist, professor of medicine, department of internal medicine, University of Cincinnati College of Medicine.

Leonard Bielory, MD, allergist and immunologist, professor, Rutgers University; attending, Robert Wood Johnson University Hospital.

Corinna Bowser, MD, allergist and immunologist, Narbeth, Pa.  

David P. Rakel, MD, founder and director, University of Wisconsin Integrative Medicine Program, Madison, Wis.

Hugh H. Windom, MD, associate clinical professor of allergy and immunology, University of South Florida.  

American Academy of Family Physicians: “Saline Nasal Irrigation for Frequent Sinusitis.”

American Academy of Family Physicians' FamilyDoctor: “Sinusitis.”

American Academy of Otolaryngology: “Fact Sheet: 20 Questions about Your Sinuses.”

Natural Medicines Comprehensive Database: “Natural Medicines in the Clinical Management of Allergic Rhinitis.”

WebMD Medical Reference: “Allergy Medications.”

News release, FDA.

UpToDate.com. “Patient information: Allergic rhinitis (seasonal allergies) (Beyond the Basics).”

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