A runny or blocked nose is probably one of the most unpleasant symptoms that can affect us all year round or during specific seasons. We often use special nasal sprays to treat a blocked nose. Some of these are designed to treat allergic rhinitis and acute sinusitis and can be used long-term, while others are for the common cold and should only be used for a short period. How can you tell which type of blocked nose you have and which nasal spray to use?
How to recognise allergic rhinitis?
There are two types of allergic rhinitis: seasonal and perennial. According to Darius Rauba, Doctor of Medical Sciences and ENT specialist at the Baltijos-Amerikos Therapy and Surgery Clinic, seasonal allergic rhinitis is easier to identify – symptoms usually worsen in spring or late summer, and this recurs every year. Breathing becomes more difficult, and the nasal lining is affected by pollen from trees in spring and grasses in summer. Pollen entering the nose can trigger an allergic reaction.
‘Other people complain of perennial rhinitis: the nose is more or less always congested, sometimes runny, sometimes not. In these cases, it is more difficult to distinguish whether this is allergic nasal congestion or if it is caused by, say, working conditions – such as air-conditioned rooms. Dry air from air conditioning has a major effect on the nasal lining. To distinguish whether it is allergic rhinitis or not, a consultation with a specialist is essential – sometimes it is enough just to look inside the nose; by seeing the colour and condition of the lining, we can tell whether the nasal congestion is allergic or inflammatory in origin,’ explains D.Rauba.
When asked how allergic rhinitis is treated, the ENT specialist emphasised that preparation in advance is particularly important when dealing with allergic rhinitis. ‘If we suspect we have seasonal allergic rhinitis, we need to start using special nasal sprays about a month before the season begins. These sprays reduce the count of eosinophils – the cells involved in allergic reactions. Eosinophils are located in the nasal lining; when an allergen enters the nose, it binds with the eosinophil, which then bursts, releasing active toxic substances that affect the nasal lining. This causes it to swell, triggering the body’s protective reaction to clear out the allergens – the person starts sneezing, mucus production increases, and the nose becomes blocked. Therefore, to prevent this, it is essential to start using these special nasal sprays a month or a couple of weeks before the start of the season. They eliminate eosinophils, so when allergens enter the nose and find none, an allergic reaction either does not occur or is much milder,’ says D.Rauba.
According to him, if the patient does not prepare, the nasal sprays will no longer be effective later on. In that case, systemic treatment with tablets, which also carry side effects, must be prescribed. ‘That is why I say that in the case of seasonal allergies, nasal sprays would help if you prepare in advance, and you wouldn’t need to take tablets that affect the whole body when only the nose needs treating,’ states the otorhinolaryngologist.
If a person is allergic to only one or a few specific things, such as animal dander, according to the specialist, immunotherapy can be used. This is a specialised treatment where a person regularly receives a small dose of the allergen they are allergic to. Over several years, according to the specialist, the body adapts to the allergen and stops reacting to it.
Sinusitis symptoms and treatment
‘If the rhinitis is allergic, you never have a blocked nose on only one side. So, if one side becomes harder to breathe through, we must pay attention and search for the cause of why this happened. The most important thing in this case is not to delay,’ says D.Rauba when asked what symptoms can warn of sinusitis.
Another symptom of sinusitis is a reduced sense of smell. It is natural to lose your sense of smell when you have a cold, but if the cold has cleared up and your sense of smell is still impaired, according to the ENT specialist, you should consult a specialist. According to him, sinusitis is characterised by pain: pressure and tension. If it is frontal sinusitis, you might wake up in the morning with a headache in your forehead, but after walking around for a few hours, the sinuses clear in an upright position, and you feel better. Another sign is when pressure or tension inside the sinuses is felt when bending forward. ‘So, pain, a blocked nose, purulent discharge that you blow out or that flows into the nasopharynx, and if all this lasts longer than 7–10 days, it suggests that the cold has developed into acute sinusitis,’ says the doctor.
According to him, many people imagine that a blocked nose automatically means sinusitis and rush to treat it with antibiotics, which is not what should be done. ‘Up to 10% of any cold can develop complications leading to acute sinusitis. And even seeing a greenish or yellowish mucus does not mean you have sinusitis, although people often decide that if this is the case, they need to take antibiotics. Nowadays, no one rushes to treat acute sinusitis with antibiotics. Out of the mentioned number of complications, only 10–20% are of bacterial origin, and at least 80% are viral. There are people who rush to take antibiotics and then complain about the problems caused by them,’ says D.Rauba.
According to the specialist, the most important thing is to clear the nose. If it clears, the body resolves it on its own within a week or two to three, and the cold, even if purulent, passes. ‘There is a whole range of medications that prevent the sinus openings from closing. The same anti-inflammatory sprays are used as in the treatment of allergic rhinitis, and mucolytic medicines can be used to thin the mucus. If all of these medicines are not enough, the sinus openings swell, there is pressure on the face, the temperature rises, and other measures no longer help, then antibiotics can be prescribed. Only in this case, they should be taken not for two or three days, but for at least 7–10 days to ensure the acute sinusitis clears up completely,’ explains the ENT specialist, adding that even when taking antibiotics, additional measures should be used to help the sinuses clear and prevent a secondary viral infection – in other words, this supportive treatment should be extended for longer.
Not all sprays can be used long-term
According to the specialist, there are different types of nasal sprays. One type is decongestant nasal sprays. These are needed when there is acute (viral) rhinitis, when the nasal lining becomes congested and too much blood flows to it. By constricting the blood vessels, these sprays decongest the lining, shrinking the turbinates so we can breathe.
‘Such sprays are very good in the first few days when we have a cold with a runny or blocked nose. If we use these sprays for longer than a week or ten days, which is how long a cold usually lasts, we will cause the nasal receptors in the lining to build up a tolerance. This leads to a situation where a person cannot live without this medicine. Overcoming this dependency is very difficult; we have to apply certain treatments, sometimes even surgery, to shrink the nasal lining,’ says D.Rauba.
Another group of medicines is intranasal corticosteroids. ‘This is a hormone-based preparation. The new-generation medications of this type are very safe, so there is no need to fear that you are using a hormone. In the US, they are prescribed to children from the age of two. They only act on the nasal lining, do not spread anywhere else, and do not cause any systemic side effects unlike other hormones. These medicines are designed to treat allergic rhinitis – both seasonal and perennial – and acute sinusitis. Sometimes they are used for life. For example, you operate on a patient’s nasal polyps, but the allergy does not go away. If the nose is left untreated, those polyps grow back in a year or two, and the patient has to be operated on again. In such cases, I tell the patient that this medicine is used continuously, perhaps with short breaks, but it is not habit-forming,’ says ENT specialist D.Rauba.
