HelixTalk Episode #48 - Self-Care of Nasal Congestion and Allergies

Date posted: August 23, 2016, 6:00 am

In this episode, we discuss the self-care of nasal congestion and allergies, including systemic/topical decongestants, nasal corticosteroids, antihistamines, cromolyn, and alternative medicine therapies.

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Key Concepts

1. Pseudoephedrine and phenylephrine are both systemic decongestants that are commonly confused by consumers.  Pseudoephedrine (Sudafed) has federal and state restrictions regarding its sale, but is better absorbed, more effective, and likely had a "worse" adverse effect profile due to its greater efficacy.
2. Pseudoephedrine (and to a lesser extent phenylephrine) can cause adverse effects like tachycardia, insomnia, jitteriness, dry mouth, headache, nausea, and symptoms mimicking prostate hyperplasia in men.
3. Among the topical decongestant sprays, oxymetazoline is the longest acting.  All topical decongestants carry a warning against their use for more than three days due to rebound congestion (rhinitis medicamentosa), although other resources suggest use up to 5 days may be acceptable.  At least one article (PubMed link) was unable to show any risk of rebound congestion even with prolonged use up to four weeks.
4. There are several over-the-counter nasal corticosteroids.  Usual use for self-care is one to two sprays in each nostril once daily.  A simple mnemonic to remember the key elements of administration is:
   • When you spray your nose, look at your toes
   • Shake it every time you take it
   • Shake and prime if it's been a long time
5. Consider recommending a contralateral hand technique for nasal corticosteroids to reduce the risk of nosebleeds.
6. Loratadine, cetirizine, and fexofenadine are over-the-counter second-generation antihistamines.  Cetirizine may be slightly more effective than the other two agents, but it is also likely more sedating (although still much less sedating than first-generation antihistamines like diphenhydramine).
7. There is either no evidence, questionable evidence, or a minuscule clinical benefit to most complementary and alternative medications to prevent cold.  Consider NOT recommending zinc-based products (like Zicam), high-dose vitamin C, and Airborne on the basis of poor or unproven efficacy.