From the Guidelines
Nasal congestion can be effectively treated with a combination of intranasal steroid (INS) and intranasal antihistamine, as this combination has been shown to be the most effective additive to INS for the treatment of allergic rhinitis. When initial therapy with an INS does not lead to adequate control of allergic nasal symptoms, or the patient cannot tolerate INS, the practitioner may choose combination therapies, of which the most effective additive to an INS is an intranasal antihistamine 1.
Treatment Options
- For severe nasal obstruction, adding topical oxymetazoline to INS for a few days has proven benefit, but due to concerns about nasal rebound, topical oxymetazoline use should be limited to a few days 1.
- If nasal sprays are disliked or not tolerated, combination therapy of an oral antihistamine and decongestant is the next most effective pharmacotherapy for AR 1.
Key Considerations
- The selection of effective pharmacotherapy for AR may be influenced by coexisting conditions of allergic conjunctivitis or asthma 1.
- While oral antihistamines and INS are common selections for primary monotherapy, their combination does not offer much clinical benefit 1.
Additional Recommendations
- Nasal saline sprays or rinses can safely be used multiple times daily to moisturize nasal passages and flush out irritants.
- Simple home remedies include using a humidifier, staying hydrated, taking hot showers, and elevating your head while sleeping.
Medication Details
- Oral decongestants like pseudoephedrine (Sudafed) 30-60mg every 4-6 hours or phenylephrine 10mg every 4 hours can help reduce swelling in nasal passages.
- Antihistamines like loratadine (Claritin) 10mg daily or cetirizine (Zyrtec) 10mg daily are helpful if allergies are causing congestion.
- Nasal steroid sprays like fluticasone (Flonase) or mometasone (Nasonex) are effective for persistent congestion when used regularly, typically 1-2 sprays per nostril daily.
From the FDA Drug Label
Fluticasone Propionate Nasal Spray, USP not only relieves sneezing, itchy nose, runny nose and itchy, watery eyes, but also relieves nasal congestion. Uses • temporarily relieves sinus congestion and pressure • temporarily relieves nasal congestion due to the common cold, hay fever or other upper respiratory allergies
Treatment of Nasal Congestion:
- Fluticasone Propionate Nasal Spray, USP can be used to relieve nasal congestion caused by allergies 2.
- Pseudoephedrine can be used to temporarily relieve nasal congestion due to the common cold, hay fever, or other upper respiratory allergies 3.
From the Research
Treatment Options for Nasal Congestion
- Nasal saline spray: A daily nasal spray with saline can prevent symptoms of common cold in healthy adults, including nasal congestion, as shown in a study published in 2004 4.
- Xylitol solution: Xlear Nasal Spray, a xylitol hyperosmolar solution, has been found to be effective in treating nasal congestion and improving quality of life in patients with inferior turbinate hypertrophy secondary to nonallergic rhinitis, although its effectiveness was lower compared to xylometazoline 5.
- Loratadine-pseudoephedrine: A single dose of loratadine-pseudoephedrine tablet has been shown to quickly and significantly improve nasal airflow in patients with allergic rhinitis, with a 31% increase in peak nasal inspiratory flow (PNIF) at hour one post-dose 6.
- Saline nasal irrigation: Saline nasal irrigation is a safe and effective adjunctive therapy for upper respiratory conditions, including chronic rhinosinusitis, mild to moderate allergic rhinitis, and acute upper respiratory tract infections 7.
- Non-pharmacological treatments: Non-pharmacological options, such as nasal saline irrigation and nasal aspiration with a medical device, have been found to be safe and effective in treating nasal congestion in infants and children, with significant improvements in nasal symptoms and reduced risk of developing acute otitis media and rhinosinusitis 8.
Key Findings
- Nasal saline spray and irrigation can help prevent and alleviate nasal congestion symptoms.
- Xylitol solution and loratadine-pseudoephedrine can be effective in treating nasal congestion, although their effectiveness may vary.
- Non-pharmacological treatments, such as nasal aspiration with a medical device, can be a valuable therapeutic support in infants and children.
- These treatments can help reduce the use of medications, such as antihistamines, decongestants, antibiotics, and corticosteroids, during the treatment of upper respiratory tract infections.