Your best weapons against allergies

Dear Dr. Roach: I live in extreme northeast Texas, so allergies are a given. Every morning my nose runs. Sometimes hot liquid runs out of my nose before I can even grab a tissue. I have taken Allegra, Claritin, Xyzal, etc. Nothing seems to help. Benadryl DOES help, but my eyes hurt when I take it. Neo-Synephrine and Afrin are for a congested nose, which is the opposite of my problem. Can you suggest an over-the-counter nasal spray? — Anon.

It could indeed be allergies causing the problem. We call that chronic perennial allergic rhinitis (“perennial” since it occurs the whole year). However, it also could be non-allergic rhinitis, and the treatments for the two may be different.

Allergies tend to get worse over time, and tend to (60 percent of the time) affect the eyes as well, leading to physical findings that an experienced doctor can see on exam.

If it is allergic, then identifying the allergen may be of benefit, since you may be able to reduce your exposure to it. An allergist can do this via either skin testing or blood tests. Additionally, knowing your allergen may lead to immunotherapy to help symptoms.

To answer your question directly, there are treatments, and you can try them, even if I think confirming the diagnosis and identifying the allergen is useful. All the pills you have tried are antihistamines. Although they are effective for some people, nasal steroids are effective for more people (but I have quite a few patients who hate and won’t use nasal sprays). Three nasal steroids are now available over the counter: fluticasone (Flonase), budesonide (Rhinocort) and triamcinolone (Nasacort).

These medications need to be used every day for them to be most effective, and it can take a week before they start working. If the nasal steroid doesn’t work, I’d suggest a visit with an allergist or an ear, nose and throat doctor.

Write to Dr. Roach at ToYourGoodHealth @med.cornell.edu.