Allergic Rhinitis: Symptoms, Breathing Issues, and Solutions

Allergic rhinitis issues

Hello, Doctor.
I would like to ask you some questions (I have quite a few, and sometimes when I go to see a doctor, I don't know how to explain everything in detail from start to finish.
Thank you for your help!):
Symptoms: I have been troubled by allergic rhinitis for more than a year and a half (I have a lot of clear nasal discharge, and when I take antihistamines, it improves significantly after a while).
It feels like the mucus is constantly running down my throat, causing a sensation of something stuck in my throat (about a year ago, I saw a doctor who performed an endoscopy and said there was no significant issue; I wonder if it could be related to autonomic nervous system dysfunction).
Occasionally, I feel the need to spit, otherwise, I experience chest tightness.
However, in the past few months, my allergy symptoms have worsened (I previously tested for allergens, and the doctor said I basically have no significant allergens, but I might be more sensitive).
My allergies are particularly severe when the temperature fluctuates.
I take antihistamines daily to improve my condition, but I still have some nasal discharge.
The sensation of something stuck in my throat persists, and I often feel nauseous (not from burping).
Recently, I realized that I have been breathing through my mouth for the past two years, which is not correct, and I want to switch to nasal breathing.
I would like to ask you some questions:
1.
When I switch to nasal breathing, I feel like I am taking in less air, and my lower ribs hurt (especially the lower ribs and the area in the front of my chest, where I recently discovered I have mild pectus excavatum; I wonder if this is related?).
After a while of nasal breathing, I feel the urge to switch back to mouth breathing (which feels more comfortable and normal).
Is this discomfort due to the transition from mouth breathing to nasal breathing?
2.
In recent months, I have frequently experienced chest tightness, which seems to coincide with the tightness in my throat.
I feel the urge to cough (which provides temporary relief).
However, recently, I sometimes experience rib pain, and I am unsure if this is related.
I also cannot determine if this is a respiratory issue or an autonomic nervous system issue.
How can I improve this?
3.
How can I practice nasal breathing when I have a runny nose? Will this cause mucus to be sucked into my lungs?
4.
How should I manage my allergy symptoms? I previously considered using a corticosteroid nasal spray, but due to my constant nasal discharge, it seems difficult to use.
Should I wait a while after taking antihistamines before using the spray to avoid it running out immediately or not reaching the nasal cavity?
5.
What is the correct way to breathe? Should I keep my mouth closed most of the time? (This may sound like a strange question, but I suddenly realized I am not sure.)
6.
Is it normal to sleep with my mouth open? Or is this also considered mouth breathing?
7.
After such a long period of mouth breathing, I sometimes feel that my upper abdomen is more distended and I experience more nausea.
Is there a connection?
Thank you for your help and answers; I greatly appreciate it!

Niming, 20~29 year old female. Ask Date: 2024/03/17

Dr. Zheng Jueyi reply Otolaryngology

1.
It may take time to get used to breathing through the nose; increasing physical activity and practice can help.

2.
There are many potential causes for chest tightness; if concerned, it is advisable to consult a pulmonologist, cardiologist, or gastroenterologist to check for related issues.

3.
Nasal mucus does not get absorbed into the lungs; if nasal secretions are excessive, it is recommended to use oral medications or nasal sprays for control.

4.
It is advisable to regularly take antihistamines or corticosteroid nasal sprays for control, along with exercise, dietary adjustments, and environmental management to comprehensively manage allergies.

5.
Keep your mouth closed and practice diaphragmatic or thoracic breathing smoothly.

6.
Mouth breathing is abnormal and can lead to snoring.

7.
Prolonged mouth breathing may be associated with increased halitosis.

Reply Date: 2024/03/17

More Info

Understanding allergic rhinitis and its associated symptoms can be quite complex, especially when compounded by issues like breathing difficulties and other related conditions. Let's break down your concerns and provide some insights and potential solutions.

1. Transitioning from Mouth Breathing to Nasal Breathing
It's common for individuals who have been mouth breathing for an extended period to experience discomfort when switching to nasal breathing. Mouth breathing can lead to a range of issues, including dry mouth, dental problems, and altered facial structure over time. When you attempt to breathe through your nose, you may feel that you are not getting enough air, which can lead to discomfort in the chest and ribs, especially if you have a condition like pectus excavatum (funnel chest). This discomfort can be exacerbated by anxiety or stress, which might make you revert to mouth breathing for a sense of relief.

Recommendation: Gradually practice nasal breathing during calm moments, and consider using nasal saline sprays to keep your nasal passages moist. This can help ease the transition.

2. Chest Tightness and Rib Pain
The sensation of tightness in your chest and throat can be linked to several factors, including anxiety, allergic reactions, or even gastroesophageal reflux disease (GERD). If your throat feels tight, it can lead to a reflexive cough, which may cause discomfort in the chest and ribs. The rib pain you are experiencing could be due to muscle strain from coughing or from the mechanics of breathing differently.

Recommendation: Consult with a healthcare provider to evaluate for any underlying respiratory issues or anxiety disorders. Breathing exercises, such as diaphragmatic breathing, can help alleviate some of the tightness.

3. Managing Nasal Congestion While Breathing
If you are experiencing a lot of nasal discharge, it can be challenging to maintain nasal breathing. It is important to clear your nasal passages before attempting to breathe through your nose. Using saline nasal sprays or performing nasal irrigation with a neti pot can help clear mucus and make nasal breathing easier.

Concern: You should not worry about inhaling mucus into your lungs; the body has mechanisms to handle mucus. However, if you feel that your nasal congestion is severe, it may be worth discussing with your doctor.

4. Adjusting Allergy Symptoms
For managing your allergic rhinitis, antihistamines are often the first line of treatment. If you find that they are not providing sufficient relief, consider discussing the use of intranasal corticosteroids with your doctor. These can be effective in reducing inflammation and mucus production in the nasal passages.

Timing for Use: It is generally recommended to use nasal sprays after your nasal passages have been cleared. If you are using antihistamines, wait a little while after taking them before using the nasal spray to ensure that the nasal passages are not overly congested.

5. Correct Breathing Techniques
The correct breathing technique involves breathing through your nose rather than your mouth. This helps filter, humidify, and warm the air before it reaches your lungs. Keeping your mouth closed while at rest is ideal, but it may take time to adjust if you have been a habitual mouth breather.

6. Sleeping Habits
Sleeping with your mouth open is typically a sign of nasal obstruction or habit. This can lead to dry mouth and other complications. If you find yourself sleeping with your mouth open, it may be beneficial to address any underlying nasal congestion or consider using a chin strap to encourage nasal breathing during sleep.

7. Connection Between Mouth Breathing and Gastrointestinal Symptoms
Mouth breathing can lead to swallowing air, which may contribute to feelings of bloating or discomfort in the upper abdomen. This can also exacerbate feelings of nausea or discomfort.

Conclusion
Managing allergic rhinitis and associated symptoms requires a multifaceted approach. It is essential to work closely with healthcare professionals, including an allergist and possibly a pulmonologist, to develop a personalized treatment plan. Regular follow-ups and adjustments to your treatment regimen can help improve your quality of life significantly. Remember, lifestyle changes, such as practicing nasal breathing and managing stress, can also play a crucial role in your overall health.

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