Expert: Marc Rubin, RPh Asthma Educator - 2/1/2012

Question
QUESTION: Dear Marc Rubin

I have problem of nasal allergy from six years and used many antihistamine, i want to ask which antihistamine is best for nasal allergy and post nasal drip, cetrizine, levocetrizine, loratadine, fexofenadine, montelukast and second i have problem of difficult breathing and feel tightness in throat. pls help is it asthma? is anthistamine taking on daily basis can be dangerous or benefit for patient becauses i have been taking antihistamine from six year and sometime montelukast.

Regards
Zafar Iqbal

ANSWER: Sorry for the delay Zafar, system crashed!

Which is best is usually a very individual genetic issue discovered by trial and error. With that said, I see the most success with fexofenadine, followed by cetrizine. If the relief isn't complete, then ADDING montelukast may help. It works about 40% of the time. If that fails, then adding a nasal steroid spray like fluticasone every morning should resolve the issue, although like with the antihistamines, you may have to try a couple out to see which is the best for you.

No problem taking antihistamines long-term, and in fact, once you have identified the allergens, it should be taken continuously during the months that the levels are the greatest, unless of course, the trigger is year-round. A critical aspect of the steroid nasal spray is technique to minimize side effects. It needs to be shaken each time, and sprayed toward the inside flair of the nose, not straight up into the sinuses.

Hope this helps. If the doctor puts you on a nasal steroid, get back to me to review the proper technique in detail.

Sincerely,

Marc

---------- FOLLOW-UP ----------

QUESTION: Dear Marc Rubin thanks for reply

Yes my doctor has prescribed my ( Triamcinolone ) nasal spray pls send me the technique how to use it. and also tell me that nasal spray good for asthma / breathing problems?

Regards
Zafar Iqbal

Answer
Avoid spraying this medication in your eyes.

Gently blow your nose before using this drug.  Shake the spray device well before each use. Remove the protective cap before using the spray. Follow the package instructions to properly prime the spray. (Generally spray 3-5 times until a nice mist sprays out)

Close one nostril by pressing it with your finger. Tilt your head down and carefully insert the nasal applicator into the other nostril. Press down firmly on the device to deliver the prescribed number of sprays. Do not spray directly onto the middle wall of your nose (nasal septum). Breathe in gently through your nose and out through your mouth. Repeat in the other nostril. Replace the cap on the nasal inhaler. Avoid blowing your nose for 15 minutes after using this medication.

It is easiest if you are facing down with the tip of the nozzle slightly in the nostril, pointed to the back wall of the nose. Another method is the opposite hand technique. With the right hand, insert the tip into the LEFT nostril, and spray into the flare of the nostril. Then, switching hands, use the left hand to hold the device as to spray into the RIGHT nostril flare. This allows the mist to spray away from the middle wall of the nose.

You do not want to spray straight up into the sinuses, or at the central wall (septum). This will lead to nose bleeds and possibly a fungal sinus infection.

It may take a full week to achieve maximum benefit.

Hope this helps!

Sincerely,

Marc