Diseases Of The Nose Throat And Ear

RHINORRHOEA 45

are used individually in the same manner. A positive result proves that the
skin is sensitive to the allergen employed, and the assumption that the nasal
mucosa is similarly sensitive is not invariably correct. This may explain some
of the disappointments from desensitization treatment.

TREATMENT. If the offending jgMgrgSILgJJI-bfi elimjnfttgtd from the patient's

normal life, this is the oSvious treatment of choice. It is most applicable to
food allergies. Unfortunately most allergens cannot be avoided, and it is all
too common that the patient is susceptible to more than one allergen or to
more than one group of allergens.

The symptoms of perennial nasal stuffiness may be treated by simple
vasocqnstrictive drops,f>r sprays^ jsnrh as 1 per cent ephedrine hydrochloride
in normal saline. There is a host of proprietary preparations "made up as
sprays and containing decongestants, antihistamines and often cortico-
steroids. These are often effective, but must Ije used with discretion aslhey
telacTtobe habit-forming and lead to a condition of chronic mucosal conges-
tion. Sodium cromoglycate (RynacrQm)_may be insufflated in powder form
from a special applicator giving a metered dose, and is a useful aid in the
treatment of hay^feyerj^ it blocks the release of the amines that congest the
mucosa. Beclomethasone dipropionatejCBeconase) may be used in a^ metered
dose in a^aefosol^spray"^"fn"e^fea[tment of nasal allergy, ancTit~Eas the
advantage of not being tdc^?ast>coi3Stri£tive? noflslFanantihistamine. It has
the disadvantage oTrequffmg regulafUse, and thus may become habit-
forming^ ~~

Anjtiihisjtainjnes, which, as the name implies, seek to minimize the effect of
histamine liberation in the allergic subject, are generally more effective in
preventing an allergic response than in curing one. They produce their
effect within hah7 an hour, and are widely prescribed in the treatment of the
established""ca.se~ana™meet with some success. There are very many such
preparations on the market, differing in their chemical composition, and it
may be a matter of trial and error witn the chronic sufferer to discover the
preparation most suitable to the individual. Most of them have the side-effect
of producing drowsiness, so that the patient must be warned of the danger of
driving a car or worMng with machinery while on a course of antihistamines,
while the drowsiness produced may have an adverse effect on schoolchildren
or students working for examinations. Some antihistamines are effective for
24 hours, e.g. promethazine (Phenergan) or triprolidine hydrochlonHer
(Pro-actidil), and others are made up in the form of slow-release tablets of
capsules^- e;gr~dipfeenylpyraline hy4Eecfaloritte~tHisWlX "ITfornpheniramine
maleate (Dimotanej ana chAorphejiiramine maleateTFTriton spaJicIeT). These
should ~be tateffjit nights whenlhe soporific effect will ensure a sound sleep
while the therapeutic effect lasts during the day. Alcohol and certain depres-
sants of the central nervous system tend to potentiate antihistamines, and
patients must be warned of this. On the other hand, phenmdamine tartrate
(TTiephorm) is a stimulant^and should not be taken jatejtt night.

^orticjsteroi^^^^Li&^[^J-Vfi in thFcTrnlroro'f allergybuTTt "should not
be used on a long-term basis because of the side-effects. It is used in severe
chronic asthma, and in such patients it controls any nasal allergy which is
present. Steroid depot therapy is effective in the prevention of hay fever, and
in some other cases of perennial allergy. An injection of 2ml methyl
,prednisQlQja£L^cetateJpepo-Medrone)^iaY^last for 3 months orllongejr, and