I have trouble getting patients to use ONE much less TWO nasal sprays for nasal allergy & congestion. Now I may have a solution this year. The buzz on the street is Meda pharmacueticals
will be introducing a nasal spray product with two ingredients for patients suffering from congestion, runny nose and sneezing. Yes, for what ails you!
I’ll give you some tidbits from the College of Allergy/Asthma/Immunology meeting this past fall about this new medication.
November 16, 2011 (Boston, Massachusetts) — A novel nasal-spray formulation that combines the intranasal antihistamine azelastine with the intranasal corticosteroid fluticasone provides greater pharmacotherapeutic benefits for the treatment of seasonal allergic rhinitis than either of these agents alone, according to a study presented during an oral session here at the American College of Allergy, Asthma & Immunology 2011 Annual Scientific Meeting.
“There are many patients with moderate or severe allergic rhinitis whose symptoms are not adequately controlled with the currently available pharmacological agents,” Eli O. Meltzer, from the Allergy and Asthma Medical Group and Research Center in San Diego, California, told Medscape Medical News. “Because of their morbidity, it is important to seek new treatments.”
National guidelines have been in agreement with this for the past several years, said session comoderator Mark Dykewicz, MD, from Wake Forest University in Winston-Salem, North Carolina.
Dr. Dykewicz, who was invited to comment on the study by Medscape Medical News, said that the 2008 Rhinitis Parameter Update of the US Joint Task Force on Practice Parameters stated that using this combination was effective.
“In contrast, most studies have failed to demonstrate that the addition of an oral antihistamine to an intranasal corticosteroid adds to the benefit of the intranasal corticosteroid,” Dr. Dykewicz said.
American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Scientific Meeting: Abstract 39. Presented November 7, 2011.
What does this mean for you?
For years, patients have added OTC antihistamines (Allegra, Zyrtec, Claritin) for allergy symptoms. Research shows you are much better off adding another nasal spray (like Astelin) than adding an oral tablet to the steroid nose spray you’re already taking. That’s why antihistamines are often ineffective….you might as well take a vitamin!
Good Night! That comes from the Man himself.
You won’t sleep well if you can’t breathe! Unfortunately, sinusitis is quite common during the Christmas Holidays.
Often patients don’t know what can be done about it. But let’s start from the very beginning…..
What are the signs and symptoms of chronic sinus infection?
1. Nasal congestion (can’t breathe through my nose) is always present during chronic sinusitis. No exceptions. I can hear this when you talk to me in the exam room–if you’ve had sinus infections for any length of time, you become accustomed to hyponasal speech. You can’t hear it, but I can (and ask your spouse or mother).
2. Repeated courses of antibiotics that just DON”T work after 10 days.
3. If the nasal drainage is clear…can you still have a sinus infection? YES. The color of nasal drainage doesn’t predict if you will have chronic sinus infection. Only a CT scan of your sinuses can show you any inflammation or mucous thickening in the sinuses
4. Don’t forget that many asthma patients have a flare sending them to the ER because of Sinus infection.
OK….so now I know what’s going on, but how do I get rid of it?
1. Remember, the engine that drives movement of mucous in the sinuses is nasal airflow. Without nasal airflow, secretions accumulate and you can’t blow your nose enough to get rid of the SNOT. I know it’s gross, but this is the key to keeping your sinuses open.
2. The purpose of nasal sprays (steroids/antihistamines) is to reduce the size of enlarged turbinates and allow nasal airflow.
3. Don’t worry about the side effects of nasal steroids. Exposure is very low and often not detectable in the bloodstream. And besides, the clinical researchers trying to find side effects of nasal steroids put themselves and their own kids on this type of medicine.
4. Persistence is the key! Use at least one spray in each nostril per day (the rest is gravy)….up to 4 sprays per day may be needed during colds or upper respiratory infections.
5. Tilt your head forward to use the spray and avoid “snorting” the spray down the back of your throat.
6. If nasal sprays don’t work because of your congestion, I recommend using NasoNeb II from ASL pharmacy. Any nose spray works better if you “pretreat” with Afrin™ or other 4-way spray, simply because you open the nose for better penetration. Your limit on use of Afrin or similar OTC nose spray is < 1 week per month–don’t worry about addiction if you stay within these boundaries.
- So there you have it….no one should suffer from sinus headaches during the Christmas holidays if you follow some simple steps:
- Find out if you have sinus infection–CT is best
- Use your nasal spray (from the doctor, not OTC) everyday as prescribed!
- Put your money where your mouth is and use correct technique with any nasal inhaler…what goes down the back of your throat can’t help.
Want to know more on this subject? The link below will take you to the most recent guidelines on treatment and management of sinusitis. In the meantime, sleep tight and enjoy the Holidays!
It’ often helpful to review questions that patients will ask, but probably won’t show up in a textbook. Here’s a little bit about the College of Allergy which can provide you with timely information on topics such as nosebleeds.
Q: My son gets frequent nosebleeds during the late spring. When he wakes up in the morning there is blood on his pillow. We have tried putting Vasoline in his nose but that doesn’t help. What can we do to prevent his nose from bleeding?
A: Nosebleeds are a common problem for children who have allergies. The bleeding happens because there are many blood vessels just inside of the nasal opening on the middle part of the nose (called the nasal septum) that can be damaged with vigorous rubbing, picking the nose or even incorrect use of nasal sprays.
Nosebleeds often happen at night when one is asleep because picking and rubbing can occur without a person being
aware of it. Unfortunately, it always seems like the nose bleeds more than it really does when your pillow is covered with blood. Ewwww!
The best way to prevent nosebleeds worsened by allergies is to treat the underlying problem that is resulting in the rubbing and picking. Treatment often involves use of medicines for allergies taken either orally – such as antihistamines – or in the nose, such as nose sprays. You guessed it, antihistamines can dry out the nose increasing the risk of a nosebleed. Nose sprays can also increase the risk of a nosebleed and proper technique is very important to prevent this complication. Spray away from the middle of the nose, up and out towards the ear.
Saltwater (saline) nasal rinses can be very effective for removing nasal secretions and dried up mucous. The rinses should not be too vigorous and the bulb syringe or Netipot used to do it shouldn’t be inserted very far into the nose to avoid trauma to the blood vessels. Residual or dried blood may come out with these rinses, and that’s OK–much less chance of causing problems in the future.