From the Guidelines
Postnasal drip is often related to allergic rhinitis, as evidenced by the presence of postnasal drip as a symptom in patients with allergic rhinitis 1.
Key Points to Consider
- Allergic rhinitis is an inflammatory, IgE-mediated disease characterized by nasal congestion, rhinorrhea, sneezing, and/or nasal itching, which can also include postnasal drip as a symptom 1.
- The temporal pattern of exposure to a triggering allergen, such as seasonal or perennial, can help classify allergic rhinitis and guide treatment strategies 1.
- A diagnosis of allergic rhinitis can be confirmed only on the basis of a history of symptoms after exposure to known allergens, which correlates with specific IgE testing 1.
- Symptoms of pruritus and sneezing are much more common in allergic than nonallergic rhinitis, while isolated postnasal drainage is less likely to be a result of allergic rhinitis 1.
Management of Allergy-Related Postnasal Drip
- Antihistamines like loratadine (10mg daily), cetirizine (10mg daily), or fexofenadine (180mg daily) can help reduce mucus production 1.
- Nasal steroid sprays such as fluticasone (1-2 sprays per nostril daily) or triamcinolone (1-2 sprays per nostril daily) are also effective for reducing inflammation and mucus 1.
- Saline nasal rinses using a neti pot or squeeze bottle can physically flush out allergens and thin mucus, while staying hydrated helps keep mucus thin and more manageable 1.
- Identifying and avoiding specific allergens is crucial for long-term management of allergy-related postnasal drip 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 perennial nonallergic rhinitis, and it is also one of the symptoms that is evaluated in the Total Nasal Symptom Score (TNSS) in patients with allergic rhinitis.
- The drug label does mention that postnasal drip is one of the symptoms that is decreased in patients treated with Fluticasone Propionate Nasal Spray, USP, in patients with perennial nonallergic rhinitis.
- However, it does not specifically state that postnasal drip is directly related to allergic rhinitis.
- The label does mention that the TNSS includes rhinorrhea, nasal obstruction, sneezing, and nasal itching in known allergic patients.
- Therefore, based on the information provided in the drug label, it can be inferred that postnasal drip may be related to allergic rhinitis, but the relationship is not explicitly stated 2.
From the Research
Relationship between Postnasal Drip and Allergic Rhinitis
- Postnasal drip (PND) is a common symptom of allergic rhinitis, characterized by an inflammation of the nasal mucosa 3.
- Allergic rhinitis is often associated with symptoms such as sneezing, nasal itching, nasal congestion, postnasal drip, and rhinorrhea 3, 4.
- The presence of postnasal drip symptoms can affect the duration of cough in patients with cough-variant and cough-predominant asthma, with patients experiencing PND having a longer time until cough disappearance 5.
- Nasal congestion, a prominent symptom of allergic rhinitis, can lead to sequelae such as sinusitis, otitis media, and sleep disturbances, including obstructive sleep apnea 6.
- Treatment of perennial allergic rhinitis with ipratropium bromide nasal spray 0.06% has been shown to be effective in controlling rhinorrhea, congestion, postnasal drip, and sneezing 7.
Symptoms and Treatment
- The symptom severity score for allergic rhinitis can be calculated by evaluating the severity of individual symptoms, including postnasal drip, using a 4-point scoring scale 3.
- Montelukast, an antagonist to the leukotriene receptor, has been shown to improve the symptom severity score of allergic rhinitis, including postnasal drip 3.
- Intranasal corticosteroids are recommended as first-line therapy for patients with moderate-to-severe allergic rhinitis and nasal congestion 4.
- Patient adherence to treatment and preferences for sensory attributes of a drug can affect outcomes 4.