{"id":275,"date":"2019-07-03T11:46:15","date_gmt":"2019-07-03T17:46:15","guid":{"rendered":"https:\/\/santafeent.fm1.dev\/allergic-rhinitus\/"},"modified":"2020-01-09T14:56:51","modified_gmt":"2020-01-09T21:56:51","slug":"allergic-rhinitus","status":"publish","type":"page","link":"https:\/\/santafeent.com\/sinus-allergy\/allergies-overview\/allergic-rhinitus\/","title":{"rendered":"Allergic Rhinitus"},"content":{"rendered":"\n<h2>How to Manage Your Allergies<\/h2>\n\n\n\n<p>This article is intended to provide practical \u2018self help\u2019 information for patients suffering from allergies and then discuss the advanced allergy care available when over-the-counter measures are not helpful.<\/p>\n\n\n\n<p>While the springtime is usually associated with our severe \u2018Juniper Flu\u2019 and the other Spring tree pollen allergies, the Fall allergy season is usually associated with grass and weed pollination. Plus, the late Fall has a second Juniper\/Mountain Cedar pollination.<\/p>\n\n\n\n<p>While our local pollens have remained the same, there has been a change in what is available to help us manage our allergies. I want to take you through a list of what is readily available as \u2018Over the Counter\u2019 (OTC) medications with the addition of several of the prescription medications.<\/p>\n\n\n\n<h3>Step 1: \u2018Self Help\u2019 For Your Allergies<\/h3>\n\n\n\n<p>Note: Since most of these are OTC products, they can be used for all ages. Please pay attention to the dosing instructions!!!<\/p>\n\n\n\n<p><strong>AVOIDANCE<\/strong>: practical measures!!!<\/p>\n\n\n\n<ul><li>Keep your cats &amp; dogs out of the bedroom&#8230; if you have allergic reactions to your animals, this will help decrease your baseline allergic reactions.<\/li><li>Dust Mite avoidance&#8230; if you have allergic reactions to dust mites then clean your mattress pad and sheets once per week on a \u2018hot water setting\u2019.<\/li><li>Pollen avoidance is much more difficult, however if you launder your clothes and shower after outside activities you will decrease your exposure to pollen. Also, wipe your animals off with a damp rag when they come in from outside&#8230; plus, they\u2019ll love the attention!<\/li><\/ul>\n\n\n\n<p><strong>MEDICATIONS<\/strong>: there are a number of very effective OTC products.<\/p>\n\n\n\n<p>Saline rinses&#8230; either a Neti Pot or Neil Med Sinus Rinse \u00ae kit (fig 1). We usually recommend twice per day rinses&#8230; especially before using the nasal steroid sprays. Saline rinses alone will provide significant relief.<\/p>\n\n\n\n<p>Use \u00bd teaspoon of sea salt and \u00bc teaspoon baking soda in 8 oz (1 cup) of warm water. (Sea salt and baking soda are both available at the grocery store.)<\/p>\n\n\n\n<p>Microwave your Neti Pot or sinus rinse kit for about 90 seconds every couple of days to decrease bacterial contamination.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright is-resized\"><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/santafeent.com\/wp-content\/uploads\/2019\/07\/neil-med-sinus-rinse.jpg\" alt=\"\" class=\"wp-image-570\" width=\"200\" height=\"280\"\/><figcaption>fig 1: Neil Med Sinus Rinse \u00ae<\/figcaption><\/figure><\/div>\n\n\n\n<p><strong>Nasal steroid sprays<\/strong>: our first choice to add to the nasal saline rinses.<\/p>\n\n\n\n<p><strong>Over the Counter (OTC)<\/strong>: Nasacort \u00ae (triamcinolone), Flonase \u00ae (fluticasone propionate), and Rhinocort \u00ae (budesonide) are great OTC products that decrease allergic tissue inflammation. (fig 2) If you get nose bleeds with these products \u2013 a common side effect in our dry climate \u2013 use your finger to apply about a pea sized amount of Aquaphor \u00ae to the inside of your nose along the midline structure. This is your nasal septum and it also usually where most nosebleeds occur&#8230; by the way, using the saline rinses followed by Aquaphor \u00ae is the first step in preventing nosebleeds!!! These OTC sprays run about $20\/month.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignleft is-resized\"><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/santafeent.com\/wp-content\/uploads\/2019\/07\/rhinocort-nasacort-flonase.jpg\" alt=\"\" class=\"wp-image-568\" width=\"300\" height=\"251\"\/><figcaption>fig 2: Rhinocort \u00ae, Nasacort \u00ae, Flonase \u00ae<\/figcaption><\/figure><\/div>\n\n\n\n<p><strong>Prescription sprays<\/strong>: there are a number of prescription nasal steroid sprays that provide the same decrease in tissue inflammation as the OTC meds. Usually, the prescription nasal steroid sprays are marketed as providing an additional advantage, such as being either \u2018non-liquid\u2019 or \u2018easier to use\u2019. (Examples: Q-Nasl \u00ae (beclomethasone), Nasonex \u00ae (mometasone), Omnaris \u00ae\/Zetonna \u00ae, (ciclesonide), Flunisolide (generic), Veramyst \u00ae (fluticasone furoate) The basic issue with these prescription medications will be financial&#8230; your insurance company\u2019s formulary may make them really expensive to use.<\/p>\n\n\n\n<p><strong>Antihistamines<\/strong>: can be used as a \u2018first choice\u2019 medication or as an \u2018add on\u2019 to the nasal saline rinses and nasal steroid sprays. Sometimes these medications can make you sleepy&#8230; if they do, take before bedtime.<\/p>\n\n\n\n<p><strong>Oral antihistamines<\/strong>: Zyrtec \u00ae (cetirizine), Allegra \u00ae (fexofenadine), Claritin \u00ae (loratidine), Zyxal \u00ae (levocetirizine). (fig 3) Personally, we use and recommend the generic equivalent for each of these&#8230; almost all grocery stores, pharmacies and \u2018big box stores\u2019 will carry these generic equivalents. (There are a number of other antihistamine products&#8230; however, most of them will make you sleepy and tired. )<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright is-resized\"><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/santafeent.com\/wp-content\/uploads\/2019\/07\/oral-antihistamines.jpg\" alt=\"\" class=\"wp-image-567\" width=\"300\" height=\"301\" srcset=\"https:\/\/santafeent.com\/wp-content\/uploads\/2019\/07\/oral-antihistamines.jpg 576w, https:\/\/santafeent.com\/wp-content\/uploads\/2019\/07\/oral-antihistamines-256x256.jpg 256w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption>fig 3: Oral antihistamines&#8230; remember, buy the generic equivalent!!!<\/figcaption><\/figure><\/div>\n\n\n\n<p><strong>Nasal antihistamines<\/strong>: these are all prescription medications. Astepro \u00ae (azelastine) &amp; Patanase \u00ae (olopatadine). We\u2019ve had good results with either of these nose sprays. (Azelastine does have a generic equivalent!)<\/p>\n\n\n\n<p><strong>Eye drops<\/strong>: Patanol \u00ae and Pazeo \u00ae (olopatadine), Optivar \u00ae (azelastine). Great \u2018add-on\u2019 meds to decrease the eye symptoms. Again, your insurance formulary costs can be really steep for these meds. There are some OTC antihistamine eyedrops as well&#8230; we just don\u2019t think they work quite as well.<\/p>\n\n\n\n<p><strong>\u2018Systemic Steroids\u2019<\/strong>: While these drugs provide significant relief to allergy symptoms, we really need to stress the risk\/benefit balance&#8230; these are prescription medications for good reason. Yes, we prescribe both oral prednisone and \u2018the steroid shot\u2019 \u2013 Kenalog \u00ae (triamcinolone). However, there is always a discussion of the risk issues with these meds. In fact, we require a consent form for Kenalog \u00ae. Here\u2019s the list of issues with systemic (oral\/shot) steroids:<\/p>\n\n\n\n<ul><li>Increased risk of infection.<\/li><li>Worsening of diabetes.<\/li><li>Osteoporosis or the bone resorption.<\/li><li>Worsening of high blood pressure.<\/li><li>Emotional changes including sleeplessness and depression.<\/li><li>Muscle wasting.<\/li><li>Cataracts.<\/li><li>Impaired wound healing.<\/li><li>Hip fracture due to loss of blood supply to the hip joint.<\/li><\/ul>\n\n\n\n<p><strong>Other Meds<\/strong>: there are a variety of other OTC and prescription medications that may be helpful with individual patients. We\u2019re not going to go into every detail in this short summary.<\/p>\n\n\n\n<p>While you could start with the OTC products \u2013 let\u2019s say a \u2018random combination\u2019 of nasal saline rinses, fluticasone and cetirizine \u2013 we think the \u2018best combo\u2019 is using the Neil Med Sinus Rinse \u00ae followed the generic equivalent of azelastine (nasal antihistamine) and one of the nasal steroid sprays. (There is a prescription nose spray that combines azelastine and fluticasone&#8230; Dymista \u00ae). If these combinations don\u2019t work&#8230; we will almost always recommend allergy testing and then immunotherapy if the allergy testing supports the diagnosis of allergies causing the patient\u2019s symptoms. (BTW&#8230; the cost of our \u2018random combination\u2019 is about $40-50\/month.)<\/p>\n\n\n\n<h3>Step 2: ENT Clinic Visit<\/h3>\n\n\n\n<p>OK&#8230; you\u2019ve tried the Over the Counter products. Nothing works&#8230; what\u2019s the next step? If your insurance plan requires a PCP (Primary Care) referral, we would first see your PCP for consideration of the prescription medications mentioned above. Or, if your insurance plan doesn\u2019t require a referral, we would be delighted to help!<\/p>\n\n\n\n<p>Initial Office Visit&#8230; your physician will want to understand the severity of your allergy symptoms and whether you are suffering some of the complications of uncontrolled allergic reactions such as asthma and recurring sinusitis. We will then go through a standard list of \u2018allergy risk factors\u2019:<\/p>\n\n\n\n<ul><li>Seasonal pollen exposures (spring, summer, fall, winter).<\/li><li>Animal exposures&#8230; cat, dog, horse, etc.<\/li><li>Home environment&#8230; mold exposures and heating\/cooling system exposures.<\/li><li>Food reactions&#8230; many of the foods we eat \u2018cross react\u2019 with certain pollens.<\/li><li>Asthma, sinusitis and migraine problems&#8230; these may indicate real problems with your allergy control.<\/li><\/ul>\n\n\n\n<p>Your physician will also perform a physical exam looking for evidence of allergic stimulation, bacterial sinusitis, deviation of the nasal septum, nasal polyps, and asthma. They may also recommend three additional studies to evaluate your nasal\/sinus anatomy and lung function.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright is-resized\"><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/santafeent.com\/wp-content\/uploads\/2019\/07\/nasal-endoscopy.jpg\" alt=\"\" class=\"wp-image-566\" width=\"300\" height=\"193\"\/><figcaption>fig 4: Nasal Endoscopy with topic anesthetic nose spray<\/figcaption><\/figure><\/div>\n\n\n\n<p><strong>Nasal Endoscopy<\/strong>: using a sterile fiberoptic endoscope, your physician may want to get a more detailed view of your nasal passages and throat structures. (fig 4) We commonly will use this procedure to correctly diagnose patients coming to the office with a history of recurring sinus infections or facial pain not responding to the usual medications&#8230; such as multiple courses of antibiotics.<\/p>\n\n\n\n<p><strong>Sinus CT Scan<\/strong>: a low dose, cone beam CT scanner used to provide additional diagnostic information in patients suffering from sinusitis, nasal polyps and facial pain.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignleft is-resized\"><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/santafeent.com\/wp-content\/uploads\/2019\/07\/ct-scan.jpg\" alt=\"\" class=\"wp-image-565\" width=\"300\" height=\"232\"\/><figcaption>fig 5: CT scan image of the sinuses<\/figcaption><\/figure><\/div>\n\n\n\n<p><strong>Spirometry<\/strong>: a breathing study to look at your lung function. This is used to help diagnose and better manage your asthma.<\/p>\n\n\n\n<p>Toward the end of your initial office visit we will discuss a number of options \u2013 avoidance measures, additional OTC and prescription medications, immunotherapy and maybe even surgical procedures for patients with well-defined abnormalities such as a deviated nasal septum or nasal polyps. For the sake of discussion, let\u2019s assume your exam is pretty much normal, you\u2019ve tried all of the OTC measures we discussed above, and you really just want to \u2018deal with the problem\u2019.<\/p>\n\n\n\n<p>So, at the end of the visit we may recommend you undergo allergy testing&#8230; usually either skin testing or IGE Rast testing of your blood.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>How to Manage Your Allergies This article is intended to provide practical \u2018self help\u2019 information for patients suffering from allergies and then discuss the advanced allergy care available when over-the-counter measures are not helpful. While the springtime is usually associated with our severe \u2018Juniper Flu\u2019 and the other Spring tree pollen allergies, the Fall allergy&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":248,"menu_order":56,"comment_status":"closed","ping_status":"closed","template":"","meta":{"schema":"","fname":"","lname":"","position":"","credentials":"","placeID":"","no_match":false,"name":"","company":"","review":"","address":"","city":"","state":"","zip":"","lat":"","lng":"","phone1":"","phone2":"","fax":"","mon1":"","mon2":"","tue1":"","tue2":"","wed1":"","wed2":"","thu1":"","thu2":"","fri1":"","fri2":"","sat1":"","sat2":"","sun1":"","sun2":"","hours-note":""},"service_tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Allergic Rhinitus - David R Brown MD Ear, Nose and Throat<\/title>\n<meta name=\"description\" content=\"(505) 820-9945 | How to Manage Your Allergies This article is intended to provide practical \u2018self help\u2019 information for patients suffering from allergies and then discuss\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/santafeent.com\/sinus-allergy\/allergies-overview\/allergic-rhinitus\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Allergic Rhinitus - David R Brown MD Ear, Nose and Throat\" \/>\n<meta property=\"og:description\" content=\"(505) 820-9945 | How to Manage Your Allergies This article is intended to provide practical \u2018self help\u2019 information for patients suffering from allergies and then discuss\" \/>\n<meta property=\"og:url\" content=\"https:\/\/santafeent.com\/sinus-allergy\/allergies-overview\/allergic-rhinitus\/\" \/>\n<meta property=\"og:site_name\" content=\"David R Brown MD Ear, Nose and Throat\" \/>\n<meta property=\"article:modified_time\" content=\"2020-01-09T21:56:51+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/[uploads%20id=570]\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"7 minutes\" \/>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Allergic Rhinitus - David R Brown MD Ear, Nose and Throat","description":"(505) 820-9945 | How to Manage Your Allergies This article is intended to provide practical \u2018self help\u2019 information for patients suffering from allergies and then discuss","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/santafeent.com\/sinus-allergy\/allergies-overview\/allergic-rhinitus\/","og_locale":"en_US","og_type":"article","og_title":"Allergic Rhinitus - David R Brown MD Ear, Nose and Throat","og_description":"(505) 820-9945 | How to Manage Your Allergies This article is intended to provide practical \u2018self help\u2019 information for patients suffering from allergies and then discuss","og_url":"https:\/\/santafeent.com\/sinus-allergy\/allergies-overview\/allergic-rhinitus\/","og_site_name":"David R Brown MD Ear, Nose and Throat","article_modified_time":"2020-01-09T21:56:51+00:00","og_image":[{"url":"[uploads id=570]"}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"7 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/santafeent.com\/sinus-allergy\/allergies-overview\/allergic-rhinitus\/","url":"https:\/\/santafeent.com\/sinus-allergy\/allergies-overview\/allergic-rhinitus\/","name":"Allergic Rhinitus - David R Brown MD Ear, Nose and Throat","isPartOf":{"@id":"https:\/\/santafeent.com\/#website"},"datePublished":"2019-07-03T17:46:15+00:00","dateModified":"2020-01-09T21:56:51+00:00","description":"(505) 820-9945 | How to Manage Your Allergies This article is intended to provide practical \u2018self help\u2019 information for patients suffering from allergies and then discuss","breadcrumb":{"@id":"https:\/\/santafeent.com\/sinus-allergy\/allergies-overview\/allergic-rhinitus\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/santafeent.com\/sinus-allergy\/allergies-overview\/allergic-rhinitus\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/santafeent.com\/sinus-allergy\/allergies-overview\/allergic-rhinitus\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/santafeent.com\/"},{"@type":"ListItem","position":2,"name":"Sinus &#038; 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