Monday, November 02, 2009 MJJ asks

Q: My boyfriend uses 4 Way nasal spray (phenylephrine HCl) several times a day and has been

using it for a long time, probably years. He has developed a hypersensitive sense of smell that bothers him and triggers migraines, congestion and irritated eyes. I am trying to convince him that he needs to stop the 4 Way, and maybe just use saline spray and Nasonex. Currently he is using Nasonex, Clarinex D12, and OTC eye drops for allergies. He has been tested for allergies twice and was told that he has non-allergic rhinitis and a hyper sense of smell, the nose of a hound dog. It is often times miserable to leave his home because perfume and fabric softener are everywhere. He gets a lot of migraines and treats them with Treximet or Maxalt. What is your advice. Thank you so much.

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blacksheepwarwick

5/17/11 6:51pm

he is taking a full package there i have to say! i am suffering from rhinitis myself and am taking nasonex, fexofenadine (antihistamine) and sodium chromoglycate eye drops. the phenylephrine is a misleading drug... meant to relieve congestion but only if taken for short term. prolonged use might cause drug induced rhinitis (medicamentosa i think is the medical term) or rebound congestion. nasonex is meant to alleviate this effect but if he keeps taking the phenylephrine then this is not working. stop that decongestant and ask your doc for a review of the nasonex and potential increase in dosing. i am taking 100ug twice a day (i.e. 2 sprays morning and evening per nostril). there will be a rebound congestion after stopping the nasal spray which you have to live with i am afraid... not sure if it ever will go back to normal but worth a shot (with the nasonex). get him to check the nasal anatomy with a doctor (turbinates, infundibulum, sinus lining) to look for thickening which does not regress after stopping the stuff. depending upon which allergy test was done this might have come back negative if he is taking claritin the days leading up to the skin prick test. if so, re-do the test without taking the antihistamines for at least a week or if possible get antibody titre test (RAST). if he finds it hard to breathe through the nose at night while off the spray you may be able to use nasal strips or some other mechanical device to open the nasal passages. mouth breathing is sufficient for survival though ;)

all those medications have side effects... they may synergise to cause more side effects... side effects include headaches, sleep disturbances (which may be caused by the nasal symptoms and which in turn can cause headaches), congestion, headaches, rhinitis, headaches, altered sense of smell, headaches (see the pattern!)... the amount he is taking probably causes sinus problems which again predisposes to all sorts of symptoms which i already mentioned. none of which are life-threatening but a nuisance nonetheless. with this regimen it's not gonna get any better i'm afraid and he will go down the route of pain relief overuse

hope that helps