April 14, 2025 • 21 mins
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Managing allergic rhinitis requires realistic expectations and a strategic approach to medication. Though no treatment will completely eliminate symptoms, the right combination of therapies can significantly reduce discomfort and improve quality of life during allergy season.
• Nasal corticosteroid sprays are first-line treatments that reduce inflammation in nasal passages
• Proper technique matters: point spray toward outside of nostril and sniff gently "like smelling a flower"
• Non-sedating antihistamines (Zyrtec, Claritin, Allegra) relieve itching, sneezing, and runny nose without drowsiness
• Nasal antihistamine sprays provide targeted relief and can start working within minutes
• Oral decongestants raise concerns about blood pressure and heart rate increases
• Avoid nasal decongestant sprays (like Afrin) beyond 2-3 days to prevent rebound congestion
• Combination therapies often work better than single medications
• Consider allergen immunotherapy when standard treatments don't provide adequate relief
Thank you for coming back to another episode of Your Checkup. Hopefully you were able to learn something for yourself, a loved one, or an allergic neighbor. Please check out our website, find us on Instagram, send us an email at yourcheckuppod@gmail.com and, most importantly, stay healthy my friends, until next time.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:07):
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Dolesky, a familymedicine resident in the
Philadelphia area.
Speaker 2 (00:22):
And I'm Nicola Rufo.
I'm a nurse.
Speaker 1 (00:24):
And we are so excited you were able to join us here
again today.
So you have been working reallyconsistently for a really long
time, like you picked your headup.
Speaker 2 (00:34):
One of us has to go to work.
Speaker 1 (00:36):
All right, don't blow me up like that.
Coming week I am, and for thelast two and a half years In
2025.
The last two and a half yearsIn 2025.
The last two and a half years Ihave, you know, 24s nights,
what have you?
I know?
Yeah, yeah, yeah, but youfinally accomplished something,
really great.
Speaker 2 (00:54):
I accomplished something really great.
You acquired a day off.
Oh, I mean, it's not really anaccomplishment.
I think it is.
My boss practically told me totake off.
Speaker 1 (01:04):
Yeah.
Speaker 2 (01:04):
So I was like thanks, sis, twist my arm she's great
and a day.
Speaker 1 (01:10):
So there happened to be days it actually so.
Speaker 2 (01:12):
It's the first weekend in April, and did I tell
you this when I was setting myout of office?
The from the previous one Ilast had was in January yeah,
it's a little long.
Speaker 1 (01:22):
Yeah, that's a little long there's.
So we had this Friday, but wehad it together, and there's
like sometimes where I'm doinglike work remotely at home and
like learning at home on aFriday or something recently,
and it does not feel like a dayoff by any means, but you were
home yesterday.
We woke up.
Thursday felt like Friday mm.
Speaker 2 (01:42):
Hmm.
Speaker 1 (01:42):
Very sincerely Friday all day felt like Saturday and
then going to bed weirdly itfelt like Sunday.
Speaker 2 (01:51):
Yeah, it did.
I think it's because we madefat rigatoni and cookies for
dinner and that's usually like aspecial Sunday thing.
Speaker 1 (01:59):
You know what?
Maybe that is why and in thisfat rigatoni we did shrimp that
dish.
I'm like a dog, my focus isonly on what's in front of me.
And now I'm not even sure theepisode where we talked about
your triumvirate of food hascome out yet, but I just can't.
It was the burger bowls, andnow I just can't get off of fat
(02:23):
rigatoni.
And I know there's more in thefridge and I can have it and
that's great, but like it, yourfood is just so amazing well,
thank you.
I just that's.
I can't.
Speaker 2 (02:34):
I can't get over it, and we might get sandwiches
tonight yeah, a hoagie with asalt and vinegar chip is
honestly top tier yeah, and Ikind of before.
Speaker 1 (02:46):
I definitely wasn't someone who was putting chips on
a sandwich I can't believe younever did that before I mean
believe it chips on a sandwich,like on a hoagie on the beach.
Speaker 2 (02:56):
Specifically, yeah plus or minus a corona.
Speaker 1 (03:00):
Or 12.
Speaker 2 (03:01):
Or 12.
There's nothing better.
Well, especially okay, perfectscenario.
We get a hoagie at the beachfrom our favorite place salt and
vinegar chips.
We're on the beach, it's latein the day, we've been on the
beach all day long.
We're kind of tired from doingnothing all day.
(03:22):
We get a sandwich, we have it,you put the salt and vinegar
chip in the hoagie and then it'sgetting a little not dark,
because I guess the sun sets atlike nine o'clock in the summer,
but it's like almost dinnertime.
It's a little cool.
Then you have to put asweatshirt on.
They have a sweatshirt and yourbathing suit.
It's the end of the day, sun'sgoing down, the lifeguards are
(03:44):
coming in and you're eating yoursandwich with your salt and
vinegar chips on the beach andit's crunchy.
There might be a little sandthere somehow.
Speaker 1 (03:54):
But for some reason it's really good.
I guess which sandwich from ourfavorite place are you putting
it?
Speaker 2 (04:02):
Well, I mean really on any of them, but I love that
turkey one with the peppershooters on top.
Speaker 1 (04:06):
I could see it going on the one we got last time.
Okay, sure, yeah, I feel likewe haven't done that a whole lot
, though, with the chips.
Speaker 2 (04:12):
I have.
I don't know what you've beendoing.
Speaker 1 (04:13):
That's fair.
I mean, you're not going to putit on a buffalo chicken version
.
Knows, maybe that would happen.
Maybe that would be somethingto try.
Speaker 2 (04:28):
Uh, I this picture that you painted needs to come
now, yeah, we can try on likememorial day weekend and we'll
report back because, it'll stillbe like kind of a little chilly
, because it'll be, may you knowyeah, oh gosh, that's.
Speaker 1 (04:38):
I can't wait for that .
In other news, I'm uh, fallingapart, um, I mean, it was like
last week at this point where Iwas like outside doing a run and
then just walking and I waslistening to the like the
feature special where lebron wason the pat mcafee show and I
(04:59):
just like randomly hyper, extendmy knee while walking up a curb
very nonchalantly, some guylike double took and saw like
what I did and I was like that'sweird.
So then I kept walking likenothing happened.
But I was like a little nervousbecause I have that whole like
work in medicine, anxiety abouthealth oh I know poor baby.
(05:20):
and then, like three days later,my calf hurts, which I'm so
much more grateful that this isprobably just a calf strain and
nothing like interior on theknee there.
But then I'm going back to thegym and I'm doing legs again and
I decide like it's time to beathletic and then boom, all of a
sudden low back pain and likethis is probably my karma, for,
(05:41):
like I don't know, I thought Iwas very sympathetic for my most
recent back pain patient, butmaybe I didn't listen as well,
or like it could have done alittle better in the on the
margins, I don't know.
But now I'm living it and thisis my karma.
Speaker 2 (05:55):
so now I have like low back pain well, you really
don't like stretch or work onany kind of like mobility, ever
no, which doesn't help you no, Idon't.
Speaker 1 (06:05):
I do feel like sometimes this is probably
catching up to me.
Um, I'm like at this point inmy life I'm someone who's like
squeezing workouts in and Idon't know, like, if I peel
myself out at 550 and then I'mable to like make it into the
room by like six, maybe I shouldstretch more.
I'm making excuses.
This is ridiculous.
(06:26):
I should just stretch more,yeah.
Speaker 2 (06:28):
It'll help.
Speaker 1 (06:29):
It probably will help .
That foam roller experience wassomething.
Speaker 2 (06:33):
I can't believe.
You have never done that and,like you, were an athlete
growing up.
Speaker 1 (06:38):
I certainly was.
No, never really foam rolled.
I mean, that's why I had somany soft tissue injuries.
Who knows, perhaps ProbablyMayhaps, mayhaps.
I'm saying mayhaps more.
All right, what do you think?
Speaker 2 (06:52):
What do you think?
Should we dive in Sure?
Speaker 1 (06:54):
Okay.
So the next section we're goingto talk about here is managing
allergic rhinitis, but usingmedications and some other
treatments as well.
So if you will join us on thisnext part of our journey here.
So the most common first linetreatment is a nasal
corticosteroid spray.
Speaker 2 (07:16):
Listen, I need to say one thing Go ahead Before we
start talking about all thesemagic medicines.
Yeah, none of them are going tofully make you feel better.
No cocktail of anything isgoing to completely change your
life.
It'll just take the edge off alittle bit.
Speaker 1 (07:33):
okay, which is better than nothing so you're like
almost implying just likemanaging symptoms instead of
like cure maybe yeah, you're notgoing to all better.
Speaker 2 (07:43):
It's gonna be like a tooth.
If you're a pollen allergygirly like myself, it's gonna be
like a two sucky months out ofthe year you can take your
medicine.
You'll feel like a little bit.
You'll be like a mildly lessmiserable well, I guess, do you?
Speaker 1 (07:58):
do you consider that maybe, like you have, you may
have a more moderate to severeflavor of this?
Oh yeah, so then maybe, maybethere is some benefit that could
be had for people with likemild ish to moderate well, yeah,
maybe I'm just saying like tolike set expectations.
Yeah, that like you're not gonnalike pop a zyrtec and like boom
(08:21):
, be fine all better yeah, andgo rolling some pollen, okay, no
, that's, I was awesome, sowe're going to go through each
class of medications and try tobe a little more detailed.
So there are nasalcorticosteroid sprays or nasal
steroids.
Essentially, how they work isthat the steroid helps reduce
(08:44):
the inflammation in the nasalpassages that are causing all of
the symptoms and that's themain cause of the allergic
rhinitis, and so the idea is toget at the core of the issue and
try to help manage it.
The effectiveness is generallythat these are considered the
first line treatment and in afew studies, are considered more
(09:05):
effective than the oralantihistamines for relieving
most symptoms of allergicrhinitis, and so they can
relieve a runny nose, congestion, itching and sneezing.
There are some examples ofover-the-counter medications by
the brand called Flonase,sensimist, flonase Allergy
(09:26):
Relief, rhinocort Allergy, andthere are some prescription
options available as well.
One of the most recent thingsI've been counseling people on
more sincerely is how to use thenasal medicines better.
So the idea is to properly usethis with good form, and what
(09:47):
you're going to do is you'regoing to hold your head straight
with your chin slightly tucked.
You are going to take off thecap and make sure, maybe send a
primer or two of the squeeze,you're going to put the
medication in your nose theapplicator and you're going to
point the applicator away fromthe middle, so towards the
(10:09):
outside of your nostril, andyou're going to squeeze and
deliver the medicine.
And you're going to squeeze anddeliver the medicine and you're
going to sniff gently likeyou're sniffing a flower.
If you snort it, you're goingto taste the medicine and it's
going to shoot all the way backinto your throat, maybe into
your lungs, and you're going totaste it.
And that's when you know you'vedone too much.
(10:31):
But if you inhale and waft likeyou're smelling a flower,
you're going to deliver themedication right into where it
needs to go up in your sinuses,towards the top of your nasal
passages.
Sometimes people will hold onenostril closed while spraying
the other and it's a decentsuggestion to spit out any extra
medication that goes into yourthroat because it's not going to
(10:53):
do anything in there.
Sometimes people have some luckusing a saline nasal spray
before they apply their aflonaseor their fluticasone, if you
will, to clean it before theyuse the medication.
Nikki, when do people usuallyfeel like they can expect relief
?
Speaker 2 (11:11):
It varies.
Some people say that they haverelief with the first day, but
it can take days to weeks toactually experience any relief.
So good luck.
Speaker 1 (11:22):
Yeah, it is important to regularly use this
medication.
It's described that they'rebest used when you do them daily
, and especially when you haverecurring or persistent symptoms
, and once your symptoms havegotten better, you might be able
to reduce the dose and so likewith.
The first thing that peopleusually say when they are
(11:43):
talking about using a medicineis, unfortunately, like I don't
care what this medicine does forme, but what is the side effect
?
So the side effects are aslightly unpleasant smell or
taste.
Sometimes there is drying ofthe nasal lining.
There can be irritation,crusting and bleeding of the
nasal septum, especially in thewinter, and that can be
(12:03):
minimized by reducing the doseand perhaps using a moisturizing
nasal gel or spray ahead oftime or switching to a
water-based spray.
Is there in terms of long-termuse?
Is it okay?
Is it something to think about?
What are we thinking about?
Long-term use?
Speaker 2 (12:20):
Long-term use of these medications are generally
safe to use and really notassociated with any side effects
For children.
However, if your child istaking it for more than two
months out of the year, it mayslightly slow your growth rate.
So something to think about.
Speaker 1 (12:42):
Talk to your doctor about and specifically, these
are very different than steroidstaken orally.
And they have far fewer sideeffects than those medications
may imply.
And for pregnancy, certainsprays like chromalin, which
we're going to mention later,fluticasone, budesonide and
memetazone are generallyconsidered safe.
(13:02):
But please don't take our wordfor it.
Ask your own doctor who'staking care of you.
So that was the nasal steroidspray.
There's another class ofmedication that can be very
helpful, and they're calledantihistamines.
You mentioned earlier in theepisode that histamine release
can be at the core of the reasonthat people are experiencing
(13:23):
these symptoms.
So antihistamines work byrelieving itching, sneezing and
the runny nose by blocking theeffects of histamine, the
chemical that's released duringthe allergic reaction.
But notably, they do notrelieve the nasal congestion,
and so there are oralantihistamines that are taken by
mouth.
(13:43):
Of course, there arenon-sedating ones, which tend to
be causing less drowsiness, andexamples of this include
loratadine or claritin,desloratadine or clarinex,
cetirizine, zyrtec,levosetirizine, called Zyzol,
fexofenidine or Allegra, andmost of these, like loratadine,
(14:08):
cetirizine, fexofenadine, areavailable over the counter.
There are ones that are moresedating, and they should be
used more with caution.
This is like Benadryl ordiphenhydramine or
chlorpheniramine or, brand name,chlor-trimetron.
Generally, newer, non-sedatingmedications are preferred
because they don't make you fallasleep.
(14:28):
The side effects are more soassociated with the older brand
and for use in pregnancy, mostof the time, cetirizine,
loratadine are helpful and safeand then use in children.
They do come in some liquidforms, and so many non-sedating
antihistamines are alsoavailable for that reason.
But antihistamines are notlimited to oral medications.
(14:50):
There are nasal antihistamineswhich some people find very
helpful.
They work by relieving symptomsof post-nasal drip, congestion
and sneezing right at the source, and they can start working
within minutes.
Examples of this are azelastineor astilin or astapro and
olopatidine, which is like abrand name patinase that
(15:16):
technique that we talked aboutbefore you should use for this.
You keep your head tiltedforward and you do all of those
things we mentioned before.
The side effect really is justa bad taste in the mouth.
So all of those can be veryhelpful, and sometimes what they
do is they combine themtogether.
They take a corticosteroid andan antihistamine spray, and so
it combines the benefits of boththe steroid and the
(15:38):
antihistamine, and there's someevidence out there that both
together may work better thaneither drug alone, which isn't
rocket science, but I think youhave to actually do the research
to be able to do that.
The brand name of thismedication is called Dimista,
where it combines fluticasoneand azelastine.
A combination of multipleover-the-counter agents is
(15:59):
probably going to give you thesame benefit.
Once again.
The side effects of this mightbe bad taste, nosebleed and
possibly a headache, and it'sapproved for use for people in
age 12 and over.
So another class of medicationsare decongestants.
How they work is they help torelieve the nasal congestion by
narrowing blood vessels in thenasal passages, and this is,
(16:24):
while they're very effective,they're often combined with
over-the-counter allergymedicines and they include
common medications likepseudofedrin or phenylephrine.
And a gigantic word of cautionis that, frankly, we discourage
people from using oraldecongestants because there is a
potential side effect ofincreased blood pressure and
(16:47):
increased heart rate.
They really aren't appropriatefor people with high blood
pressure and certaincardiovascular conditions, and
that's what we have to say aboutthat.
They are not really safe forpeople who are pregnant, and
especially in the firsttrimester.
Nasal decongestion sprays, likemedicines like oxymetolazone or
(17:07):
Afrin, are also out there, orother brands of phenylephrine,
and really these are notrecommended for allergic
rhinitis because, well, frankly,they can't be used for more
than two or three days in a rowat a time, because they can
cause something, or reboundcongestion or rhinitis
(17:27):
medicamentosa, which isdifficult to treat and is
consistent persistent rhinitiswhen the medicine isn't present,
and that is very challenging,and so it's best to avoid that
altogether by avoiding thesemedicines, if you can.
One of the last ones we're goingto talk about is acromalin
nasal spray.
What this does is it preventsthe symptoms of allergic
(17:50):
rhinitis by interfering with theability of allergy cells to
release the inflammatorychemicals.
Really, these aren't aseffective as other treatments,
but sometimes they can be usedbefore symptoms begin.
If you know you're heading toan area, it's just another
option in the toolbox.
It happens to be really safefor people who are pregnant and
also possible for children aswell.
(18:12):
It really has to be usedseveral times per day to be
effective.
Can you tell us a little bitmore about nasal irrigation and
saline sprays?
Speaker 2 (18:22):
I mean, it's exactly what it sounds like.
You're just rinsing the nosewith a saltwater solution and
the idea is that it washes awaythe allergens from the nasal
lining to remove the allergen.
Speaker 1 (18:36):
Those were all of the most common treatment options
and there are a lot of optionsavailable are all of the most
common treatment options andthere are a lot of options
available.
But something to note is thatif and we're not going to speak
a whole lot on this becauseneither of us do this every day
and it's more specialty realm isthat allergen immunotherapy
whether that be an allergy shotor an oral medication, could be
(18:56):
an option.
But in my experience that ispretty much limited to an
allergy specialist, which, ifyour symptoms are really bad and
aren't managed by anythingwe've previously talked about,
perhaps you need to think aboutit.
And that's pretty much wherewe'll limit our conversation to
today, so we don't speak too faroutside of the scope of what
we're more familiar with.
(19:17):
So, in conclusion for thisweek's episode of your checkup,
we just really want to reiteratethat allergic rhinitis is very
common, but hopefully withtoday's tools, you can recognize
that it might be a little bitmanageable.
Right, like there's no magicbullet.
Perhaps that's going to makeyou feel all the way better, but
maybe we've come across somethings that might help.
(19:38):
We should identify triggers andreduce the exposure to those.
We talked about differentmedication options and made you
all aware that there are allergyspecialists out there and maybe
immunotherapies that could behelpful if none of the stuff
that you listened to earlier hasbeen helping you, and, moreover
, we want to thank you forcoming back to another episode
(19:59):
of your Checkup.
Hopefully you were able tolearn something for yourself, a
loved one or an allergicneighbor.
Please check out our website,find us on instagram, send us an
email, your checkup pod atgmailcom and, most importantly,
stay healthy, my friends, untilnext time.
I'm ed daleski.
I'm nicole rufo.
Thank you and goodbye, bye.
(20:21):
This information may provide abrief overview of diagnosis,
treatment and medications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments or
medications for a specificperson.
This is not medical advice oran attempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(20:42):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Dolesky, a familymedicine resident in the
Philadelphia area.
Speaker 2 (00:22):
And I'm Nicola Rufo.
I'm a nurse.
Speaker 1 (00:24):
And we are so excited you were able to join us here
again today.
So you have been working reallyconsistently for a really long
time, like you picked your headup.
Speaker 2 (00:34):
One of us has to go to work.
Speaker 1 (00:36):
All right, don't blow me up like that.
Coming week I am, and for thelast two and a half years In
2025.
The last two and a half yearsIn 2025.
The last two and a half years Ihave, you know, 24s nights,
what have you?
I know?
Yeah, yeah, yeah, but youfinally accomplished something,
really great.
Speaker 2 (00:54):
I accomplished something really great.
You acquired a day off.
Oh, I mean, it's not really anaccomplishment.
I think it is.
My boss practically told me totake off.
Speaker 1 (01:04):
Yeah.
Speaker 2 (01:04):
So I was like thanks, sis, twist my arm she's great
and a day.
Speaker 1 (01:10):
So there happened to be days it actually so.
Speaker 2 (01:12):
It's the first weekend in April, and did I tell
you this when I was setting myout of office?
The from the previous one Ilast had was in January yeah,
it's a little long.
Speaker 1 (01:22):
Yeah, that's a little long there's.
So we had this Friday, but wehad it together, and there's
like sometimes where I'm doinglike work remotely at home and
like learning at home on aFriday or something recently,
and it does not feel like a dayoff by any means, but you were
home yesterday.
We woke up.
Thursday felt like Friday mm.
Speaker 2 (01:42):
Hmm.
Speaker 1 (01:42):
Very sincerely Friday all day felt like Saturday and
then going to bed weirdly itfelt like Sunday.
Speaker 2 (01:51):
Yeah, it did.
I think it's because we madefat rigatoni and cookies for
dinner and that's usually like aspecial Sunday thing.
Speaker 1 (01:59):
You know what?
Maybe that is why and in thisfat rigatoni we did shrimp that
dish.
I'm like a dog, my focus isonly on what's in front of me.
And now I'm not even sure theepisode where we talked about
your triumvirate of food hascome out yet, but I just can't.
It was the burger bowls, andnow I just can't get off of fat
(02:23):
rigatoni.
And I know there's more in thefridge and I can have it and
that's great, but like it, yourfood is just so amazing well,
thank you.
I just that's.
I can't.
Speaker 2 (02:34):
I can't get over it, and we might get sandwiches
tonight yeah, a hoagie with asalt and vinegar chip is
honestly top tier yeah, and Ikind of before.
Speaker 1 (02:46):
I definitely wasn't someone who was putting chips on
a sandwich I can't believe younever did that before I mean
believe it chips on a sandwich,like on a hoagie on the beach.
Speaker 2 (02:56):
Specifically, yeah plus or minus a corona.
Speaker 1 (03:00):
Or 12.
Speaker 2 (03:01):
Or 12.
There's nothing better.
Well, especially okay, perfectscenario.
We get a hoagie at the beachfrom our favorite place salt and
vinegar chips.
We're on the beach, it's latein the day, we've been on the
beach all day long.
We're kind of tired from doingnothing all day.
(03:22):
We get a sandwich, we have it,you put the salt and vinegar
chip in the hoagie and then it'sgetting a little not dark,
because I guess the sun sets atlike nine o'clock in the summer,
but it's like almost dinnertime.
It's a little cool.
Then you have to put asweatshirt on.
They have a sweatshirt and yourbathing suit.
It's the end of the day, sun'sgoing down, the lifeguards are
(03:44):
coming in and you're eating yoursandwich with your salt and
vinegar chips on the beach andit's crunchy.
There might be a little sandthere somehow.
Speaker 1 (03:54):
But for some reason it's really good.
I guess which sandwich from ourfavorite place are you putting
it?
Speaker 2 (04:02):
Well, I mean really on any of them, but I love that
turkey one with the peppershooters on top.
Speaker 1 (04:06):
I could see it going on the one we got last time.
Okay, sure, yeah, I feel likewe haven't done that a whole lot
, though, with the chips.
Speaker 2 (04:12):
I have.
I don't know what you've beendoing.
Speaker 1 (04:13):
That's fair.
I mean, you're not going to putit on a buffalo chicken version
.
Knows, maybe that would happen.
Maybe that would be somethingto try.
Speaker 2 (04:28):
Uh, I this picture that you painted needs to come
now, yeah, we can try on likememorial day weekend and we'll
report back because, it'll stillbe like kind of a little chilly
, because it'll be, may you knowyeah, oh gosh, that's.
Speaker 1 (04:38):
I can't wait for that .
In other news, I'm uh, fallingapart, um, I mean, it was like
last week at this point where Iwas like outside doing a run and
then just walking and I waslistening to the like the
feature special where lebron wason the pat mcafee show and I
(04:59):
just like randomly hyper, extendmy knee while walking up a curb
very nonchalantly, some guylike double took and saw like
what I did and I was like that'sweird.
So then I kept walking likenothing happened.
But I was like a little nervousbecause I have that whole like
work in medicine, anxiety abouthealth oh I know poor baby.
(05:20):
and then, like three days later,my calf hurts, which I'm so
much more grateful that this isprobably just a calf strain and
nothing like interior on theknee there.
But then I'm going back to thegym and I'm doing legs again and
I decide like it's time to beathletic and then boom, all of a
sudden low back pain and likethis is probably my karma, for,
(05:41):
like I don't know, I thought Iwas very sympathetic for my most
recent back pain patient, butmaybe I didn't listen as well,
or like it could have done alittle better in the on the
margins, I don't know.
But now I'm living it and thisis my karma.
Speaker 2 (05:55):
so now I have like low back pain well, you really
don't like stretch or work onany kind of like mobility, ever
no, which doesn't help you no, Idon't.
Speaker 1 (06:05):
I do feel like sometimes this is probably
catching up to me.
Um, I'm like at this point inmy life I'm someone who's like
squeezing workouts in and Idon't know, like, if I peel
myself out at 550 and then I'mable to like make it into the
room by like six, maybe I shouldstretch more.
I'm making excuses.
This is ridiculous.
(06:26):
I should just stretch more,yeah.
Speaker 2 (06:28):
It'll help.
Speaker 1 (06:29):
It probably will help .
That foam roller experience wassomething.
Speaker 2 (06:33):
I can't believe.
You have never done that and,like you, were an athlete
growing up.
Speaker 1 (06:38):
I certainly was.
No, never really foam rolled.
I mean, that's why I had somany soft tissue injuries.
Who knows, perhaps ProbablyMayhaps, mayhaps.
I'm saying mayhaps more.
All right, what do you think?
Speaker 2 (06:52):
What do you think?
Should we dive in Sure?
Speaker 1 (06:54):
Okay.
So the next section we're goingto talk about here is managing
allergic rhinitis, but usingmedications and some other
treatments as well.
So if you will join us on thisnext part of our journey here.
So the most common first linetreatment is a nasal
corticosteroid spray.
Speaker 2 (07:16):
Listen, I need to say one thing Go ahead Before we
start talking about all thesemagic medicines.
Yeah, none of them are going tofully make you feel better.
No cocktail of anything isgoing to completely change your
life.
It'll just take the edge off alittle bit.
Speaker 1 (07:33):
okay, which is better than nothing so you're like
almost implying just likemanaging symptoms instead of
like cure maybe yeah, you're notgoing to all better.
Speaker 2 (07:43):
It's gonna be like a tooth.
If you're a pollen allergygirly like myself, it's gonna be
like a two sucky months out ofthe year you can take your
medicine.
You'll feel like a little bit.
You'll be like a mildly lessmiserable well, I guess, do you?
Speaker 1 (07:58):
do you consider that maybe, like you have, you may
have a more moderate to severeflavor of this?
Oh yeah, so then maybe, maybethere is some benefit that could
be had for people with likemild ish to moderate well, yeah,
maybe I'm just saying like tolike set expectations.
Yeah, that like you're not gonnalike pop a zyrtec and like boom
(08:21):
, be fine all better yeah, andgo rolling some pollen, okay, no
, that's, I was awesome, sowe're going to go through each
class of medications and try tobe a little more detailed.
So there are nasalcorticosteroid sprays or nasal
steroids.
Essentially, how they work isthat the steroid helps reduce
(08:44):
the inflammation in the nasalpassages that are causing all of
the symptoms and that's themain cause of the allergic
rhinitis, and so the idea is toget at the core of the issue and
try to help manage it.
The effectiveness is generallythat these are considered the
first line treatment and in afew studies, are considered more
(09:05):
effective than the oralantihistamines for relieving
most symptoms of allergicrhinitis, and so they can
relieve a runny nose, congestion, itching and sneezing.
There are some examples ofover-the-counter medications by
the brand called Flonase,sensimist, flonase Allergy
(09:26):
Relief, rhinocort Allergy, andthere are some prescription
options available as well.
One of the most recent thingsI've been counseling people on
more sincerely is how to use thenasal medicines better.
So the idea is to properly usethis with good form, and what
(09:47):
you're going to do is you'regoing to hold your head straight
with your chin slightly tucked.
You are going to take off thecap and make sure, maybe send a
primer or two of the squeeze,you're going to put the
medication in your nose theapplicator and you're going to
point the applicator away fromthe middle, so towards the
(10:09):
outside of your nostril, andyou're going to squeeze and
deliver the medicine.
And you're going to squeeze anddeliver the medicine and you're
going to sniff gently likeyou're sniffing a flower.
If you snort it, you're goingto taste the medicine and it's
going to shoot all the way backinto your throat, maybe into
your lungs, and you're going totaste it.
And that's when you know you'vedone too much.
(10:31):
But if you inhale and waft likeyou're smelling a flower,
you're going to deliver themedication right into where it
needs to go up in your sinuses,towards the top of your nasal
passages.
Sometimes people will hold onenostril closed while spraying
the other and it's a decentsuggestion to spit out any extra
medication that goes into yourthroat because it's not going to
(10:53):
do anything in there.
Sometimes people have some luckusing a saline nasal spray
before they apply their aflonaseor their fluticasone, if you
will, to clean it before theyuse the medication.
Nikki, when do people usuallyfeel like they can expect relief
?
Speaker 2 (11:11):
It varies.
Some people say that they haverelief with the first day, but
it can take days to weeks toactually experience any relief.
So good luck.
Speaker 1 (11:22):
Yeah, it is important to regularly use this
medication.
It's described that they'rebest used when you do them daily
, and especially when you haverecurring or persistent symptoms
, and once your symptoms havegotten better, you might be able
to reduce the dose and so likewith.
The first thing that peopleusually say when they are
(11:43):
talking about using a medicineis, unfortunately, like I don't
care what this medicine does forme, but what is the side effect
?
So the side effects are aslightly unpleasant smell or
taste.
Sometimes there is drying ofthe nasal lining.
There can be irritation,crusting and bleeding of the
nasal septum, especially in thewinter, and that can be
(12:03):
minimized by reducing the doseand perhaps using a moisturizing
nasal gel or spray ahead oftime or switching to a
water-based spray.
Is there in terms of long-termuse?
Is it okay?
Is it something to think about?
What are we thinking about?
Long-term use?
Speaker 2 (12:20):
Long-term use of these medications are generally
safe to use and really notassociated with any side effects
For children.
However, if your child istaking it for more than two
months out of the year, it mayslightly slow your growth rate.
So something to think about.
Speaker 1 (12:42):
Talk to your doctor about and specifically, these
are very different than steroidstaken orally.
And they have far fewer sideeffects than those medications
may imply.
And for pregnancy, certainsprays like chromalin, which
we're going to mention later,fluticasone, budesonide and
memetazone are generallyconsidered safe.
(13:02):
But please don't take our wordfor it.
Ask your own doctor who'staking care of you.
So that was the nasal steroidspray.
There's another class ofmedication that can be very
helpful, and they're calledantihistamines.
You mentioned earlier in theepisode that histamine release
can be at the core of the reasonthat people are experiencing
(13:23):
these symptoms.
So antihistamines work byrelieving itching, sneezing and
the runny nose by blocking theeffects of histamine, the
chemical that's released duringthe allergic reaction.
But notably, they do notrelieve the nasal congestion,
and so there are oralantihistamines that are taken by
mouth.
(13:43):
Of course, there arenon-sedating ones, which tend to
be causing less drowsiness, andexamples of this include
loratadine or claritin,desloratadine or clarinex,
cetirizine, zyrtec,levosetirizine, called Zyzol,
fexofenidine or Allegra, andmost of these, like loratadine,
(14:08):
cetirizine, fexofenadine, areavailable over the counter.
There are ones that are moresedating, and they should be
used more with caution.
This is like Benadryl ordiphenhydramine or
chlorpheniramine or, brand name,chlor-trimetron.
Generally, newer, non-sedatingmedications are preferred
because they don't make you fallasleep.
(14:28):
The side effects are more soassociated with the older brand
and for use in pregnancy, mostof the time, cetirizine,
loratadine are helpful and safeand then use in children.
They do come in some liquidforms, and so many non-sedating
antihistamines are alsoavailable for that reason.
But antihistamines are notlimited to oral medications.
(14:50):
There are nasal antihistamineswhich some people find very
helpful.
They work by relieving symptomsof post-nasal drip, congestion
and sneezing right at the source, and they can start working
within minutes.
Examples of this are azelastineor astilin or astapro and
olopatidine, which is like abrand name patinase that
(15:16):
technique that we talked aboutbefore you should use for this.
You keep your head tiltedforward and you do all of those
things we mentioned before.
The side effect really is justa bad taste in the mouth.
So all of those can be veryhelpful, and sometimes what they
do is they combine themtogether.
They take a corticosteroid andan antihistamine spray, and so
it combines the benefits of boththe steroid and the
(15:38):
antihistamine, and there's someevidence out there that both
together may work better thaneither drug alone, which isn't
rocket science, but I think youhave to actually do the research
to be able to do that.
The brand name of thismedication is called Dimista,
where it combines fluticasoneand azelastine.
A combination of multipleover-the-counter agents is
(15:59):
probably going to give you thesame benefit.
Once again.
The side effects of this mightbe bad taste, nosebleed and
possibly a headache, and it'sapproved for use for people in
age 12 and over.
So another class of medicationsare decongestants.
How they work is they help torelieve the nasal congestion by
narrowing blood vessels in thenasal passages, and this is,
(16:24):
while they're very effective,they're often combined with
over-the-counter allergymedicines and they include
common medications likepseudofedrin or phenylephrine.
And a gigantic word of cautionis that, frankly, we discourage
people from using oraldecongestants because there is a
potential side effect ofincreased blood pressure and
(16:47):
increased heart rate.
They really aren't appropriatefor people with high blood
pressure and certaincardiovascular conditions, and
that's what we have to say aboutthat.
They are not really safe forpeople who are pregnant, and
especially in the firsttrimester.
Nasal decongestion sprays, likemedicines like oxymetolazone or
(17:07):
Afrin, are also out there, orother brands of phenylephrine,
and really these are notrecommended for allergic
rhinitis because, well, frankly,they can't be used for more
than two or three days in a rowat a time, because they can
cause something, or reboundcongestion or rhinitis
(17:27):
medicamentosa, which isdifficult to treat and is
consistent persistent rhinitiswhen the medicine isn't present,
and that is very challenging,and so it's best to avoid that
altogether by avoiding thesemedicines, if you can.
One of the last ones we're goingto talk about is acromalin
nasal spray.
What this does is it preventsthe symptoms of allergic
(17:50):
rhinitis by interfering with theability of allergy cells to
release the inflammatorychemicals.
Really, these aren't aseffective as other treatments,
but sometimes they can be usedbefore symptoms begin.
If you know you're heading toan area, it's just another
option in the toolbox.
It happens to be really safefor people who are pregnant and
also possible for children aswell.
(18:12):
It really has to be usedseveral times per day to be
effective.
Can you tell us a little bitmore about nasal irrigation and
saline sprays?
Speaker 2 (18:22):
I mean, it's exactly what it sounds like.
You're just rinsing the nosewith a saltwater solution and
the idea is that it washes awaythe allergens from the nasal
lining to remove the allergen.
Speaker 1 (18:36):
Those were all of the most common treatment options
and there are a lot of optionsavailable are all of the most
common treatment options andthere are a lot of options
available.
But something to note is thatif and we're not going to speak
a whole lot on this becauseneither of us do this every day
and it's more specialty realm isthat allergen immunotherapy
whether that be an allergy shotor an oral medication, could be
(18:56):
an option.
But in my experience that ispretty much limited to an
allergy specialist, which, ifyour symptoms are really bad and
aren't managed by anythingwe've previously talked about,
perhaps you need to think aboutit.
And that's pretty much wherewe'll limit our conversation to
today, so we don't speak too faroutside of the scope of what
we're more familiar with.
(19:17):
So, in conclusion for thisweek's episode of your checkup,
we just really want to reiteratethat allergic rhinitis is very
common, but hopefully withtoday's tools, you can recognize
that it might be a little bitmanageable.
Right, like there's no magicbullet.
Perhaps that's going to makeyou feel all the way better, but
maybe we've come across somethings that might help.
(19:38):
We should identify triggers andreduce the exposure to those.
We talked about differentmedication options and made you
all aware that there are allergyspecialists out there and maybe
immunotherapies that could behelpful if none of the stuff
that you listened to earlier hasbeen helping you, and, moreover
, we want to thank you forcoming back to another episode
(19:59):
of your Checkup.
Hopefully you were able tolearn something for yourself, a
loved one or an allergicneighbor.
Please check out our website,find us on instagram, send us an
email, your checkup pod atgmailcom and, most importantly,
stay healthy, my friends, untilnext time.
I'm ed daleski.
I'm nicole rufo.
Thank you and goodbye, bye.
(20:21):
This information may provide abrief overview of diagnosis,
treatment and medications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments or
medications for a specificperson.
This is not medical advice oran attempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(20:42):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
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