Chronic Nasal Drip and Nasal Allergies - What You Need to Know

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here’s Deborah Howell.

Deborah Howell (Host): And welcome to the show. I am Deborah Howell, and today we’ll be discussing the symptoms and treatment of nasal allergies and chronic nasal drip. Our guest is Dr. Michael Cho, an otolaryngologist with Saddleback Memorial and Head and Neck Associates of Orange County. Welcome, Dr. Cho.

Michael Cho, MD: How are you? Thanks for having me.

Deborah Howell (Host): I’m wonderful, and I’m hoping you can tell me, what is chronic nasal drip and what causes it?

Michael Cho, MD: You know, chronic nasal drip is a condition that really affects a lot of people these days. And it’s separated into two major bodies: allergies and non-allergic chronic nasal drip. It’s a condition where basically you have mucus that’s overproduced and either comes out the front of your nose or goes down the back of your throat.

Deborah Howell (Host): Okay, that’s pretty easy. Now, what are the symptoms of chronic nasal drip?

Michael Cho, MD: Sometimes people have just the drainage, other times people will have allergy symptoms of sneezing, stuffy nose, even pressure and headaches at times. Lastly, and in very severe cases, it can progress to infections with colored drainage or fevers.

Deborah Howell (Host): Wow, not pleasant. Are there ways to stop chronic nasal drip?

Michael Cho, MD: Typically these days there’s a lot of medications that are pills or sprays that can address those symptoms. And they’re usually available over the counter, but also some of the prescription medications are even more effective and are available through your physician.

Deborah Howell (Host): Got it. Okay, so there is some relief in sight. So how does chronic nasal drip differ from nasal allergies?

Michael Cho, MD: So, people mostly refer to chronic nasal drip as the type of drip that’s from non-allergy drainage. And it’s usually patients that are older and on multiple medications. They don’t respond to pollen and grass and tree exposure. They are triggered by temperature, exercise, sometimes even food, or dust and certain barometric pressure changes.

Deborah Howell (Host): Okay, now can these two different types be related to one another?

Michael Cho, MD: They can, in the sense that you can have both. But they are two different entities, but they both have similar symptoms. Meaning when you have allergies to grass and trees, you have very similar congestion and dripping symptoms as you do with non-allergic nasal drip.

Deborah Howell (Host): Okay, so of course it’s important for a patient to distinguish. And in that case, when should you see a doctor for nasal allergies?

Michael Cho, MD: I’d say most people should go out and try some of the over-the-counter medications such as Flonase and antihistamine pills such as Claritin. And usually after giving it a try for three to four days, if there’s no improvement, then I think it would be time to seek the consultation of a physician.

Deborah Howell (Host): Okay, that sounds pretty reasonable. And are there ways to prevent nasal drip or nasal allergies?

Michael Cho, MD: Chronic nasal drip, the non-allergic type, can be prevented if you remain indoors and avoid major temperature changes or avoid exercise. And those kinds of things are obviously not a good idea, so there’s not very easy ways of preventing non-allergic nasal drip. Now, nasal allergies, typically exposure to grass and trees or dust mites and other allergens, can be prevented if you use a HEPA filter, keeping the air conditioner on or the fan in your house running through filters, and mattress covers that protect you from dust mites. And these sort of allergy-type preventative techniques.

Deborah Howell (Host): Got it. Okay. My mom always had a little drip on the end of her nose late in life. Is that post-nasal drip or is that something else?

Michael Cho, MD: So that - that’s the non-allergic type that so many people are afflicted by. And they, you know, see an allergist and try to get treated and it doesn’t work and they give up. And so those are the non-allergic nasal drip, or the formal name is non-allergic rhinitis. And those are the type of drip issues that can’t be treated through typical allergy treatments and getting medications that dry the nose. Notably, something called ipratropium or Atrovent, which isn’t commonly used. And so normally you may have to see an otolaryngologist to kind of try that medication for chronic nasal drip.

Deborah Howell (Host): And are there side effects associated with that?

Michael Cho, MD: Sometimes people get dry mouth, sometimes feel a little sleepy, but that spray usually lasts about four to six hours and can be repeated throughout the day, and the dose can be changed. You can do one spray or half a spray. And so it’s really a good way to kind of combat that problem in some of our population of patients out there that don’t respond to the normal allergy treatments.

Deborah Howell (Host): Okay. And what are some of the treatments available for nasal allergies?

Michael Cho, MD: So besides the over-the-counter pills, Claritin, antihistamines, and also Flonase, nasal steroid sprays, which is another broad group of treatments, there are antihistamine nasal sprays out there. Similar to Claritin, but that goes through the nose. And then more advanced treatments beyond that would involve seeing an allergist and getting skin tested and considering shots that desensitize you to whatever you’re allergic to. So if you’re allergic to trees, you usually have tree serum that they inject into your skin that allows you over the period of months to years to become desensitized and is a way to quote unquote cure your allergies.

Deborah Howell (Host): So there is relief for people who are thinking... So at what point do you really go to see a doctor about your post-nasal drip?

Michael Cho, MD: I would say that if it’s affecting you more than a week or two, I really encourage patients to come see us. But sometimes, you know, patients come see us after years of seeing multiple doctors and not having any success. And I think that we can give them a certain wider range of options that they may not have seen in earlier encounters with physicians. And so I would say anyone who has issues like this, they should come see an otolaryngologist and get evaluated or reevaluated in combination with an allergist.

Deborah Howell (Host): Tell us about some surgical options for people with extreme cases.

Michael Cho, MD: You know, there’s patients that don’t respond sometimes to medications or respond partially. There are in-office procedures where we actually use radiofrequency or sort of vibration treatments to the tissue in their nose to shrink it permanently or semi-permanently. And so these office procedures usually 30 minutes or so can help with a lot of these symptoms. And then even more aggressive than that would be a surgical intervention in the operating room where we actually remove or resect this tissue. These turbinates that kind of afflict patients with chronic nasal drip.

Deborah Howell (Host): As you said, a wide variety of options that we didn’t used to have.

Michael Cho, MD: Definitely, definitely.

Deborah Howell (Host): What would you say to a person suffering from post-nasal drip in 2017?

Michael Cho, MD: I would say that there are a line of new medications that are coming down the pipeline over the next year to five years, which are really exciting for patients. And patients that have allergies and allergic drip or, as we call it, allergic rhinitis, but also patients with non-allergic rhinitis. And so I think that for patients that have seen doctors in the past for this condition and have kind of given up on it, may have a renewed sense of hope that some of these newer medications and treatments might be of value to them.

Deborah Howell (Host): And how do these new medications differ?

Michael Cho, MD: Most of them are higher generation, higher dosages without having the same side effects. Some of them are completely different classes of medications that attack the inflammatory pathways that cause the cascade of symptoms of swelling and dripping and sneezing. So there are multiple ways that they differ from the older medications that have been out for a longer period of time.

Deborah Howell (Host): So patients, keep checking in with your doctors. We're not sure when these are going to be available, but in the next five years, so there is hope.

Michael Cho, MD: Definitely, and I think anytime you have questions, seeing your physician and seeing what other new opportunities are out there is always a good way to go and keep seeing that line of communication.

Deborah Howell (Host): Well, thank you so much, Dr. Cho, for your time and your expertise today. We really enjoyed having you on the show.

Michael Cho, MD: My pleasure. Thank you very much.

Deborah Howell (Host): For more information or to listen to a podcast of this show, please visit memorialcare.org. That’s memorialcare.org. I’m Deborah Howell. Have yourself a terrific day.