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Why Nasal Allergies Matter...

Mar 27, 2013 09:15AM ● By tina

North Texas ranks as being one of the worst areas in the country for allergies

By Paul Kim, MD

Family physician on the medical staff at Baylor Regional Medical Center at Grapevine

What is allergic rhinitis? It is the inflammation of the nasal passages, characterized by sneezing, nasal congestion, nasal itching, and runny nose. The eyes, ears, sinuses, and throat can also be involved. Often, allergies that are not appropriately treated become viral infections or bacterial infections primarily of the sinuses.

Many people continue their daily lives with undiagnosed allergic rhinitis. Unfortunately when we are diagnosed we often do nothing about it. According to Quest Diagnostics in 2011, upon reviewing the allergies based on laboratory results amongst the big cities across America, Dallas ranked the worst with a sensitization index of 697. That means many many people are being affected by allergies here in our metroplex.

Across the nation, allergic rhinitis costs 5.3 billion dollars a year to treat directly and indirectly, causes 3 additional doctor visits per year and leads to 9 more prescriptions being written per affected patient. This leads on average to a 1500 dollar increase in cost per year per allergic patient.

When you have symptoms a simple test to see if you have a cold or allergies is to take a strong antihistamine like Benadry/zyrtec. If most symptoms improve (please note that antihistamines cause drowsiness), allergies are playing a bigger role than we think and maybe we can wait on starting an antibiotic.

According to most professional societies who treat allergies the first line medication used for mild to moderate allergic rhinitis should be an intranasal corticosteroid alone which has a better side effect profile than antihistamines. That little nose spray with that blue cap that you get as a sample will treat eye symptoms, nose and throat itching, sneezing and runny nose. The key to using this medication however is to use it regularly. It is thought that 3 days of continued use are needed before you start feeling a bulk of the positive effect in reducing allergies. You can monitor your need for the spray by following allergy counts on a site like

Oral antihistamines are effective at relieving the histamine related symptoms such as sneezing, itching, runny nose, and eye changes but not as effective at treating nasal congestion. The more effective ones are also more sedating. Intranasal antihistamines that deliver a high concentration of medication to the specific targeted are very useful and they do not cause you to get as drowsy as an oral pill would.

Nasal irrigation is another great way to help relieve symptoms by getting rid (albeit temporarily) of the allergen inducing the symptoms.

Nasal decongestants like oxymetazoline can cause rebound congestion after 3-5 days of use. Phenelyphrine and pseudoephedrine can cause rebound congestion after more prolonged use (2 weeks). Oxymetazoline often known as Afrin can cause rebound recurring congestion that is often very difficult to treat.

Intranasal cromolyn has decreased effectiveness at decreasing symptoms and montelukast showed only minimal improvement of nasal congestion in adults. 

Immunotherapy that introduces the allergen extract by being given as a shot or drops placed under the tongue has shown efficacy in 95% of patients who note significant improvement of allergy symptoms after 1 year of regular therapy.

Though it can be effective in some patients the evidence regarding acupuncture , probiotics,  and herbal preparations in treating allergies is not robust enough to be recommended with high confidence.

Most importantly, if you feel symptoms and if oral antihistamines do not seem effective enough or cause significant side effects, please contact your physician who would love to help you win the battle against something that can significantly detract from your quality of life. 

About Baylor Regional Medical Center at Grapevine

Baylor Regional Medical Center at Grapevine is a full-service, fully-accredited not-for-profit hospital serving residents in more than 20 cities throughout the Dallas/Fort Worth region. Focused on being the best place to give and receive quality, safe and compassionate care, Baylor Grapevine works to lead the transformation of health care. The 276-bed hospital offers advanced medical services for cardiovascular services, women’s services, oncology, neurology, spine care, orthopedics, diagnostic imaging, neonatal intensive care, intensive and emergency care.

About Baylor Health Care System

Baylor Health Care System is a not-for-profit, faith-based supporting organization providing services to a network of acute care hospitals and related health care entities that provide patient care, medical education, research and community service. Baylor recorded more than 2.8 million patient encounters, $4 billion in total operating revenue, $5.2 billion in total assets and $494 million in community benefit in fiscal year 2010.  Baylor’s network of more than 300 access points includes 27 owned/operated/ ventured/affiliated hospitals; joint ventured ambulatory surgical centers; satellite outpatient locations; senior centers and more than 150 HealthTexas Provider Network physician clinics.