CongestionNasal congestion affects approximately 50 percent of people with nasal allergies, and is often the most bothersome symptom. Anyone who’s experienced a bad cold can relate: you’re miserable when you can’t breathe through your nose and have to breathe with your mouth open. Allergic congestion is caused by inflammation within the nasal passages, and is often due to the release of leukotrienes, not histamine, from mast cells. Not all allergy medicines treat nasal congestion; so if this is your worst allergy symptom, choose your medicine carefully.
Nasal steroid sprays are, in my opinion, the best long-term choice for treating nasal congestion. Nasal antihistamine sprays and montelukast (also known as Singulair, which blocks leukotrienes) are reasonable alternatives for treating nasal congestion as well. Oral decongestants, such as those medications containing pseudoephedrine (Sudafed), will treat nasal congestion, but the side effects of these medications prohibit their long-term use for most people. Oral antihistamines, for the most part, don’t treat nasal congestion, which is why there are antihistamine-decongestant combinations available, such as loratadine/pseudoephedrine (Claritin-D) (again, the decongestant in this limits the long-term use for most people due to side effects).
SneezingSneezing is certainly an annoying symptom, and can be quite embarrassing in public if the sneezing is repetitive. Sneezing is usually caused by the release of allergic chemicals, such as histamine, within the nasal passages, and therefore this symptom is usually treated quite easily with oral antihistamines. Nasal steroid sprays and nasal antihistamine sprays also work well for the treatment of sneezing. Singulair would not be expected to be of much use for this symptom.
Learn more about what causes sneezing.
ItchingItching of the nose, eyes, ears and throat is another common symptom of allergic rhinitis, and is also caused by the release of histamine from allergic cells within the nose. Itching responds best to oral antihistamines, but nasal steroid sprays and nasal antihistamine sprays would also work well for this symptom. Singulair, which doesn’t block histamine, would not be expected to be very helpful.
Runny NoseOccasionally, I see patients in my clinic whose major or only symptom is a runny nose. Many will say, “my nose drips like a faucet,” and these people are often seen with a nasal tissue or handkerchief constantly dabbing at their noses. The causes of a runny nose could be related to allergic chemicals such as histamine or leukotrienes, or possibly an irritant effect within the nasal passages.
A runny nose may respond to oral antihistamines, nasal steroid sprays or nasal antihistamine sprays, or to Singulair to varying degrees. However, when this symptom is a person’s only or main nasal symptom, I often treat with an anticholinergic nasal spray, such as ipratropium bromide (Nasal Atrovent). This nasal spray does nothing more than turn off the "faucet," stopping mucus production, and won’t treat other allergy symptoms. For some people, drying up the nose is all that is needed, and Nasal Atrovent can be a life-changing medication for people with chronically runny noses.
Learn out more about the treatments for allergic rhinitis.
Wallace DV, Dykewicz MS, chief editors. The Diagnosis and Management of Rhinitis: An Updated Practice Parameter. J Allergy Clin Immunol. 2008;122:S1-84. DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.