Saturday 20 October 2018

Dear Dr Nina: My daughter seems to have a permanent sniffle

Dr Nina Byrnes
Dr Nina Byrnes

Nina Byrnes

My adult daughter has a more or less permanent sniffle, which seems to have come on in her teens. Her nose is always running and she has to have a box of tissues beside her bed at all times as she will wake during the night to clear her airwaves. She does suffer from seasonal allergies - hay fever - which make the sniffle worse, but it is there in all seasons. I can't think of a time when she hasn't had it, at least not since she was a young child. She refuses to consider taking any action about this, saying she is used to it and it doesn't bother her much. Could there be some structural problem causing this?

Dr Nina replies: Your daughter doesn't just have seasonal hay fever, she has it all year. This condition is called 'perennial rhinitis'. All rhinitis causes a sensation of blocked nose, congestion and can cause sneezing, itchy eyes and nasal drip. Other symptoms include reduced taste, red eyes, mouth breathing, snoring, reduced sleep and fatigue. Most associate rhinitis with summer grasses and pollens, but symptoms can occur seasonally for some, or all year round or others. Common triggers in winter months are house dust mites, moulds, fungal spores, and animal dander.

Rhinitis occurs in about 20pc of the population. It affects all ages and is more common in those with a personal or family history of asthma or eczema.

For those trying to avoid medication, first line treatment involves reducing exposure to the triggers. There are things you can do at home to help. During spring and summer, avoid cutting grass or activities that expose you to grassy areas. Stay indoors when the pollen count is over 50 - Asthma.ie has a daily pollen count.

Keep windows and doors shut. Don't keep fresh flowers in the house. Shower when you come in from outside to remove any pollens from your clothes. Keep pets outside or wash them regularly. Dust regularly with a damp cloth and vacuum regularly with a HEPA filter. Don't dry your clothes on an outside line. If you do go outside, consider placing Vaseline at your nasal opening to catch any pollen that might try and get in. Wear wrap-around sunglasses to keep pollen away from your eyes. Keep car windows closed and consider placing a pollen filter in your car.

In autumn and winter, carpets and blow heaters will harbour and circulate dust and spores. If it is impossible to avoid your triggers, then using a daily nasal rinse may help. There are many available over the counter in pharmacies. Used correctly, these can flush dust, spores and irritating mucus form the nasal passages helping to keep them clear.

Medication can help, so is worth a try for problematic symptoms. Antihistamines reduce the body's allergic response, helping to limit the congestion, swelling and nasal drip associated with rhinitis. It is preferable to use those that are less sedating by day, but an older sedating one may have benefits if taken at night, as disturbed sleep can be a feature of rhinitis.

Steroid nasal sprays are essentially the main stay of treatment for rhinitis whenever it occurs. They act locally in the nasal passages so absorption into the body is minimal. They help reduce swelling in the nasal passages, thus reducing congestion and blockage. Steroid nasal sprays are generally considered safe and they can be used on an ongoing basis if required.

It is important that remedies are used in the correct way and the correct order.

If sprays, rinses and antihistamines aren't working, there are other prescription options and it is worth talking to your doctor or attending an allergy specialist for these. The newest therapy on offer is sublingual immunotherapy (SLIT), of which there are two treatments available.

If you have any health queries for Dr Nina Byrnes, please email drnina@independent.ie. Please note that Dr Nina cannot enter into individual correspondence

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