Sinusitis and Allergy Medications

On the surface, choosing a sinus or allergy medicine like Zyrtec, Claritin, or Benadryl (diphenhydramine) is simple and straightforward. Most of us start by walking into our Seattle neighborhood pharmacy. Which pill or potion should we try? Some of us read every label. Others call the pharmacist over for advice. Still others know exactly what sinus or allergy medicine they want after seeing an ad on TV. So after browsing, brain picking, and media surfing, we make our purchase. Maybe, our trip to the pharmacy wasn’t to get off-the-shelf relief. It could be that we’ve tried or don’t trust the safety of self-prescribed remedies. No, today we’re here to get a real medication that was authorized by our doctor. In this article, we’ll take a close look at the main types of sinus and allergy medications and offer an alternative view that may have you thinking twice about popping your next new pill.  I’m already thinking twice, tell me more about an alternative.

Dr. Frank, editor, sinusninja.com

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Truly alternative medicine for sinusitis and allergies in Seattle

ND’s have a unique perspective on the nature of disease, what it actually is, and what causes it.

Before jumping into drug treatments for sinusitis and nasal allergies, let’s take a step back and decide when (or if) we need them.

Every doctor is concerned with three basic things: symptoms, cause, and what to do. Whether you see an MD or an ND, they will hear your story, diagnose the cause, and prescribe a course of action. The best result is a return to normal health. The worst, realizing your condition is untreatable and you will decline over time. Let’s take a look at how MD’s and ND’s view sinus disease.

Sinus symptoms and the antibiotic “fix”

Nose congestion, odd colored discharge, facial and forehead pain, feelings of pressure in the cheeks or between the eyes, low grade fever, and general fatigue are clear symptoms of sinusitis. Obviously, your body is making some kind of error which must be corrected. Within a few minutes of hearing your story, your MD is reaching for a prescription pad and advising a course of antibiotics. Seems like a simple case. But hold on. You probably didn’t realize that your doctor has jumped right to diagnosis and treatment on the basis of one critical assumption: Your body is making a mistake.

It makes sense to name bacteria as the cause and offer therapy to remove them. Still, disease-causing microorganisms are everywhere. If bacteria were the cause of sinus problems then everyone who breathes would have chronic sinusitis. What’s more, if antibiotics were the fix, we wouldn’t be meeting folks everyday at Nova Sinus Center who are on their second, third, and fourth courses of antibiotic therapy.

When faced with a challenge (illness), it’s often a good idea to start from square one. The answer often lies in a missed cue or a faulty assumption. Pool players know that a winning game is all about setting up a winning shot. One winning shot leads to another until the table is cleared. First however, the aspiring pool champion has to learn to cue. To be sure, winning is all in the set up.

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How your MD looks at chronic sinusitis

When MD’s go to school, they learn all the ways the body can make errors. Then they go about learning how to fix them. Drug therapy is one way, surgery is another. Of all human illnesses however, only a small number are actually caused by the body’s error. One example is an error in the genetic code. Another is an organ or tissue response to an unavoidable accident or trauma. Drug and surgical intervention is well suited in these cases since the root cause is metabolic or structural. The majority of chronic, non-emergent illnesses however are caused by mistakes you and your ND at Nova Sinus Center may be able to identify and correct.

How your ND at Nova Sinus Center looks at chronic sinusitis

Let’s suppose for a moment that your body is reacting normally to the given conditions. In the case of chronic sinusitis, these are overgrowth and entrapment of bacteria in the air-filled spaces of the face and skull bones. Bacteria release a number of chemical substances, some of which cause the classic signs of inflammation: swelling, heat, functional loss, redness, and pain. Such inflammation is a normal response. What isn’t normal are the conditions that caused the bacteria to colonize so aggressively in the first place.

The best physicians of the past and present will tell you: No therapy is curative. Normal health evolves from the body itself when given the right conditions. If you’re fortunate to be one of the few for whom antibiotics have “worked,” congratulations. That is, until the next episode. If you and your doctor are not working to adjust the root causes, your chronic sinusitis will continue. The same is true for sinus surgery. While functional endoscopic sinus surgery (FESS) and balloon sinuplasty can restore sinus ventilation and outflows it does little to address the errors that caused your sinus problems to begin with. The evidence? We see folks at Nova Sinus Center looking for help after their second and third sinus surgeries.

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Battling bugs, squashing symptoms

Any drug you may be taking for sinusitis is doing one of two things: battling bugs or squashing symptoms. What is it not doing? Curing your illness or identifying avoidable mistakes. Some clients are surprised to hear that 94% of us will not get better with antibiotics. Others are all too aware of the intestinal side effects like gas, bloating, and diarrhea. Many more are seeking an alternative to feeling “wired and tired” on sinus and allergy medications intended to offer a better quality of life. In conclusion, let’s summarize the main classes of sinus and allergy medications.

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Sinusitis in Seattle? Here’s our summary of sinus and allergy medications.

Antibiotics

Common examples: Amoxicillin, Augmentin®, Levaquin®, Cipro®, Zithromax (Z-Pak)®

Prescription or OTC: Rx required
What they do: Reduce the number of bacteria so the immune system can fight off those remaining
What they miss: Biofilm colonies are often antibiotic resistant, not effective against viral or fungal sinusitis
Key adverse effects: Gas, bloating, diarrhea (due to die off of beneficial gut flora)
Do we advise or prescribe them? Not routinely. Reserved for especially resistant cases. Used in conjunction with Sinus Ninja treatments and lifestyle changes.

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Decongestants

Common examples: Sudafed®, Actifed®, Advil Cold and Sinus®
Prescription or OTC:
Over the counter (OTC)
What they do: Produce blood vessel constriction in the nose and sinuses leading to reduced congestion
What they miss: Use in pregnancy is controversial, moderate abuse and addiction potential
Key adverse effects: Insomnia, dizziness, heart palpitations, increased blood pressure
Do we advise them? Never

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Decongestant Nasal Sprays

Common examples: Afrin®, Neo-Synephrine®
Prescription or OTC:
Over the counter (OTC)
What they do: Produce blood vessel constriction in the nose and sinuses leading to reduced congestion
What they miss: Significant abuse and addiction potential
Key Adverse effects: Use longer than 3 days results in rebound congestion (worse than before use)
Do we advise them? Never

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Antihistamines

Common examples: Benadryl®, Zyrtec®, Claritin®
Prescription or OTC:
Over the counter (OTC)
What they do: Block histamine receptors which reduces seasonal allergy symptoms
What they miss: All are sedating, Zyrtec® and Claritin® less so. Benadryl® is the same drug as Nytol®, a sleep aid.
Key adverse effects: Drug resistance makes them less effective over time. Folks often “rotate” through various formulations until none are effective. It’s also well known that antihistamines cause mucus thickening and crusting of the ostiomeatal complex – the conjoined outflow from all of the major sinuses. Sinus Ninja treatments are especially helpful while taking antihistamines to avoid the crusting and blockage of the sinus outflows.
Do we advise them? On a limited basis, for relief of severe seasonal allergy symptoms. Used in conjunction with Sinus Ninja treatments and lifestyle changes.

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Antihistamine Nasal Sprays

Common examples: Astelin®, Astepro®
Prescription or OTC: Rx only
What they do: Locally inhibits the action of histamine which reduces seasonal allergy symptoms. Also has anti-inflammatory and mast-cell stabilizing effects (stops histamine release from the cells where it’s made).
What they miss: Potentially causes mucus thickening and crusting of the ostiomeatal complex.
Key adverse effects: Bitter taste, headache, nasal burning, nosebleed, drowsiness
Do we advise or prescribe them? On a limited basis, for relief of severe seasonal allergy symptoms. Used in conjunction with Sinus Ninja treatments and lifestyle changes.

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Corticosteroids

Common example: Prednisone
Prescription or OTC: Rx only
What it does: Suppresses the immune response decreasing inflammation in the nose and sinuses
What it misses: Long term use is not advised. Prednisone 21-day taper is only moderately effective, has significant side effects, and is not a useful strategy for lifelong nose and sinus health.
Key adverse effects: Side effects are numerous and can be significant
Do we advise or prescribe them? On a rare and very limited basis, for last-line treatment of severe sinusitis before surgical revision is advised. Topical options are used first (see next). Used in conjunction with Sinus Ninja treatments and lifestyle changes.

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Intranasal Steroid Sprays

Common examples: Beclomethasone, Beconase®, fluticasone, Flonase®, budesonide, Rhinocort®, Veramyst®, Nasonex®, Omnaris®
Prescription or OTC: Rx only
What they do: Locally suppress the immune response decreasing inflammation in the nose and sinuses
What they miss: Intranasal steroid sprays are the most common prescription for nose and sinus inflammation. Because they act locally, there is less (but not absent) risk for systemic absorption. Omnaris® is the newest spray that takes advantage of pro-drug conversion to reduce absorption. It is controversial for use in pregnancy.
Key adverse effects: Side effects are reduced as compared with oral dosing. Significant absorption is possible however and use must be cautiously monitored.
Do we advise or prescribe them? On a limited basis, for relief of severe sinusitis and seasonal allergy symptoms. Used in conjunction with Sinus Ninja treatments and lifestyle changes.

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Leukotriene Inhibitors

Common example: Singulair®
Prescription or OTC: Rx only
What it does: Inhibits the action of pro-inflammatory mediators made in the nose and sinuses (leukotrienes)
What it misses: May not be as effective as intranasal steroid sprays.
Key adverse effects: Headache, earache, sore throat, and slight increase in respiratory infections
Do we advise or prescribe it? On a limited basis, for relief of severe seasonal allergy symptoms. Used in conjunction with Sinus Ninja treatments and lifestyle changes. Chewable tablet, especially useful in children older than 2.

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Mast Cell Stabilizer Sprays

Common example: Cromolyn sodium, Nasal Crom®
Prescription or OTC: Over the counter (OTC)
What it does: Prevents the release of mediators that would normally attract inflammatory cells.
What it misses: Takes up to four weeks to be effective.
Key adverse effects: Lightheadedness, sneezing, nasal irritation
Do we advise or prescribe them? Yes. Though we do have a nasal spray available in-office that is a more natural alternative and is often equally effective. Ask us about it.

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Mucolytics

Common example: Guaifenesin, Mucinex® (NOT, Mucinex-D or DM)
Prescription or OTC: Over the counter (OTC)
What it does: Increases the volume and reduces the viscosity of secretions (mucous) in the upper and lower respiratory passageways
What it misses: Careful attention must be paid to adequate water consumption while taking this medicine. Otherwise, it will not be optimally effective. In general, an extra 2-3 glasses of water should be consumed daily.
Key adverse effects: In general, very few side effects have been reported. In fact, there are a few reported health benefits which include uric acid excretion (benefits gout), keeping the vocal cords coated with secondary mucous (benefit to speakers and singers), and acting as a skeletal muscle relaxant.
Do we advise or prescribe it? Yes, when used in conjunction with Sinus Ninja treatments and lifestyle changes.

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Nasal Anticholinergics

Common example: Ipratropium bromide, Atrovent®
Prescription or OTC: Rx only
What it does: When applied locally, Atrovent® inhibits secretions from the serous and seromucous glands lining the nasal mucosa.
What it misses: Atrovent® does not relieve nasal congestion due to the common cold or seasonal allergy. The safety and effectiveness of the use of Atrovent® Nasal Spray 0.06% beyond four days in patients with the common cold or beyond three weeks in patients with seasonal allergic rhinitis has not been established.
Key adverse effects: Immediate hypersensitivity reactions may occur after administration of ipratropium bromide, as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema.
Do we advise or prescribe it? On a very limited basis, for relief of severe cold and flu or seasonal allergy symptoms. Used in conjunction with Sinus Ninja treatments and lifestyle changes.

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Like many interventions in medicine, the alternative treatment referenced on this site is an empirical one. That is, we “try it” to see if it works. No promise of result is implied or intended.

This site is not intended to provide medical advice or to be a substitute for proper diagnosis and treatment by a qualified health care provider. If you have concerns about your condition, seek medical help right away.

All referenced medication names are registered trademarks of their respective developers and/or manufacturers.

Sinus Ninja ™, SinusNinja.com ™, An Ancient Weapon for Sinusitis ™,  REST ™, Respiratory Care Suite ™, Respiratory Suite Treatment ™, A NEW way to treat sinus trouble ™, Give your nose a REST ™, and Sneeze, Sniffle, Snore? ™ are all trademarks of Nova Sinus Center, LLC / Frank Aversano, ND.

Nova Sinus Center ™, The Nautilus Newsletter ™, and The Nose in the News ™ are all trademarks of Nova Sinus Center, LLC / Frank Aversano, ND.

© 2012 Frank Aversano, ND / Nova Sinus Center, LLC  Trademarks

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