Q. I am allergic to cold air. How can I get it treated?
Hello doctor,
I have cold air allergy problem. I cannot stay in an AC environment, like airport, theaters, restaurant, buses, even if I cover my mouth and ear. If I wait for a few hours, I get a cough and feel unwell. If I stay more, then I get a headache. I have been taking medicines which includes Chlorpheniramine Maleate (2 mg), Paracetamol(500 mg), Phenylephrine (10 mg) which giving little relief but not that much.
Is there any way like a special mask or any medicines which can allow me in such places temporary? This is causing me big trouble when I go out for a journey. Apart from that, I have cold drinks and food allergy too. I get a cough, but I can prevent it by not having them.
Hello,
Welcome to icliniq.com.
What do precisely your symptoms are? Do you have any nasal problem or breathing trouble, any wheezing? Do you get the same sign when you get exposed to smoke or dust? Since when are you having the symptoms. Have you taken any inhalers and if so have you found relief?
Thank you doctor,
Symptoms are when I inhale cold AC air, allergy reaction starts. I feel little unwell, getting a little cough, pain in the head which increases as I stay longer in AC and my nose getting jammed a little. No wheezing problem. No problem when getting exposed to smoke and dust. My nose is little sensitive, so I do not like smoke and dirt, but it is not giving any reaction yet.
I am having these issues from the past two years, which got increased throughout time. I took an only regular inhaler, but it is giving minor relief only. I take medicine which includes Chlorpheniramine Maleate (2 mg), Paracetamol (500 mg), Phenylephrine (10 mg). I think it is making my nose blocked so any decongestants inhaler will help? If yes, please suggest. I need to take it only when I go out for a journey. Not in daily life, so I need a good one. And if possible without antihistamine as it is making me sleepy.
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 an SOS basis.
You can try antihistamines which produce very less 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 needs to factor in vasomotor rhinitis as well. One should have a baseline investigation of nasal endoscopy and computed tomography of sinuses.
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,
- Azelastine Hydrochloride IP 10% w/v,
- Fluticasone Propionate IP 0.0357% w/v,
- Benzalkonium Chloride Solution IP 0.02% w/v (as preservative),
- 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. So I am not sure if immunotherapy can work. Also, should I take the spray an hour before going into a cold environment? or 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 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 meal). The spray is not like a decongestant and should not be taken when you have the problems 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 occuring on an SOS basis.
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.
- Any normal decongestant (nonsteroid) spray and Allerga M both can 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 cannot find plain Azelastine sprays online. 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 like that?
Hi,
Thank you for the reply,
- 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.
- 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.
- 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.
Hello doctor,
Thank you for the reply,
I will surely try as you informed and post back after a month. One more thing, I would like to fix as I said in the first post I cannot drink cold drinks. Whenever I drink cold drinks I get 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.
Same issue happens when I eat cold food like ice cream. Symptoms are low and goes away itself without any medicines. However if I eat multiple time 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 by avoiding those but that is the best possible solution for you.
Moreover, the 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 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.
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