Allergic Rhinitis (Hay Fever and Rose Fever) and Chronic Nasal Congestion

Description

Alternative Names

Decongestants

For mild allergic rhinitis, a nasal wash can be helpful for removing mucus from the nose. Decongestants may help dry nasal congestion. They work by shrinking vessels in the nose. By reducing blockage, they decrease the risk of developing sinusitis caused by viruses or bacteria. Many over-the-counter decongestants are available, either in tablet form or as nasal or inhaled decongestants that are applied directly into the airways as sprays, drops, or vapors.

Nasal-Delivery Decongestants

Nasal-delivery decongestants are applied directly into the nasal passages with a spray, gel, drops, or vapors. Nasal forms work faster than oral decongestants and have fewer side effects. They often require frequent administration, although long-acting forms are now available. Ingredients and brands of nasal decongestants include the following:

Long Acting Nasal-Delivery Decongestants. They are effective in a few minutes and remain so for six to 12 hours. The primary ingredients in long-acting decongestants are the following:

• Oxymetazoline: Brands include Vicks Sinex (12-hour brands), Afrin (12-hour brands), Dristan 12-Hour, Good Sense, Nostrilla, Neo-Synephrine 12-Hour.
• Xylometazoline: Inspire, Otrivin, Natru-vent.

Short-Acting Nasal-Delivery Decongestants. The effects usually last about four hours. The primary ingredients in short-acing decongestants are the following:

• Phenylephrine: Neo-Synephrine (mild, regular, high-potency), 4-Way, Dristan Mist Spray, Vicks Sinex).
• Naphazoline (Naphcon Forte, Privine).

Dependency and Rebound. The major hazard with nasal-delivery decongestants, particularly long-acting forms is a cycle of dependency and rebound effects. The 12-hour brands pose a particular risk for this effect. This effect works in the following way:

• With prolonged use (more than three to five days), nasal decongestants lose effectiveness and even cause swelling in the nasal passages.
• The patient then increases the frequency of their dose. The congestion worsens and the patient responds with even more frequent doses, in some cases to as often as every hour.
• Individuals then become dependent on them.

Tips for Use. The following precautions are important for people taking nasal decongestants:

• When using a nasal spray, spray each nostril once. Wait a minute to allow absorption into the mucosal tissues, and then spray again.
• Keep the nasal passages moist. All forms of nasal decongestants can cause irritation and stinging. They also may dry out the affected areas and damage tissues.
• Do not share droppers and inhalators with other people.
• Use decongestants only for conditions requiring short-term use, such as before air travel or for a single-allergy attack. Do not take them more than three days in a row. With prolonged use, nasal decongestants become ineffective and result in the so-called rebound effect and dependence.
• Discard sprayers, inhalators, or other decongestant delivery devices when the medication is no longer needed. Over time, these devices can become reservoirs for bacteria.
• Discard the medicine if it becomes cloudy or unclear.

Oral Decongestants

Oral decongestants also come in many brands, which mainly differ in their ingredients. The most common active ingredient is pseudoephedrine (Sudafed, Actifed, Drixoral). The alternative decongestant, phenylpropanolamine (PPA) was taken off the market.

Side Effects of Decongestants

Decongestants have certain adverse effects, which are more apt to occur in oral than nasal decongestants and include the following:

• Agitation and nervousness.
• Drowsiness (particularly with oral decongestants and in combination with alcohol).
• Changes in heart rate and blood pressure.
• Avoid combinations of oral decongestants with alcohol or certain drugs, including monoamine oxidase inhibitors (MAOI) and sedatives.

Individuals at Risk for Complications from Decongestants. People who may be at higher risk for complications are those with certain medical conditions, including disorders that make blood vessels highly susceptible to contraction. Such condition include the following:

• Heart disease.
• High blood pressure.
• Thyroid disease.
• Diabetes.
• Prostate problems that cause urinary difficulties.
• Migraines.
• Raynaud's phenomenon.
• High sensitivity to cold.
• Emphysema or chronic bronchitis. (Such individuals should particularly avoid high-potency short-acting nasal decongestant.)
• People taking medications that increase serotonin levels, such as certain antidepressants, anti-migraine agents, diet pills, St. John's Wort, and methamphetamine. The combinations can cause blood vessels in the brain to narrow suddenly, causing severe headaches and even stroke.

Anyone with these conditions should not use either oral or nasal decongestants without a doctor's guidance. Other groups who should also use these agents with caution are the following:

• Anyone who is pregnant should not use these agents without consulting a physician.
• Children appear to metabolize decongestants differently than adults. Decongestants should not be used at all in infants and small children, who are at particular risk for side effects that depress the central nervous system. Such symptoms cause changes in blood pressure, drowsiness, deep sleep, and, rarely, coma.