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Is there a mask or medicine to manage allergic rhinitis?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

I feel I am allergic to cold air. I can not stay in air-conditioned environments like airports, theaters, restaurants, and buses, even if I cover my mouth and ears. If I wait for a few hours, I cough and feel unwell. If I stay longer, then I get a headache. I have been taking medicines like Chlorpheniramine maleate 2 mg, Paracetamol 500 mg, and Phenylephrine 10 mg, which give little relief, but not completely.

Is there any way like a special mask or any medicines, which can allow me to stay in such places temporarily? This is causing me big trouble when I go out for a journey. Apart from that, I have cold drinks and food allergies too. I get a cough, but I can prevent it by not having them. Please help.

Thank you.

Hello,

Welcome to icliniq.com.

What exactly are your symptoms? Do you have any nasal problems, breathing trouble, or any wheezing? Do you get the same sign when you get exposed to smoke or dust? Since when have you been having the symptoms? Have you taken any inhalers, and if so, have you found relief?

Please revert with the answers so that I can help you better.

Thank you.

Patient's Query

Hi doctor,

Thank you for your reply.

My symptoms are when I inhale cold AC air, and allergy reactions start. I feel a little unwell, get a little cough, and pain in the head, which increases as I stay longer in AC. I also have a small nose block. I do not have any wheezing issues. No problem when getting exposed to smoke or dust. My nose is a little sensitive, so I do not like smoke and dirt, but it is not giving any reaction yet.

I have been having these issues for the past two years, which increased over time. I took only a regular inhaler, but it is giving only a little relief. I take medicine which includes Chlorpheniramine maleate 2 mg, Paracetamol 500 mg, and Phenylephrine 10 mg. I think it is making my nose blocked. Will any decongestant inhaler help? If yes, please suggest. I need to take it only when I go out for a journey, not in daily life. If possible without any antihistamine, as it makes me sleepy.

Thank you.

Hello,

Welcome back to icliniq.com.

You seem to be having allergic rhinitis. The medicine you are taking is not appropriate for that. Nasal decongestants like Otrivin (Xylometazoline) and Nasivion (Oxymetazoline) serve to act during infective colds and nasal congestion, whereas allergic congestion needs an anti-inflammatory medicine like steroid nasal sprays. Allergic sprays need to be taken for a long term and do not function on SOS basis.

You can try antihistamines, which produce very little sleep like Bilastine, Ebastine, and Fexofenadine during such episodes. However, long-term relief will be obtained by steroid nasal sprays like Fluticasone and Mometasone. One should have a baseline investigation of nasal endoscopy and computed tomography of sinuses.

I hope that you get your answer.

Please let me know if you want some help.

Thank you.

Patient's Query

Hi,

Hello doctor,

Thank you for the reply.

So it has been confirmed that I have allergic rhinitis. The doctor gave me Nezalast, which includes,

  1. Azelastine hydrochloride IP 10% w/v.
  2. Fluticasone propionate IP 0.0357% w/v.
  3. Benzalkonium chloride Solution IP 0.02% w/v (as preservative).
  4. Phenyl ethyl alcohol IP 0.25% v/v (as preservative).

It looks like vasomotor rhinitis also has the same treatment (spray).

I wanted to ask, can immunotherapy work in my case, and by using it, can I have a long-term effect? I have this issue due to cold air, not any allergen like pollen. I am not sure if immunotherapy will work. Also, should I take the spray an hour before going into a cold environment? I can take it at the exact time when exposed to cold air.

Thank you.

Hi,

Welcome back to icliniq.com.

If it is vasomotor rhinitis (a condition where the linings of the nose get inflamed) like what you suspect, then immunotherapy has no role. However, we can still do a skin prick test, and see if you have any aeroallergen sensitivity. If at all you do have any sensitivity, then we can think again about allergic rhinitis and immunotherapy.

The nasal spray you have been prescribed has to be taken once daily at the same time (preferably after a meal). The spray is not like a decongestant, and should not be taken when you have the problem alone. These are steroids and need to be taken for a couple of weeks. After two weeks of this spray, you should switch over to a normal Fluticasone spray, and continue it for another four to six weeks.

Antihistamines are required as well. Try using some good antipollution masks, which can cover your face, nose, and mouth from any cold air or polluted air. This will prevent the triggering of your rhinitis problem.

There are plain Azelastine sprays, which may act in addition to the Fluticasone sprays, and prevent the symptoms from occurring on an SOS basis.

I hope that you get your answer.

Please let me know if you want some help.

Thank you.

Patient's Query

Hello doctor,

Thank you for making things clear.

I do have allergies. Are there immunotherapies for cold air allergy issues like mine? It is not pollen or any other thing, but only a cold air reaction. I am having trouble in the winter season too, in the early morning, and at late night, when it is so cold out there.

You said Fluticasone is a steroid, and there are also normal Fluticasone sprays available. But Fluticasone is a steroid, right? I am a bit confused.

Do any normal decongestant (nonsteroid) spray and Allerga M both work for such a period? Usually, this issue bothers me only when I go on trips for six to seven days.

If yes, please inform me or prescribe me the name of such a nonsteroid decongestant spray. Also, as you said, I can not find plain Azelastine sprays on the internet. They all have Fluticasone in them.

Any suggestions on what I should do, because it is pointless if I have to use spray regularly, or should I start using spray two weeks before going on the trip, and then stop using it once I am home? Is there any way we can do that? Please help.

Thank you.

Hi,

Welcome back to icliniq.com.

  1. Cold air allergy is not the correct way to describe it. if the coldness of air is causing you problems it's vasomotor rhinitis and not allergy. if there is some pollen or weed dust in the winter air that's causing the problem then it's allergy most likely. a confirmation can be obtained using a skin prick test with appropriate aeroallergens.
  2. Fluticasone used in nasal sprays, being an intranasal steroid, has no side effects due to negligible or zero systemic absorption into the bloodstream. However, if you are worried about steroid use due to the propaganda against it you may choose to avoid it. plain fluticasone is fluticasone without combination with azelastine. azelastine is like your Allegra but it acts intranasally in spray form.
  3. Normal nasal decongestants like Otrivin or Xyloflo or Nasivion can serve the purpose of relief from blockage on an SOS basis, say use for a few days, about four or five maximum, and then stop. You may use these sprays once or twice daily. These have the side effect of rebound congestion and rhinitis medicamentosa.

Using a steroid nasal spray two weeks before the trip and stopping after you return home, with the use of Allegra M during the trip on an SOS basis is a good option to keep your problem at bay. It will be more advisable than Otrivin or other nasal decongestant sprays.

Patient's Query

Hello doctor,

Thank you for the reply,

I will surely try as you informed me and post back after a month. One more thing, I would like to fix as I said, I can not drink cold drinks. Whenever I drink cold drinks I get a cough, cold, nasal discharge, and fever. The doctor prescribed me antibiotics for five days to fix it. When this happens, cough and nasal discharge both are green in color and only last time both were white.

The same issue happens when I eat cold food like ice cream. Symptoms are low and go away without any medicines. However, if I eat multiple times, the same issue happens as I said above. Will this spray work? or any medicine I should take before I can have cold drinks.

Thank you.

Hi,

Welcome back to icliniq.com.

The spray will help to some extent. But the best solution for this is to avoid cold items altogether. I understand it is gonna be a bit uncomfortable to avoid those, but that is the best possible solution for you.

Moreover, cold foods trigger a lot of vasomotor phenomena inside the nasal cavities, and upper throat causing a lot of effects subsequently like nasal congestion, fullness, heaviness, and so on.

Avoid cold foods, and do not think of any medicine that would let you have cold items. The allergy tablets and sprays will help you to a certain extent in tolerating such items but not entirely symptom-free.

I hope that you get your answer.

Please let me know if you want some help.

Thank you.

Medically reviewed byDr. Nithila. A

Published At September 27, 2019
Reviewed AtNovember 8, 2024

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