Runny Nose (Rhinitis) and Relief

Several things can trigger a runny nose (rhinitis): Allergies, viruses, bacteria, nasal polyps, a deviated septum, certain foods (especially spicy ones), environmental irritants, some medications, withdrawal from opioids, pregnancy, and I have met several people with an unusual problem called nonallergic rhinitis. In the latter case, nonallergic rhinitis doesn't usually cause itchy nose, eyes, or throat symptoms associated with allergies such as hay fever. This tends to be a recurrent problem: A person often develops a runny nose, post-nasal drip, and cough.  A person thinks they have allergies, but all the ENT (ear, nose, and throat) exams and allergy tests are negative. And one last very remote cause: Cerebrospinal leak: This is an ongoing, rare leak in the tissue between the brain and the sinus cavity (this is a rare problem - a hypochondriac's dream - certainly far from the first thing you would consider, but can remotely occur).

A Runny Nose

If it does not go away, your runny nose tends to go through a series of stages and can often lead to a sinus infection. Even before the runny nose,  a sore throat occurs. The day after that, watery mucus starts to drain out of your nose and down your throat. Several days later, if the runny nose has not gone away, the mucus becomes thick and eventually discolored. Ear pressure, pain, and popping may develop because the nasal sinuses are connected to the ears by the Eustachian tubes. Postnasal drainage drips down into the lungs, causing a cough (the sore throat has typically gone away at this point). Sometimes, sinus drainage affects the eyes, causing eye swelling or possibly "pink eye" (nasal passages are connected to the eye).

Learn more about runny nose (rhinitis) and relief here through exploring different alternatives. The object of treatment here is not only for comfort but to stop the runny nose in its tracks before secondary problems develop: Ear, throat, cough, and transitioning from a viral to bacterial sinus infection. At the beginning of a cold, I often tell people that there are two ways to deal with cold symptoms: one is to clear up, and the other is to go "green." We want to go the first way. It can be challenging, but it can be done.

It is vital to allow the mucus to run to some degree. It is the body's way of killing and clearing out any viruses, bacteria, or other foreign particles trying to get into your body. However, you want things to run smoothly and avoid worsening; you want comfort and resolution.

Many people tell me, "When I started getting sick, I took whatever I could find in my medicine cabinet." That may be a fair temporary measure, but try targeting your symptoms. Below are some approaches to treatment and support specifically for nasal and sinus problems, specifically runny, watery nasal drainage.

CONVENTIONAL OVER-THE-COUNTER TREATMENT FOR THE RUNNY NOSE (RHINITIS) FOR RELIEF

To determine the best treatment, think about the underlying cause of your runny nose.

Is it a cold, a virus, or allergies?

No matter what, you need to rest and stay well hydrated. Your immune system—your body—will not do its best unless you do this.

1. Use Kleenex and allow your nose to run a little bit if it is not irritating or you are not in public. Your body is doing its job. Mucus is there to help get rid of the infection.

2. Neti Pots - These are sold over the counter. Most are teapot-shaped devices that look like something straight out of I Dream of Jeannie "Put that in my nose?" you ask. You run the fluid into one nostril and let it run out the other - it flushes out your sinus. Some people swear by these, and others do not tolerate them well. They are best when used early on in a sinus issue when there is not as much swelling in the sinus ("Well, I let the solution run in, but nothing came out - it was too swollen in there"!) and it is best not used if there is ear involvement because the excess fluid in the eustachian tube (connecting the sinus to the ear) can cause more pressure and more discomfort.

Neti Pots must be used EXACTLY as directed (no tap water—tap water may contain harmful bacteria known to cause brain tissue destruction and death). It is imperative to clean it very well after each use. A person can use it every day, especially during an acute bout of sinusitis, but it can cause more irritation. If associated problems occur, decrease usage or stop using it altogether.

3. Nasal Saline Spray: While a nasal saline spray, like Ocean Nasal Spray, may not flush out your sinus very well, it may be more convenient, a little less invasive, and more comfortable to use. This spray helps clear your nose and keeps mucus from getting too thick.

4. Xylitol nasal spray (X-Clear) may decrease nasal viral shedding and inflammation. It is suggested that it might lower the incidence of anosmia (loss of smell) in Covid-19 (1).

5. Nasal Decongestants - This would be something like Afrin (oxymetazoline) nasal spray. It is one of the best temporary fixes for nasal drainage and congestion because it helps shrink the blood vessels in your nose and sinuses. Because it decreases sinus pressure, it can also work for ear pressure (flight attendants and pilots use this fairly often for ear pressure changes!).  Some people truly fear Afrin because they hear about "Afrin addictions." That sounds scary. Afrin does not cause a psychological addiction, but can cause physical dependence if you use the stuff for more than three days. Beyond three days, if you do not use it, then suddenly stop, blood vessels dilate, and you feel a LOT of congestion again. Your nose and sinuses feel like you must always use it. The answer to that problem? DO NOT USE IT FOR MORE THAN THREE DAYS!

Afrin does have a blood pressure warning, but it usually stays localized, chiefly to the sinus. If you have high blood pressure and use this, watch your blood pressure.

6. Oral Decongestants: This would be something like Sudafed (pseudoephedrine) or a "D" (decongestant) product—for example, Claritin-D, Zyrtec-D, Allegra-D, and so on (not the "DM"—that is for a cough). Like Afrin, these products also help decrease inflammation in the nasal passages and sinuses (and related pressure behind the ears). 

The problem with this medicine is that while it helps you breathe through your nasal passages, it often affects your whole body, so it can cause sleeplessness, heart palpitations, and increase your blood pressure (especially if you have preexisting BP problems). All too often, I have seen Sudafed do this to the point that it puts people into a blood pressure danger zone. It will come down, but it sometimes takes a day to clear. So, if you have blood pressure problems, stay away from it ("You think you have a problem with your sinus; you ought to see your blood pressure!"). Also, some over-the-counter cold and flu medicines use phenylephrine ("PE") instead of Sudafed. Last fall, the FDA declared that phenylephrine is ineffective as a decongestant. It is still on the market and is contained in a lot of cold and flu preparations. Most of my patients agree that it does not work well. It can also cause blood pressure problems, but does not seem to do this as much as Sudafed. 

Again, decongestants are drying agents, so they can be counterproductive. If your mucus dries out too much, it can get tenacious and worsen the infection: Bacteria love that dark, warm, moist environment and may move in on top of your virus! Remember—mucus serves a purpose in fighting and clearing out infection. If you use Sudafed, you want to stay very well hydrated—lots of fluids and maybe add a nasal saline mist spray.

Incidentally, you get this from the pharmacy and will need to show them your driver's license (people have been known to make meth-like substances with this).

6. Antihistamines (oral)—Are frequently recommended as an alternative to decongestants for people with high blood pressure, such as Coricidan HBP, which contains an antihistamine instead of a decongestant. This medicine consistently gets only fair reviews from my patients compared to oral decongestants; however, it may be a better choice for those with high blood pressure. Other popular antihistamines include Claritin, Allegra, and Zyrtec. Antihistamines can stop a runny nose, but may not be a good choice for sinus problems unrelated to allergies. They often dry your mucus out too much, which can worsen your sinus infection.

Some are even sedating. Outside of Coricidan HBP, if you need it, it is best to leave these for allergies.

7. Mucinex Plain (guaifenesin) - This is another interesting over-the-counter drug that people often use indiscriminately. It is an expectorant, so it breaks up very thick mucous. You probably do not want to use this if you have thin or watery mucous and a watery postnasal drip. Use it if your mucus is getting thick. Its primary action is to loosen mucous so you can blow it out and cough it up, and it can make sinus drainage more profuse. You need to drink lots of water with it to make it work well. While directions say to take it twice a day, one might speculate that you do NOT want to take the evening dose because more watered-down mucus will go down your throat, possibly causing a worsening sore throat and an increase in cough. 

8. Ibuprofen (Advil, Motrin), used as directed over the counter, has been noted to help with sinus pressure and sinus headaches because it is an anti-inflammatory. It does not, however, relieve congestion. According to WebMD, some studies show it can worsen symptoms or cause recurrence.

Nasal Steroids - The most common nasal anti-inflammatories are Flonase and Nasonex. While plenty of providers prescribe these for a sinus infection, they are better for long-term use for things like allergies and chronic sinusitis. Occasionally, I will have a patient say that it started working on the same day they started it, but typically, they do not work for two to three days, with maximum efficacy in two weeks. They can also be costly. So, while they might work, there are likely better alternatives. These can be used long-term and do not produce physical dependence. By the way, tilt your head forward and look down at the floor when you spray this stuff into your nose. It penetrates the sinus better and does not all run down your throat.

Similisan—Cardiospermum—sinus relief nasal mist—"natural cortisone"—usually works well for congestion. It is sold over the counter in many retail pharmacies.

Combination/Multi-symptom Medications -The "cold and flu" medicines tend to contain a combination of the medications above, some of which you may not need or may be counterproductive. It is vital that you READ YOUR LABELS and follow instructions. Use medicine wisely and appropriately. Stay well hydrated. Rest.

These over-the-counter medicines are there to help you get through your viral and allergy storms until you start feeling better. Of course, if you are very ill or are getting progressively worse - fevers, pain, and mucous is becoming purulent, consider speaking to a healthcare provider.

Menthol Lozenges may help control a runny nose.

NATURAL REMEDIES FOR THE RUNNY NOSE (RHINITIS) FOR RELIEF

Steam (from the shower, a pot of hot water (be careful!), a sink, or facial steamer). Most patients agree that this helps to loosen your thicker mucus, get rid of old mucus, and decrease congestion - at least temporarily. Be sure to run your bathroom fan, if possible, after using steam, as it can foster mold growth, which may not be too good for you either.

Humidifiers - Like Neti Pots, humidifiers have to be used exactly as directed. Do not use plain tap water unless expressly stated in the instructions (humidifiers that use tap water have a special filter that is able to filter out small particles like bacteria and other pathogens). 

Warm, moist packs over the bridge of the nose for 15-20 minutes two to four times a day, may help.

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Bromelain - According to ConsumerLab, bromelain has been reported to reduce nasal inflammation and improve breathing difficulty in people with sinusitis. It comes in capsule form.

Goldenseal -  This has properties that help slow inflammation and a drippy nose. In addition, if you feel you may be developing a bacterial sinus infection, goldenseal also has immune-strengthening and antimicrobial properties. It comes in tea, extract, pills, and nasal spray, and may be an excellent option to consider.

Andrographis - Antibacterial, antiviral, antifungal, and potent anti-inflammatory, often used to treat cold and sinus.

Horseradish - This has mild antimicrobial properties. It also acts as a decongestant AND expectorant. And it helps speed recovery from sinusitis. It works best when fresh and can be mixed with honey and vinegar, used as a tea (Add 2 tsp horseradish, -1 tsp ginger, and about 1 cup of water - 3 times a day), or just 3 to 5 gm freshly grated root three times a day.

Grapefruit Seed Extract (GSE) has natural antibiotic, antioxidant, antibacterial, and antiviral properties. You can irrigate the nasal passages, take it in capsule or tablet form, drink it mixed with water (or other fluid), or use it as a nasal spray or oil. 

Ginger Preparations Can Be Used to Clear Sinus

Ginger - Ginger is a good anti-inflammatory for the sinus and an expectorant that helps loosen mucus. It also has some antibiotic properties. Most people use it in tea for the sinus, but it comes in many other forms.

Essential Oils

Generally, these are diffused for inhalation to help clear your sinuses. For more information about a particular oil, click on its name.

Eucalyptus Oil - This oil has antiviral, antibacterial, and anti-inflammatory properties—people like it for sinus problems.

​Oregano has antibiotic, antifungal, and anti-inflammatory properties, so it typically relieves some of the pressure in the sinus.

Tea Tree Oil - This essential oil reportedly has antifungal, antibacterial, antiviral, and anti-inflammatory characteristics. It 

Most of these oils are best used via a diffuser or by adding about three drops to a pot of steaming water and inhaling. Unless directed otherwise, oral consumption may not be safe.

PRESCRIPTIVE TREATMENT FOR A RUNNY NOSE AND RELIEF

Nasal Steroids - Like Flonase (fluticasone) and Nasonex (mometasone) can be found over the counter, but sometimes, they are covered by your insurance if prescribed by a healthcare provider, in which case, they may be a lot less expensive. These can be used long-term and do not produce physical dependence.

Nasal Antihistamines - Patanase (olopatadine) - This is mainly for a runny nose due to allergies, but may be used for a runny nose due to a cold to help dry things up. These can be used long-term and do not produce physical dependence.

Combination Nasal Steroid and Nasal Antihistamine - Dymista Nasal Spray (azelastine and fluticasone together- a nasal antihistamine and steroid together in a nasal spray). This reportedly helps with a postnasal "drip" as well. Pricey but covered by some insurances. I would say this is a go-to for people who cannot control their rhinitis with other medications mentioned above. If all else fails, you can use Flonase AND Astelin (azelastine) nasal sprays together, which pretty much amounts to the same thing. These can be used long-term and do not produce physical dependence.

Anticholinergic Nasal Spray-Ipratropium bromide nasal spray  (No longer available as Atrovent spray.

If you have tried the over-the-counter products and other approaches and they are failing to help your rhinitis, you may want to talk to an allergist or ENT. If you want to try a prescription (above) consider trying telehealth.