Managing Allergic Rhinitis: Tips for Nasal Congestion and Post-Nasal Drip

Nasal allergies, post-nasal drip, nasal congestion, nasal irrigation?

Hello Doctor, I have a history of nasal allergies, and whenever there are significant changes in weather, temperature, or environment, I start to experience symptoms like frequent sniffing and a runny nose.
Since I was diagnosed in early June, I have become very sensitive to heat.
I used to avoid using air conditioning, but now I have to turn it on right after I shower and keep it on until I go to bed.
However, I’m not sure if this is the reason, but I have started to experience more nasal congestion and post-nasal drip.
I often feel like there is phlegm stuck in my throat that I can’t cough up, and at times, I have a sensation of something being lodged in my throat.
I consulted a gastroenterologist, and after listening to my symptoms, the doctor suggested that I might be experiencing autonomic nervous system dysregulation.
After taking medication for a few days, the sensation of a foreign body in my throat has diminished, but I still feel phlegm deep in my throat.
Recently, I have started using nasal irrigation to alleviate the discomfort of nasal congestion and post-nasal drip, doing it both in the morning and evening.
However, I’ve noticed that after rinsing in the morning and evening, I end up with even more nasal discharge, which is clear but thick.
Especially after rinsing before bed, I experience nasal congestion again when I lie down.
I would like to ask the doctor if there are any other suggestions to improve this situation.
I apologize for the lengthy message, and thank you for your patience in reading it.

Nìmíng, 20~29 year old female. Ask Date: 2022/09/19

Dr. Ji Zhaoyun reply Otolaryngology

Allergic rhinitis is primarily triggered by allergens in the environment, especially in individuals with a genetic predisposition.
If one parent has allergic rhinitis, the likelihood of their child developing the condition increases fourfold.
Treatment typically begins with oral medications and nasal sprays, and surgery may be considered if necessary.
The main medications include oral antihistamines and intranasal corticosteroids used in combination.
Depending on the situation, local antihistamines or vasoconstrictors, as well as 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 to alleviate these issues.
Avoiding allergens and minimizing irritants, such as wearing masks, regularly cleaning bedding, and staying away from environments with extreme temperature or humidity changes and air pollution, are also important.
Although allergic rhinitis can be bothersome, with appropriate medication or combined surgical treatment, along with efforts to avoid allergens and irritants, it can be well-controlled, significantly improving quality of life.

Reply Date: 2022/09/19

More Info

Managing allergic rhinitis, especially when it leads to nasal congestion and post-nasal drip, can be quite challenging. Your symptoms, including nasal congestion, post-nasal drip, and the sensation of mucus in your throat, are common among individuals with allergic rhinitis. Here are some strategies and tips that may help alleviate your symptoms:
1. Identify and Avoid Triggers: Since you mentioned that changes in weather and temperature trigger your allergies, it’s crucial to identify specific allergens that may be affecting you. Common triggers include pollen, dust mites, mold, and pet dander. Keeping a diary of your symptoms and potential triggers can help you pinpoint what to avoid.

2. Nasal Irrigation: You mentioned trying nasal irrigation, which can be beneficial for clearing mucus and allergens from your nasal passages. However, if you find that it leads to increased nasal discharge, it may be due to the irritation of the nasal mucosa or the body’s response to the saline solution. Ensure you are using a saline solution that is isotonic (similar salt concentration to your body) and consider trying a different technique or frequency. If you are using a neti pot or squeeze bottle, ensure they are clean to avoid introducing bacteria.

3. Use of Antihistamines: Over-the-counter antihistamines can help reduce the symptoms of allergic rhinitis. They work by blocking the action of histamine, a substance in the body that causes allergic symptoms. Non-drowsy options like loratadine or cetirizine can be taken during the day, while sedating antihistamines like diphenhydramine may be more suitable for nighttime use.

4. Nasal Corticosteroids: These are often the most effective treatment for allergic rhinitis. They reduce inflammation in the nasal passages, helping to alleviate congestion and post-nasal drip. Common options include fluticasone (Flonase) and mometasone (Nasonex). These medications may take a few days to show full effects, so consistency is key.

5. Decongestants: If you experience significant nasal congestion, short-term use of oral or nasal decongestants may provide relief. However, nasal decongestant sprays should not be used for more than three consecutive days to avoid rebound congestion.

6. Stay Hydrated: Drinking plenty of fluids can help thin mucus, making it easier to expel. Warm liquids, such as herbal teas or broths, can be particularly soothing.

7. Environmental Control: Since you are sensitive to temperature changes, maintaining a stable indoor environment can help. Use air conditioning during hot weather and consider using a humidifier in dry conditions to keep the air moist, which can help soothe irritated nasal passages.

8. Consult an Allergist: If your symptoms persist despite these measures, it may be beneficial to consult an allergist. They can perform tests to identify specific allergens and may recommend allergy shots (immunotherapy) to help desensitize your immune system to these triggers.

9. Manage Stress: Since you mentioned experiencing stress and anxiety, it’s important to address these factors as they can exacerbate allergic symptoms. Techniques such as mindfulness, yoga, or cognitive-behavioral therapy may help in managing stress levels.

10. Follow-Up with Healthcare Providers: Since you have seen various specialists, it’s essential to keep them informed about your ongoing symptoms and any new treatments you try. They can provide tailored advice and adjust your treatment plan as necessary.

In summary, managing allergic rhinitis involves a combination of avoiding triggers, using medications effectively, and maintaining a healthy lifestyle. If your symptoms continue to interfere with your daily life, seeking further evaluation from an allergist or an ENT specialist may provide additional insights and treatment options.

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