Managing Nasal Allergies and Discomfort: Expert ENT Insights

Nasal allergies with discomfort during the breathing process?

I have been using a nasal spray with aminophylline in both nostrils, but I still feel discomfort in my nose, and sometimes I also feel discomfort around my nose or a sensation of pressure in my head.
I underwent a nasal endoscopy two months ago, during which chronic laryngitis was diagnosed, but I no longer have those symptoms.
I'm unsure about what further steps I can take to address this issue.

Bo, 40~49 year old female. Ask Date: 2021/07/07

Dr. Ji Zhaoyun reply Otolaryngology

Regarding allergic rhinitis, there are several important concepts: The constitution and environmental allergens and irritants are the main triggering factors.
If one parent has allergic rhinitis, the likelihood of the child developing allergic rhinitis is four times higher.
The most common allergen is dust mites, followed by animals, insects, mold, and pollen.
Recently recognized fine particulate matter (PM2.5) is also an important irritant.

For treatment, oral medications and nasal sprays are initially used, and surgery may be considered if necessary.
The primary medications include oral antihistamines and intranasal corticosteroid sprays, often used in combination.
Depending on the situation, local antihistamines/vasoconstrictors or oral leukotriene receptor antagonists may also be employed.
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 can be performed.
Recently, minimally invasive surgical techniques have been developed, which require shorter operation times and do not necessitate hospitalization, making them widely applicable.
To avoid allergens and reduce irritants, wearing masks, maintaining a good home environment, regularly cleaning bedding, avoiding extreme temperature/humidity changes, and reducing outdoor activities during severe PM2.5 air pollution are key points for daily care.
Although allergic rhinitis can be bothersome, with appropriate medications or combined surgery, and by avoiding allergens and irritants as much as possible, it can be well controlled, significantly improving the quality of daily life and making academic and work tasks easier to manage.
Wishing you peace and health.

Reply Date: 2021/07/07

More Info

Managing nasal allergies and discomfort can be quite challenging, especially when symptoms persist despite treatment. Based on your description, it seems you are experiencing ongoing nasal discomfort and pressure, even after using a nasal spray like Aerius (a common antihistamine) and having undergone a nasal endoscopy that revealed chronic laryngitis two months ago. Here are some insights and recommendations that may help you manage your symptoms more effectively.

Understanding Nasal Allergies and Discomfort
Nasal allergies, commonly known as allergic rhinitis, occur when your immune system overreacts to allergens in the environment, such as pollen, dust mites, pet dander, or mold. Symptoms can include nasal congestion, sneezing, itching, and postnasal drip, which can lead to discomfort in the nasal area and even headaches or a feeling of pressure in the head.

Chronic nasal discomfort can also stem from non-allergic rhinitis, which may be triggered by irritants like smoke, strong odors, or changes in weather. Additionally, structural issues within the nasal passages, such as a deviated septum or nasal polyps, can contribute to persistent symptoms.

Recommendations for Management
1. Consult an Allergist or ENT Specialist: Since you have already seen an ENT specialist, it may be beneficial to consult an allergist for further evaluation. They can perform specific allergy tests to identify potential triggers and recommend appropriate treatments.

2. Optimize Your Nasal Spray Use: While Aerius is effective for managing allergy symptoms, it may not be sufficient for nasal congestion. Consider using a nasal corticosteroid spray (like Fluticasone or Budesonide) in conjunction with your antihistamine. These sprays reduce inflammation in the nasal passages and can provide relief from congestion and discomfort.

3. Saline Nasal Irrigation: Regularly using saline nasal sprays or performing nasal irrigation (using a neti pot or saline rinse) can help clear allergens and mucus from your nasal passages, reducing irritation and discomfort.

4. Avoid Triggers: Identify and minimize exposure to known allergens or irritants. This may include using air purifiers, keeping windows closed during high pollen seasons, and regularly cleaning your living space to reduce dust and pet dander.

5. Consider Other Treatments: If your symptoms persist, discuss the possibility of other treatments with your healthcare provider. Options may include:
- Immunotherapy: Allergy shots or sublingual tablets can help desensitize your immune system to specific allergens over time.

- Decongestants: Short-term use of oral or nasal decongestants can help relieve nasal congestion, but they should not be used for extended periods to avoid rebound congestion.

- Lifestyle Modifications: Staying hydrated, using a humidifier, and practicing good nasal hygiene can also support your nasal health.

6. Monitor for Other Conditions: Since you mentioned a history of chronic laryngitis, it’s important to monitor for any signs of recurrent throat issues or other respiratory symptoms. If you experience persistent discomfort or new symptoms, follow up with your healthcare provider for further evaluation.

Conclusion
Managing nasal allergies and discomfort requires a comprehensive approach that includes identifying triggers, optimizing treatment regimens, and considering additional therapies as needed. By working closely with your healthcare providers and implementing these strategies, you can improve your quality of life and reduce the impact of nasal allergies on your daily activities. If symptoms continue to interfere with your well-being, do not hesitate to seek further medical advice for tailored solutions.

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