Managing Severe Allergic Rhinitis: When Medications Fail

Severe production of excessive nasal mucus?

Hello Dr.
Chen,
I have had allergic chronic rhinitis since childhood, and my home has several types of antihistamines and nasal sprays for treating nasal allergies.
However, since yesterday morning, my allergic rhinitis has inexplicably worsened.
This time, the symptoms seem different from my usual experience of frequent sneezing and intense itching; my nose doesn't feel very itchy, and I only sneezed a few times throughout the day (when I have a severe episode, I can sneeze over 300 times in a day).
However, my nasal passages quickly produce clear and "sticky" mucus.
The amount is so large that it cannot be contained by a whole tissue, and after using two tissues to temporarily clear it, the same amount of mucus accumulates in both nostrils within about a minute.
This cycle continues...
I took medication for my nasal allergies, but the problem is that a few hours later, part of the medication's effects kicked in...
I became drowsy, and I had no choice but to sleep deeply for a while.
To my surprise, after sleeping for over four hours, my symptoms did not improve, which is quite puzzling.
I took antihistamines to treat my nasal allergies, but instead, I ended up suffering from the medication's sedative effects, while my nose remained completely ineffective.
Could you please tell me if allergic rhinitis can present in a manner like mine? If the medication is ineffective, what other treatments can I try? Thank you.

bing bing mao, 20~29 year old female. Ask Date: 2009/07/01

Dr. Chen Jianzhi reply Otolaryngology

Dear Inquirer,
According to your inquiry, the standard treatment for allergic rhinitis primarily involves antihistamines.
However, there are many different antihistamines available, and the choice of medication should be based on individual tolerance to minimize side effects while effectively treating the condition.
The medication you are currently using may not be suitable for your present situation.
There are also other treatment options for allergic rhinitis; some have been phased out, while others are still in experimental stages.
We look forward to the development of better methods in the future.
Sincerely,
Dr.
Chien-Chih Chen
Physician at Taoyuan Hospital, Department of Health
Lecturer at Fu Jen Catholic University

Reply Date: 2009/07/01

More Info

Managing severe allergic rhinitis can be quite challenging, especially when conventional medications fail to provide relief. Your experience with chronic allergic rhinitis and the recent exacerbation of symptoms is not uncommon among individuals with a history of allergies. Let's delve into your situation and explore potential management strategies.

Firstly, allergic rhinitis is characterized by symptoms such as sneezing, nasal itching, and the production of clear, watery nasal discharge. However, it can also present with less typical symptoms, such as the thick, clear nasal discharge you described. This can occur due to inflammation and irritation of the nasal mucosa, leading to increased mucus production. The fact that you experienced a significant increase in nasal discharge without the usual intense itching or sneezing suggests that your body may be responding differently this time, possibly due to a change in environmental allergens or other triggers.

The use of antihistamines is a common first-line treatment for allergic rhinitis. However, as you've noted, these medications can sometimes cause drowsiness, which can be counterproductive, especially if you're trying to manage your symptoms during the day. If the antihistamines you're using are not providing adequate relief, you might consider the following alternatives:
1. Intranasal Corticosteroids: These are often considered the most effective treatment for allergic rhinitis. They work by reducing inflammation in the nasal passages and can significantly decrease mucus production. Common options include fluticasone (Flonase) and mometasone (Nasonex). If you haven't tried these yet, it may be worth discussing with your healthcare provider.

2. Leukotriene Receptor Antagonists: Medications like montelukast (Singulair) can help alleviate symptoms of allergic rhinitis by blocking the action of leukotrienes, which are inflammatory chemicals released during an allergic reaction. This can be particularly beneficial if you have asthma or other allergic conditions.

3. Nasal Saline Irrigation: Using a saline nasal spray or performing nasal irrigation with a neti pot can help clear mucus and allergens from your nasal passages, providing symptomatic relief.

4. Allergen Avoidance: Identifying and avoiding specific allergens can be crucial. This may involve keeping windows closed during high pollen seasons, using air purifiers, and regularly cleaning your living space to reduce dust and pet dander.

5. Immunotherapy: If your symptoms are severe and persistent despite medication, you might consider allergy shots (subcutaneous immunotherapy) or sublingual tablets. These treatments work by gradually desensitizing your immune system to specific allergens.

6. Consultation with an Allergist: If your symptoms continue to be unmanageable, it may be beneficial to consult an allergist. They can perform tests to identify specific allergens and tailor a treatment plan that may include advanced therapies.

In summary, while your current medications may not be providing the relief you need, there are several alternative strategies to consider. It's essential to communicate openly with your healthcare provider about your symptoms and the impact they have on your daily life. Together, you can develop a comprehensive management plan that addresses your specific needs and improves your quality of life. Remember, managing allergic rhinitis often requires a multifaceted approach, and what works for one person may not work for another. Therefore, patience and persistence in finding the right combination of treatments are key.

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