/ May 21, 2014/ Allergic Rhinitis, Allergy, Seasonal Allergies/ 23 comments

Allergic Rhinitis

Dr.Ashok A.Shah Dr. Ashok A. Shah M.D.
Board certified Allergist
About the author: Dr. Shah started his pediatric residency at Louisiana State University Charity Hospital in New Orleans from 1977 to 1980. From 1980 to 1982, he did his Allergy, Asthma and Clinical immunology fellowship at St. Christopher’s Hospital with Temple University in Philadelphia. He is an active staff member of both Frisbie Memorial Hospital and Wenthworth Douglass Hospital. He is also a member of the New Hampshire Allergy Society and served as its president from 2009 to 2010.

I have been in practice as an allergist for last 32 years.
Over this time frame treatments have changed significantly. Second generation antihistamines were new when I started practice. Inhaled steroids came after that. Third generation antihistamines and more refined nasal steroid inhalers followed. Saline nasal washes were available that time but were not popular. ENT doctors used to use them after surgery.
Now all doctors who treat nasal conditions are using nasal saline therapy frequently. Better devices make it simpler and less messy to use. If I prescribe prescription nasal spray, it makes sense that patients clean their noses with saline first and then use prescription nasal spray. It makes the whole therapy work much more effectively. During winter air gets much drier and incidence of nose bleed increase especially with use of nasal steroid sprays. Saline nasal sprays provide added moisture in nasal passage to decrease incidences of epistaxis.

There are still many patients who will not comply with recommendation for various reasons. Some patients feel there is too much saline and they get drowning feeling. Some patients feel it is messy or are afraid saline will go in their throat and ears. Most people who try first time are somewhat apprehensive but once they use more often results are quite evident and compelling. For many patients it is like addiction even though there is nothing in it to make them that way.
It appears that as time goes by, in future more doctors and patients will appreciate the benefit of this simple device and use them routinely as part of their daily hygiene similar to brushing teeth. However I will not recommend nasal saline wash for completely asymptomatic patients with their nasal exams being completely normal. There is a chance that one might alter normal nasal flora and make asymptomatic patients symptomatic by introducing organisms in areas previously not exposed to under normal conditions.

Nasal saline mist inhalations like nebulizer are also effective for some patients. It is especially beneficial for patients who have poor technique to use nasal spray. It is available for antibiotic use also for patients with persistent chronic sinusitis.

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