Allergic rhinitis can be described as inflammation within the lining of your nose due to various allergens, such as pollen, dust mites, pet dander, and mould spores. When exposed to these allergens, the immune system overreacts, releasing histamines and other chemicals that cause swelling, congestion, sneezing, itching, and nasal discharge. Here we provide various ways on how this can be managed.
Identify Triggers
The first step in managing nasal obstruction due to allergies is to identify your specific triggers. Keep track of your symptoms and note any patterns or trends that may indicate exposure to certain allergens. We can organise allergy tests, often in the form of skin prick tests or blood tests to help in identifying possible triggers.
Minimise Exposure
Once we have identified allergens, we can take proactive steps to minimise your exposure to them. For example:
Pollen: Check pollen forecasts and try to stay indoors during high pollen count days. Keep windows closed and some also consider using air conditioning.
Dust mites: Encase mattresses and pillows in allergen-proof covers, wash bedding regularly in hot water, and vacuum carpets and upholstery frequently.
Pet dander: Limit contact with pets, especially in areas where they spend a lot of time. Bathe pets regularly and use an air purifier to help remove allergens from the air.
Mould: Keep indoor humidity levels low, fix any water leaks or moisture issues promptly, and clean mold-prone areas regularly.
Nasal Washes (Irrigation)
Nasal irrigation, also known as nasal douching or saline nasal wash, can help alleviate nasal congestion and flush out allergens and irritants from the nasal passages. You can use a saline nasal spray or a neti pot filled with a saline solution to rinse your nasal passages. Be sure to use distilled or sterile water for nasal irrigation to avoid the risk of infection.
Medications
We can consider a range of medical therapies to help provide relief of symptoms due to allergies:
Antihistamines: These medications block the action of histamines, reducing allergic symptoms such as sneezing, itching, and often, nasal congestion. Examples include Loratadine (Claritin), Cetirizine (Zyrtec), and Fexofenadine (Allegra).
Decongestants: Decongestant nasal sprays or oral decongestants can help shrink swollen nasal tissues and alleviate congestion. However, use decongestant nasal sprays sparingly and for short periods to avoid rebound congestion (we would suggest a maximum of seven days).
Nasal corticosteroids: These medications reduce inflammation in the nasal passages and can effectively relieve nasal congestion, sneezing, and runny nose. Examples include Fluticasone Furoate (Avamys), Fluticasone Propionate (Flixonase), Budesonide (Rhinocort), and triamcinolone (Nasacort). Dymista nasal spray has a combination of steroids (fluticasone) and antihistamine (azelastine), hence many patients find this most beneficial for their nasal symptoms.
Immunotherapy: This is organised by an allergy specialist (immunologist) and involves gradually exposing patients to small doses of allergens to desensitize their immune system for those patients with severe allergies uncontrolled with other medications. The treatment is given through injections or sublingual drops under medical supervision. While it requires commitment and patience, immunotherapy can provide long-term relief of symptoms.
Surgery
Although we are managing a condition that affects the whole body, for those patients with persistent nasal obstruction who have a structural abnormality, surgery can be considered. These most commonly involve inferior turbinate surgery and/or septoplasty. Please refer to these specific sections for further details.
