If your nose is constantly blocked, this may indicate an allergy. A test creates certainty and the basis for targeted therapy.
Are you one of those people who constantly have a stuffy nose? Who constantly fiddle with nasal sprays even though they know all too well that decongestant sprays shouldn’t be used for “longer than a week”? At least that’s what you hear when you buy such a medication in the pharmacy. Whenever I said that, I felt a little uncomfortable – most customers waved me off, at least bored and often annoyed; You don’t want to lecture anyone, but you have a duty to advise them. And if you spray for too long, you really risk something: not only that you may have to spray more and more often to clear your nose. There is also a risk that the nasal mucosa will be damaged and even swell. The result can even be a so-called stinky nose, which I can’t even imagine. A bacterium that feels really comfortable on the damaged tissue breaks down the nasal secretion… producing a very unpleasant odor.
What you actually have to ask the customer is: Is your nose blocked, especially in the morning? This is a belief of mine that I share with very dedicated allergists – that many nasal spray junkies are actually allergic to house dust mites. I have two of them at home myself.
When I had only known my husband for a few weeks, he explained to me one morning, sniffling, “I’ve had a cold for 20 years.” I thought, great, a man who jokes. But it wasn’t at all: his nose was constantly blocked and he often felt sick. But somehow he had decided to just endure it. What should you do against frequent, subtle infections? There are no pills for it, and it wasn’t anything serious.
Ten years until the nose was free
It took another ten years before his nose was suddenly free. What happened? After surviving several pneumonias, our daughter was diagnosed with “allergic asthma” – I found that surprising because allergies had played practically no role in our family up to that point. Like around seven percent of Germans, she reacts allergically to the excretions of house dust mites, which are mainly found in mattresses. The pediatrician prescribed a so-called renovation of her bed so that she no longer has to breathe in at night, which is harmful to her. And because the little one often came to us at night back then, we completely covered all the beds in the house with mite protection covers (so-called encasings). Well, that made all the difference for my husband too. Suddenly he woke up in the morning and could breathe well. After 30 years. Now we happily live in a mite-free household and are constantly fighting the battle against the tiny arachnids that cause so much trouble.
Why am I bringing this up now? Because for house dust mite allergy sufferers, the beginning of the heating season is the same as spring with hay fever. Prime time. The heated air simply becomes too dry for the mites to survive. Because they can’t drink. Many more die than in summer. Their bodies break down and the components are distributed throughout the room, encouraged by the flow that occurs when hot air from a heating system meets cold room air.
An allergy test creates certainty
And allergy sufferers react precisely to these mite components, which is why they often don’t feel well in October, especially since we spend a lot more time indoors now than in July. I can only advise anyone who suddenly has a persistent cold at this time of year to get an allergy test. Especially if the typical course of the viral infection – scratchy throat – runny nose – stuffy nose – cough cannot be identified, but the nose just keeps closing.
I really mean everyone, because you can develop an allergy even in mid-life or in retirement. It doesn’t have to take decades until things get better. The right medication for house dust mite allergy sufferers would not be the decongestant nasal spray at all, but rather one with cortisone, such as the active ingredients beclometasone, mometasone or fluticasone. They have also been available without a prescription for several years. Actually great, but: If you don’t need a prescription for a medicine, that usually means that your statutory health insurance won’t pay for it. In the case of these nasal sprays, however, things are different. They are on the so-called OTC exception list, in expert terms: on the “list of permitted exceptions to the statutory exclusion from prescriptions according to Section 34 Paragraph 1 Sentence 2”.
It seems to me that the regulation is specifically designed for people who are allergic to house dust mites, because the prerequisite for the costs to be covered is “persistent allergic rhinitis with serious symptoms”. The inflammation must therefore be persistent. And house dust is present all year round, albeit with the aforementioned seasonal peak. But these sprays take a few days to reduce the inflammation in the nasal mucosa to the point where it subsides and you can breathe again.
Which spray works best?
And of course – it’s often a cold that makes your nose close. That’s why I want to say a little more about how best to deal with decongestant nasal sprays. First of all, you should always choose one without preservatives. The widely used benzalkonium chloride, for example, irritates and damages the nasal mucosa, according to the guidelines on sinusitis from the German Society for General Medicine and Family Medicine, DEGAM.
Then it may make sense to buy the children’s dosage. It is usually half that height. (Of course, if you keep spraying with it, this tip won’t help.) You should only start spraying on the third day, when your nose really closes up, and it’s better to just dab away the runny nose beforehand. It also makes sense not to spray around the clock, but after the first three days, only take the spray at night.
Another trick is to spray in just one nostril if that’s enough for a quiet night. The next evening it’s time for the other thing. You can also try to break the habit of spraying. DEGAM recommends that anyone who sprays with the lowest possible dosage and without preservatives can do so for up to ten days. However, it seems to me that word has not yet spread among pharmacists.
Note: The column cannot replace individual advice in the pharmacy, nor can it replace the information leaflet or medical diagnosis and treatment.
You can find all episodes of the “The Pharmacist” column here.