Is postnasal drip (PND) related to allergic rhinitis?

From the Guidelines

Yes, postnasal drip is often related to allergic rhinitis, as it is one of the key symptoms of the condition, along with sneezing, nasal congestion, and itching of the nose, palate, or eyes. According to the clinical practice guideline on allergic rhinitis 1, postnasal drip is a common symptom of allergic rhinitis, which is an inflammatory, IgE-mediated disease characterized by nasal congestion, rhinorrhea, sneezing, and/or nasal itching. The guideline also notes that symptoms of allergic rhinitis can be triggered by exposure to allergens such as pollen, dust mites, or pet dander.

The diagnosis of allergic rhinitis can be confirmed by a history of symptoms after exposure to known allergens, which correlates with specific IgE testing 1. However, the history and physical examination alone can often suggest either allergic rhinitis or nonallergic rhinitis. Symptoms of pruritus and sneezing are much more common in allergic than nonallergic rhinitis, and seasonal exacerbations are also suggestive of allergic rhinitis.

The management of postnasal drip related to allergic rhinitis can include antihistamines like cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily), as well as nasal corticosteroid sprays such as fluticasone (1-2 sprays per nostril daily) or mometasone (2 sprays per nostril daily) to reduce inflammation and mucus production 1. Saline nasal rinses using a neti pot or squeeze bottle can also help flush out allergens and thin mucus. Identifying and avoiding specific allergens is also crucial for long-term management.

Some key points to consider in the management of postnasal drip related to allergic rhinitis include:

• Identifying and avoiding specific allergens
• Using antihistamines and nasal corticosteroid sprays to reduce inflammation and mucus production
• Using saline nasal rinses to flush out allergens and thin mucus
• Considering immunotherapy for patients with concurrent asthma or atopic dermatitis
• Evaluating for comorbidities such as asthma, atopic dermatitis, and sleep-disordered breathing 1.

From the FDA Drug Label

The trials evaluated the patient-rated TNSS (nasal obstruction, postnasal drip, rhinorrhea) in patients treated for 28 days of doubleblind therapy and in 1 of the 3 trials for 6 months of open-label treatment Two of these trials demonstrated that patients treated with Fluticasone Propionate Nasal Spray, USP, at a dosage of 100 mcg twice daily exhibited statistically significant decreases in TNSS compared with patients treated with vehicle.

Postnasal drip (PND) is a symptom that is related to allergic rhinitis, as well as nonallergic rhinitis. The drug label mentions that the trials evaluated the patient-rated TNSS which includes postnasal drip, nasal obstruction, and rhinorrhea in patients with perennial nonallergic rhinitis and allergic rhinitis.

• The studies demonstrated a decrease in nasal symptoms, including postnasal drip, in patients treated with Fluticasone Propionate Nasal Spray, USP.
• However, the label does not provide a direct causal relationship between postnasal drip and allergic rhinitis. 2

From the Research

Relationship between Postnasal Drip and Allergic Rhinitis

• Postnasal drip (PND) is a symptom that can be associated with various conditions, including allergic rhinitis 3.
• Allergic rhinitis is characterized by symptoms such as sneezing, nasal itching, nasal congestion, postnasal drip, and rhinorrhea 4, 5.
• The presence of postnasal drip is a common symptom of allergic rhinitis, with studies indicating that it is one of the key symptoms of the condition 4, 5.
• Treatment of allergic rhinitis often involves addressing postnasal drip, with medications such as montelukast showing improvement in symptom severity scores, including postnasal drip 4.
• Other studies have also highlighted the importance of managing postnasal drip in the context of allergic rhinitis, with recommendations for treatment including intranasal corticosteroids and antihistamines 5, 6.

Common Symptoms and Treatment

• Common symptoms of allergic rhinitis include nasal congestion, sneezing, rhinorrhea, and postnasal drip 4, 5.
• Treatment options for allergic rhinitis often focus on relieving these symptoms, with a range of medications and therapies available 5, 6.
• Intranasal corticosteroids are recommended as first-line therapy for patients with moderate-to-severe allergic rhinitis, particularly when nasal congestion is a prominent symptom 6.
• Patient adherence to treatment is also crucial, with factors such as patient preferences and sensory attributes of medications influencing outcomes 6.

Etiology and Evaluation

• Nasal congestion, which can lead to postnasal drip, can be caused by a range of factors, including allergic rhinitis, vasomotor rhinitis, and upper respiratory viral infections 7.
• Evaluation and diagnosis of nasal congestion and postnasal drip involve a range of approaches, including medical history, physical examination, and diagnostic tests 7.
• Treatment options for nasal congestion and postnasal drip depend on the underlying cause, with conservative treatments such as decongestant pharmacotherapy and antiallergy measures available, as well as surgical procedures in some cases 7.