A runny and congested nose can be a nuisance, especially with the constant wiping of snot and lack of taste sensation. Nasal congestion happens when the membrane linings of the nose are inflamed and swollen, producing excessive mucus that blocks the nasal passages. Medically, the inflamed nasal passage is known as rhinitis, which can be caused by allergic reactions, common cold, or medications. Besides congested nose with watery nasal discharge, symptoms of rhinitis include sneezing, facial pain, loss of taste, itchy nose and itchy red eyes. For most people, allergic rhinitis is a lifelong condition which comes and goes. Fortunately, it is possible to achieve nasal congestion relief with a combination of preventive measures and medications.

The best way to relieve nasal congestion is to avoid getting rhinitis in the first place. This can be done by practising trigger avoidance. The major factors that can trigger allergic rhinitis are pollens, insects, moulds and animals’ allergens like fur, skin or saliva. It is quite easy to identify the trigger allergens based on the symptoms developed after exposure. To eliminate insects and dust, routinely wash bed sheets and blankets with detergent and dry them well. Vacuuming and dusting regularly also helps to keep mites off. If the person is allergic to pets, the best way is to remove it from the house. This is followed by thorough cleaning of the carpets, sofa, curtains and beds. For sensitive individuals, cockroaches droppings and mould spores can trigger allergic rhinitis.

Even with the best housekeeping, most people with rhinitis can benefit greatly from medications to control those annoying symptoms. Although many medications can be obtained easily over the counter, patients should be careful with the potential serious side effects of some drugs. Commonly used therapies include saline spray or irrigation, glucocorticoid nasal spray, an oral antihistamine, antihistamine spray, mast cell stabilisers, leukotriene modifiers and ipratropium. In contrast, nasal decongestant sprays like phenylephrine or oxymetazoline, and systemic glucocorticoid should not be routinely used to treat allergic rhinitis.

Nasal saline sprays or irrigations can effectively wash away allergens from the nasal passages. These are often used for mild symptoms, or as an additional step to clean the membrane lining before applying other topical medications. Sprays or irrigation can be performed when needed or on a daily basis. Squeeze bottles or bulb syringes are helpful devices to aid this therapy. Avoid cold water when irrigating. Use sterile or previously boiled water which is warm or at room temperature for better comfort. There is evidence that saline spray and irrigation improve symptoms and carry little risks.

The single most effective therapy for nasal congestion is glucocorticoid nasal spray. It inhibits inflammation by downregulating inflammatory responses and suppressing signal molecules that promote inflammation. Examples of glucocorticoid nasal sprays are beclomethasone, budesonide and fluticasone propionate. Studies showed that these agents are more effective than oral antihistamine and antihistamine spray to relieve nasal congestion, nasal discharge, post-nasal drip and total nasal symptoms. For optimal use, a maximum dose for age is started. The patient should position the head properly to prevent spray from draining down the throat. Keep head pointed slightly downward while spraying and avoid tilting the head back. Do not point the spray at the septum (middle of the nose) and irrigate nasal passages with saline there is mucous crusting. Potential side effects of long-term glucocorticoid nasal sprays are nose bleeding and septal perforation. Otherwise, the risk of adverse reactions related to glucocorticoid agents are relatively small in a nasal spray, including adrenal suppression, slow growth in children, weakened bone, glaucoma and cataract. Thus, keep dosage at the lowest possible when symptoms are well controlled.

The oral antihistamine works by binding to H1 receptors to downregulate inflammation. This reduces sneezing, itching and runny nose but is generally less effective than glucocorticoid sprays. After ingestion, it takes about one hour to have results. Among the 3 generations of antihistamine, the 2nd one is most preferred, such as cetirizine and loratadine. This is because they have lesser sedating effects than the 1st gen drugs like chlorpheniramine and diphenhydramine which can make patients sleepy and drowsy, increasing the risk of motor vehicle accidents. However, both 1st and 2nd gens can cause problematic side effects like dry eyes, dry mouth and urinary hesitancy. 3rd gen is generally nonsedating. Meanwhile, other medications are less used due to more side effects or reserved for severe patients used only by doctors in hospital settings.

In short, the best way to relieve nasal congestion is by using glucocorticoid nasal spray.

Katherine Poitras