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Q. I would like to have the best treatment for constant running nose.

Answered by
Dr. Shyam Kalyan N
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 30, 2015 and last reviewed on: Oct 09, 2018

Hi doctor,

I have problems with my nose for over 10 years. My nose runs all time every day. I got a surgery on the nasal valve and it got worse. The surgeon told me that it is normal and prescribed me Xozal. I am using it for past three months but no improvement with it. I wish to get something prescribed through which I will be able to live like a normal person, not having tissue all day.

#

Hi,

Welcome to icliniq.com.

You seem to be suffering from allergic rhinitis which is a form of hypersensitivity and it causes running nose. However this has an offending agent and when the allergen is avoided, the allergy subsides.

To confirm whether it is allergy we can do two tests which includes absolute eosinophil count and serum IgE. The positive signal shows that you suffer from allergy. A negative in the above tests need not always rule out allergy.

For allergic rhinitis, the accompanying symptoms are itching of eyes or nose, occasional nose block and sneezing multiple times.

  • Allergic rhinitis gets temporarily relieved by Xozal (Levocetirizine, an antihistaminic). For allergic rhinitis we usually give an intra-nasal steroid, Mometasone Furoate.
  • I will explain the dosage of the steroid spray once you provide me details whether you have the above symptoms or not. Also it is advisable to check the two tests I suggested.

Next, constant running nose can be due to nasal polyps, chronic sinusitis, inverted papilloma, nasal malignancy, deviated nasal septum, etc.

Please give me details regarding the following too:

  • Have you experienced any nasal bleeding?
  • Do you have any nasal pain/facial pain/headache/brow pain?

What is the color and consistency of nasal discharge?

Is there any foul smell from the discharge?

How you perceive smell?

Kindly attach your previous investigations, reports and medical records pertaining to this matter so that we can arrive at a decisive diagnosis and institute the correct medications for you.


Differential diagnosis:

Allergic rhinitis
Ethmoidal polyposis
Chronic hypertrophic rhinitis
Chronic rhinosinusitis
Inverted papilloma
Nasal malignancy

Regarding follow up:

Revert back with the reports to an ENT otolaryngologist online.---> https://www.icliniq.com/ask-a-doctor-online/ENT-Otolaryngologist

Hi doctor,

I got those two tests done and the results are, absolute eosinophil count is 189 and serum IgE is 17.9.

There is no itching of eyes or nose. I do not sneeze multiple times. There is no nasal bleeding/pain/brow pain. But I daily have headaches. I have occasional nasal block. The discharge is very clear, watery without any smell. My smell sensation is good when there is no block in my nose. I have also tried Pulmicort spray but it did not help.

#

Hi, Welcome back to icliniq.com.

With the information you have provided regarding additional symptoms, I understand that you have only constant running nose without any of the other associated symptoms of allergy. These points towards an allergic pathology in your nose.

Your absolute eosinophil count is normal. To interpret the IgE value I need to know the units which your lab has used because different labs use different standards.

To make a decisive diagnosis of allergic rhinitis, we need to rule out any local pathology inside the nose, like polyps, deviated nasal septum, hypertrophied turbinate, etc. For the same you need in person consultation with an ENT surgeon who can do an anterior rhinoscopy and nasendoscopy and check the interiors of your nose.

A presumptive diagnosis on reasonable grounds and available evidence is allergic rhinitis. I suggest the following treatment to you.

  1. Metaspray (Mometasone Furoate) 50 mcg. Use this spray after gently blowing your nose. Direct towards the sides of each nostril and spray once in morning and once in evening on either nostril. Do not inhale vigorously after the spray, as this would bring the particles to throat whereas they have to act inside the nasal pathway.
  2. Continue the spray twice a day each nostril for two weeks and see for improvement. If improvement is there then after two weeks take it once a day in both nostrils for next one month.
  3. Take tablet Montelukast 10 mg once a day before food in the morning for a week.
  4. When you have extreme running nose, take a tablet of Levocetirizine 5 mg (Xozal) once a day. If you feel sleepy with Levocetirizine, you may take Fexofenadine 120 mg/180 mg. 180 mg Fexofenadine may be taken only when it is very severe.

You need to follow some general precautions to prevent allergy. I have enlisted them as follows.

  1. Avoid smoke/dust/polluted areas. Wear mask when you are at your work place. Change the mask daily.
  2. Do not smoke or use snuffs powder. Desist drinking. Avoid passive smoking and aerated cool drinks.
  3. When you wake up, fold the bed spread over which you slept, without disturbing it and take it outside the house and shake it vigorously. So that all the dust/pollen/dandruff/dead skin cells/dried cosmetic powders all go off.
  4. Wash the bed linens, curtains and carpets once a week. Those which cannot be washed dust them outside the house and not inside.
  5. Change the pillow cover every four to five days and wash it with extra soap.
  6. Make a note of all things you do each day and make special notes on the days you have allergy. Note down the places you visit, stuff you do, things you eat, etc. In that way you may be able to find the offending particle or allergen because of which you develop allergy.
  7. During winter season winds blow and climate is somewhat dry. Due to the winds, dust, pollen, flower particles, mud particles get transported and get inhaled by us which leads to allergy. It is better to stay indoor and keep windows closed in times of such strong winds. Open windows early morning for good ventilation and keep windows closed during rush hour, office traffic, etc.
  8. Do not sleep straight under the fan or air conditioner. Keep air conditioner at appropriate temperature with good moisture.
  9. Dry your hair soon after head bath and do not apply oil over hair for long duration.
  10. Take meals warm rather than cold.
  11. Drink 4 to 5 L of lukewarm water every day and eat nutritious food rich in proteins, vitamins and minerals. Eat a gooseberry daily as it is an excellent source of Vitamin C and helps prevent infections.

Follow the suggestions I have given and you will feel better soon.


The Probable causes:

Allergens may be dust,dust mite, smoke, pollution, wind, pollen, saw dust, husk, agricultural dust, industrial air.
Food allergens such as prawns, peanuts, milk and gluten.

Regarding follow up:

Revert back with serum IgE report and previous reports to an ENT otolaryngologist online.---> https://www.icliniq.com/ask-a-doctor-online/ENT-Otolaryngologist

Hi doctor,

My surgeon has done anterior rhinoscopy and nasoendoscopy and told me that I do not have any problem. I have never done tests for my nose before.My nose is running every day of the year. Serum IgE 17.9 Iu/ml. I never smoke.

#

Hi, Welcome back to icliniq.com.

  • Your IgE values are normal. However the symptoms are strongly suggestive of allergic rhinitis. Please follow what I have told in the previous reply. See if there is an improvement.
  • Start Mometasone spray and take all the precautions. Remember that allergy cannot be cured but it can be avoided if one is careful.
  • Try making the diary as I mentioned and find out what possible particles are causing allergy for you. If the spray does not help you even after few months you can undergo a patch test to find out the exact allergen and do hyposensitization against that allergen as measure to prevent allergy to it.

Hope to see you in good health soon.

For further information consult an ENT otolaryngologist online -->  https://www.icliniq.com/ask-a-doctor-online/ENT-Otolaryngologist

Hello doctor,

I did not get Fexofenadine in my place. Can you suggest something else? Also, I have tried Xozal for several months, and it did not help me at all. Thank you.

#

Hello,

Welcome back to icliniq.com.

Instead of Fexofenadine, you can try Loratadine or Desloratadine.

  • Brands of Loratadine: Claritin, Alavert, Claritin 24 Hour Allergy, Bollinol, Biliranin, Clerityne, Helporigin, Horestil, Igir, Loratan, Lora, etc.
  • Brands of Fexofenadine: Allegra, Allegix, Allerfedine, Fexodine, Fexidine, Fexy, Flexofen, etc.
  • Brands of Desloratadine: Aerinaze, Aerius, Azomyr, Neoclarityn, etc.

Try getting any of the above and make sure that the contents of the tablet are what you want. Beware of the combination drugs. In your condition, a combination with Montelukast will be helpful, but combinations with Pseudoephedrine are unnecessary.

I have searched for brand names of these drugs from the internet and included those pertinent to your country. However, please note that these brand names are different in different countries and may not always rhyme with their chemical names. Hence, I suggest that before buying the product or consuming it, you make sure the contents are what you want.

Also understand that Levocetirizine, Fexofenadine, Loratadine, and Desloratadine are all antihistaminics. All are second generation antihistaminics which are supposed to cause very less CNS depressant effects (sleepiness). However, Desloratadine, Loratadine, and Fexofenadine produce almost nil sleep compared to others.

Have you started on Mometasone furoate nasal spray? That is the most important aspect of the treatment. Also, follow other general measures, precautions, and advice I gave.

Hope you feel better soon.

For further doubts consult an ENT otolaryngologist online --> https://www.icliniq.com/ask-a-doctor-online/ENT-Otolaryngologist


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