the Duration and Management of Rhinitis Treatment

Treatment for rhinitis?

I visited a doctor for a cold and was prescribed antihistamines for three days.
After recovering from the cold, I still experienced discomfort in my ears, nose, and throat.
I consulted a second doctor who prescribed a month’s supply of antihistamines.
After finishing the month, I still had symptoms but did not return for further consultation.
During a follow-up appointment, the doctor mentioned that taking the medication after a break would yield better results and provided another month’s supply.
Since rhinitis is difficult to resolve, I left it untreated for a while, but the discomfort persisted.
I then saw a third doctor who prescribed antihistamines for three days.
What is the typical duration of treatment for rhinitis? It’s not ideal to take medication continuously, yet not treating it leads to discomfort.
I experience ear, nose, and throat symptoms daily, varying in location and severity.
If I notice improvement with a particular doctor, can I request a month’s supply if they initially prescribe only three days? Should I take a break after finishing a month’s supply before returning for a follow-up, or should I go back immediately after finishing the medication? How can I ensure the effects are sustained? Thank you.

Niming, 30~39 year old female. Ask Date: 2018/10/22

Dr. Ji Zhaoyun reply Otolaryngology

Hello, if allergic rhinitis is primarily triggered by allergens in the environment and one parent has a history of allergic rhinitis, the likelihood of the child developing allergic rhinitis is four times higher.
Treatment typically begins with oral medications and nasal sprays, and surgery may be considered if necessary.
The main medications include oral antihistamines and intranasal corticosteroid sprays used in combination.
Depending on the situation, local antihistamines/vasoconstrictors or oral leukotriene receptor antagonists may also be utilized.
If symptoms do not improve with medication and there is significant structural obstruction, such as a deviated septum, enlarged inferior turbinates, or nasal valve narrowing, appropriate surgical intervention may be warranted.

To avoid allergens, it is advisable to reduce irritants by wearing masks, regularly cleaning bedding, avoiding extreme temperature/humidity changes, and minimizing exposure to air pollution.
Although allergic rhinitis can be bothersome, with appropriate medication or combined surgical treatment, and by avoiding allergens and irritants, it can be well-controlled, significantly improving quality of life.

However, in the case of sinusitis, common symptoms include nasal congestion, yellow-green nasal discharge, fever, facial pain, foul smell, and changes in smell, though not all symptoms may be present.
Diagnostic methods include endoscopy and imaging studies.
If acute sinusitis persists despite antibiotic treatment for more than two weeks, it is advisable to consult an otolaryngologist for bacterial culture.
If more virulent bacteria are identified, a stronger antibiotic may be required.
It is recommended to purchase a nasal irrigation device (containing isotonic saline) and perform rinses 1-2 times daily to enhance treatment efficacy.
Additionally, avoiding late nights, refraining from smoking, and controlling blood sugar levels for diabetic patients are essential.
If sinusitis does not resolve after 2-3 months of treatment, it is likely to be chronic sinusitis, necessitating further evaluation and possible surgical intervention.
It is advisable to seek assessment from an otolaryngologist.

Wishing you peace and health.

Director of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare,
Chi Chao-Yun

Reply Date: 2018/10/22

More Info

Managing rhinitis can be a complex process, especially when symptoms persist despite treatment. Rhinitis, which can be allergic or non-allergic, often requires a tailored approach to effectively alleviate symptoms. Understanding the duration and management of rhinitis treatment is crucial for achieving long-term relief.

Duration of Treatment:
The duration of rhinitis treatment can vary significantly based on the underlying cause and the severity of symptoms. For allergic rhinitis, antihistamines are commonly prescribed. These medications can provide quick relief from symptoms such as sneezing, itching, and nasal congestion. However, they may not address the root cause of the allergy. Typically, a course of antihistamines can last from a few days to several weeks, depending on the patient's response and the allergen exposure.

In your case, it seems you have been prescribed antihistamines for varying durations by different doctors. A common practice is to start with a short course (like three days) to assess the effectiveness. If symptoms improve, a longer course may be recommended. However, if symptoms persist, it may indicate that the treatment needs to be adjusted or that additional therapies are necessary.

Management Strategies:
1. Antihistamines: These are the first line of treatment for allergic rhinitis. They can be taken daily during allergy seasons or continuously if symptoms are chronic. If you find that a specific antihistamine works well for you, it is reasonable to ask your doctor for a longer prescription.

2. Nasal Corticosteroids: These are often more effective than antihistamines for controlling nasal inflammation and congestion. They can be used daily and may take several days to reach their full effect. If you have not been prescribed these yet, it might be worth discussing with your doctor.

3. Decongestants: These can provide temporary relief from nasal congestion but should not be used for extended periods due to the risk of rebound congestion.

4. Avoidance of Triggers: Identifying and avoiding allergens (like pollen, dust mites, or pet dander) can significantly reduce symptoms. This might involve lifestyle changes, such as using air purifiers or changing bedding frequently.

5. Immunotherapy: For those with persistent allergic rhinitis, allergy shots or sublingual tablets can be an option. This treatment gradually desensitizes the immune system to specific allergens over time.

Consulting Your Doctor:
If you notice improvement with a specific treatment, it is advisable to communicate this to your doctor. You can request a longer prescription if you feel that the medication is effective. However, it’s essential to have regular follow-ups to monitor your symptoms and adjust treatment as necessary.
If you are experiencing ongoing symptoms despite treatment, it may be beneficial to seek a specialist, such as an allergist or an ear, nose, and throat (ENT) doctor. They can provide a more comprehensive evaluation and may suggest additional diagnostic tests to identify underlying issues.

Conclusion:
In summary, the management of rhinitis can be a trial-and-error process, and the duration of treatment can vary widely. It is important to maintain open communication with your healthcare provider about your symptoms and treatment responses. Regular follow-ups and adjustments to your treatment plan can help you achieve better control over your rhinitis symptoms, leading to improved quality of life. If you find a treatment that works, don’t hesitate to discuss extending that treatment with your doctor.

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