Allergies and other Congestions
© John Messmer 1999
Stuffiness, runny nose, sneezes, facial pain, clogged ears, cough are common symptoms of the class of problems called "rhinitis" or "inflammation of the nose." There can be many causes of rhinitis but the basic categories fall into irritants and allergens.
Allergic rhinitis is the reason most often attributed to the group of symptoms noted above, but it is not always the case. In allergic rhinitis, one’s immune system reacts to some foreign chemical, often a protein, present in the environment and which finds its way into the nose, eyes or throat. Examples of these allergens are: pollen (grass, trees, weeds), cat dander (the microscopic bits of dried salivary proteins from grooming fur), house dust (actually feces from dust mites), mold spores, and unusual things, such as, the odor of hops near a brewery. When the immune system recognizes the material as foreign and if one has the genetic predisposition, the immune system attempts to destroy the foreign substance. In the process, chemicals are released into the local environment and sometimes these chemicals overflow into the general system. These mediators of inflammation increase the loss of fluid from the capillaries and allow white blood cells and chemicals such as histamine to get into the nose, eyes and throat. The result is runny nose, sneezes, etc.
Vasomotor rhinitis is another common affliction. In this version, the respiratory tract overreacts to irritants. The nasal membranes are supposed to swell a bit and release fluid in response to dust, pollens, smoke, chemicals (e.g., perfume) and other irritants. This is to rinse away the irritant and protect the membranes. In vasomotor rhinitis, the nose and throat react viciously causing much more congestion and drainage than is really necessary.
The best treatment is prevention: avoid smoke, dust and pollen, perfumes. Rinsing the nose with saline sprays can also help. Congestion often responds to warm compresses on the cheeks and inhaled steam, being careful not to burn the nose.
For allergies, antihistamines can inhibit the reaction. Some singers find these too drying. There are many available, but if none are tolerated or they are not effective alone, nasal steroids may be effective. Nasal steroids are quite safe used properly. Your doctor can help you decide if it is appropriate for you. Nasalcrom or cromolyn is available over the counter in most places and is among the safest medications available. It only works for allergies, not vasomotor rhinitis and must be used regularly for best effect. There is a nasally applied antihistamine available also. This has the benefit of rapid absorption and local irrigation of the nose.
Nasal steroids can help vasomotor rhinitis also by inhibiting the local irritation and by constricting the capillaries in the nose. Relief is not often as good as with allergies but is often enough.
Nasal decongestant sprays, such as, Afrin and Neosynephrine should be used only in short duration (two or three days at a time only) since they can cause rebound congestion if used continuously - this is called rhinitis medicamentosa and is very difficult to treat. If one is congested and needs relief for one performance, it might be reasonable to use these once.
Oral decongestants can help also. There are three available generally: pseudoephedrine, phenylpropanolamine and phenylephrine. The latter is not found in decongestants much due to its heart stimulatory effect. Phenylpropanolamine is also stimulating to the heart, though many can tolerate it. It can raise blood pressure, cause tremors and rapid heart beat. It tends to suppress appetite and is the ingredient in over the counter appetite suppressants. It constricts the muscles that allow the bladder to drain and in men, can cause inability to urinate. Pseudoephedrine can be tolerated by most people but some will have side effects similar to phenylpropanolamine. Ephedrine which sounds like pseudoephedrine is not the same thing. This is used in asthma, though less so in recent years due to its very stimulating effect on the heart.
If one has allergies and is not getting sufficient benefit from the above, testing for the specific allergen can be done and sometimes regular injections of small doses of the allergen can reduce one’s reaction to it. It does not always work, but is reliable enough to consider.
It can be tricky to differentiate one cause of rhinitis from another. Discuss it with your doctor and let you doctor know you are a singer so he or she can work within your needs.