Ask: My nose is non-stop. The mucus is clear and sometimes there is a salty taste in the back of my throat. Is there anything I can do or take to dry it?
Anthony Richards, Horncastle, Lincs.
Answer: Your symptoms are probably due to allergic rhinitis, a common condition that affects around one in five people.
It is caused by the immune system responding to a harmless allergen – this can be from substance to perfume. As a result, the cells in the lining of the nose become inflamed and produce too much mucus, leading to cold-like symptoms such as sneezing, congestion or, as in your case, a runny nose.
For most people, dust mites, feathers in bedding or pillows, the fur of pets and various fungi and spores are the culprits for a flowing nose (file image)
It can also cause an itchy nose or throat and itchy, watery eyes. All of these symptoms have a purpose – it’s the body’s way of releasing the allergen.
In some cases, the condition is only a minor irritation, but severe symptoms can affect sleep, concentration, and energy levels, so it can have a significant impact on quality of life.
Perhaps the best known form of allergic rhinitis is hay fever, with pollen from trees or grass causing problems for months.
However, your symptoms occur throughout the year, so I suspect that you have chronic non-seasonal allergic rhinitis. “Multiannual” simply means that your symptoms are not seasonal, but are caused by something that is constantly in your environment.
For most people, house mites, feathers in bedding or pillows, the fur of pets and various fungi and spores are the culprits.
In your case, the answer may be in your work. You say in your longer letter that you work on a farm, and this is an environment where you may be exposed to animals, hay and all sorts of other possible allergens.
I suggest you ask your pharmacist for beclomethasone (brand names are Beconase), a corticosteroid spray that is available without a prescription. Taken as directed – normally two strokes in each nostril twice a day – it relieves symptoms by reducing inflammation in the lining of the nose.
This is the mildest of steroids, but in some people the nose becomes dry and nose bleeds may occur.
Allergy-resistant covers for pillows, comforters and mattresses can, for example, help people who are sensitive to dust mites, while an allergy to a cat can be alleviated by not letting the animal sleep in the bedroom
If your symptoms have not improved after a month, consult your pharmacist again and ask about the use of cetirizine or loratadine, take one of these each morning while you continue to use the nasal spray.
These drugs are antihistamines – histamines are substances produced by the body during an allergic reaction that causes the symptoms – and act as both a preventative and a treatment. Again, no prescription is needed.
If you find that one of these strategies is effective, this confirms that your symptoms are indeed due to an allergy and that you should continue treatment indefinitely.
Of course it is logical to try to avoid the allergens that cause symptoms. Allergy-resistant covers for pillows, comforters and mattresses, for example, can help people who are sensitive to dust mites, while an allergy to a cat can be alleviated by not letting the animal sleep in the bedroom.
However, I appreciate that it may be harder to prevent exposure to allergens that are part of your working life.
If your symptoms persist despite these treatments, you probably have non-allergic rhinitis – inflammation of the nasal wall that is not caused by an allergy. This less common diagnosis can be confirmed by an ear, nose and throat specialist – your doctor can refer you.
Some patients with non-allergic rhinitis, especially older men, respond well to long-term use of a nasal spray called ipratropium bromide. Instead of reducing inflammation in the nose, it reduces the amount of mucus produced.
Whatever the diagnosis, I hope that one of the treatments above will be effective for you and will eliminate this miserable, long-term complaint.
In my opinion … GPs need to learn end-of-life skills
Palliative care has been an important part of my life since I was a medical student who shaded a doctor who brought me home every day.
Often there were moving visits to patients who were in the last days of their lives, where my mentor would help support caregivers, stay in touch with neighborhood nurses, monitor medication, and especially provide comfort.
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They were usually patients he had known for many years, and he was their expert medical friend, as well as a vital source of support.
It is clear that death does not respect office hours and my mentor was available day and night for a crisis of pain management or the eventual demise of the patient, who so often seemed to be in the darkest hour before sunrise.
I hardly realized that palliative care would become such a big part of my life, as both the medical director of a hospice and a general practitioner in a practice aimed at having patients die at home, if it is their wish or desire of them is loved ones.
Today, many terminally ill patients still have the desire to spend their last days surrounded by their loved ones at home, but many are denied this desire, with surveys by Macmillan Cancer Support showing that nearly three-quarters of cancer patients who died in the hospital had want to be home.
Local hospices offer vital home support, but heavy workloads and, I suspect, lack of training and experience in this area mean that GPs are less involved than in the past.
Making formal palliative care training a mandatory part of the training of future general practitioners would allow more people to get the kind of peaceful, dignified death they deserve.