Why 1st Generation Antihistamines Are More Powerful and How to Manage Allergic Rhinitis

With the recent cooling weather, patients with COVID-19 and Type A influenza are surging simultaneously. Since both diseases are accompanied by high fever and body aches, their symptoms are similar and difficult to distinguish, but differences may exist depending on the severity of the sore throat or cases of contact with others. Director Lee Sang-hoon of Uihak Channel Biondwi explained in a video the ENT diseases and medications that patients frequently ask about in detail.

Why it is difficult to distinguish COVID-19 and influenza in the field

Among patients visiting hospitals recently, many complain of body aches accompanied by high fever, throat pain, and aching all over the body. Director Lee Sang-hoon explained that it is not easy to clearly distinguish the two diseases in the field because both COVID-19 and influenza cause high fevers of over 38 degrees Celsius and upper respiratory virus symptoms.

However, looking at subtle differences, in the case of COVID-19, there is a tendency for sore throat to appear slightly more compared to influenza. Additionally, epidemiological situations can be considered. While influenza often involves cases of contact with confirmed influenza patients nearby, if a high fever persists even without contact with people nearby, COVID-19 can be suspected. Meanwhile, the COVID-19 virus continues to mutate, and the fatality rate is decreasing and symptoms are weakening compared to the early pandemic period. He added that in some cases, there may be no fever at all.

This year's influenza pattern shows some differences from previous years. Typically, influenza begins to spread from late October to early November and usually peaks in December or January, but this year, the outbreak began in late August, making it difficult to predict. As the outbreak started early, it is uncertain whether it will end early. If many people are infected in the early stages of the outbreak and antibodies are formed, it could end early, but since Type B influenza or common cold viruses may appear consecutively after Type A influenza, it is expected that there will be many cold patients this year.

Why 1st generation antihistamines work better for allergic rhinitis

Among patients with allergic rhinitis, there are many cases where they felt a greater effect from 1st generation antihistamines (such as Actifed) used in the past than from 2nd or 3rd generation antihistamines (such as Allegra, Talion, etc.). This is due to differences in the characteristics of the medications. 1st generation antihistamines have a very powerful antihistamine effect itself that suppresses runny nose, sneezing, and itching. However, the disadvantage is that side effects such as drowsiness or dry mouth (xerostomia) are large.

On the other hand, 2nd and 3rd generation drugs were developed with a focus on reducing side effects like drowsiness or dry mouth, which are fatal disadvantages of the 1st generation. In the process of reducing side effects, the powerful runny nose suppression effect that the 1st generation possessed inevitably becomes relatively weaker. Therefore, if drowsiness or dry mouth does not matter much and a powerful effect is desired, 1st generation drugs can be used, but they are also in the trend of being discontinued recently. In this case, there are ways to supplement the effect by taking various 2nd and 3rd generation drugs together (shuffling) or by combining them with steroids or nasal sprays.

Post-nasal drip and tonsil stones, management methods according to symptoms

Regarding post-nasal drip symptoms, where sticky mucus flows from deep inside the nose, two main causes can be suspected. The first is chronic sinusitis. If the mucus is yellowish, highly viscous, and accompanied by headache or nasal congestion, it is highly likely to be sinusitis. In the case of chronic sinusitis, there may be structural causes such as nasal polyps or a deviated septum, so confirmation through X-ray or CT scans is necessary.

The second is allergic rhinitis. Mucus caused by allergic rhinitis is usually clear, but it can become sticky if it dries in a dry state. Also, if allergic rhinitis patients are left untreated, it can lead to sinusitis. For an accurate diagnosis, X-ray or CT scans and allergy tests are required, and saline irrigation or antibiotic prescriptions are carried out.

Meanwhile, tonsil stones, which cause a sensation of a foreign object in the throat, occur when food debris accumulates in the basalt-like holes (crypts) in the tonsils. The fundamental way to solve this is surgery to remove the tonsils themselves, but besides surgery, management methods such as gargling diligently after eating are recommended. In the case of the influenza vaccine, since the difference in efficacy between domestic and imported vaccines has not been clearly proven, it is recommended to take a vaccine that can be administered as soon as possible so as not to miss the vaccination period. Since imported vaccines may be supplied later than domestic ones, choosing a domestic vaccine is also a method if you want rapid vaccination.