The first sneeze of the Start of Autumn—don't let nasal congestion medications b

As the Start of Autumn arrives, the "annual drama" for patients with allergic rhinitis officially begins.

My nose feels like a valve that has been tightly screwed shut—completely blocked, with no airflow whatsoever;

Sniffles occur repeatedly, and the nasal discharge cannot be stopped;

During the day, I experience dizziness and a feeling of mental cloudiness; at night, when lying down, my nasal congestion worsens, causing me to toss and turn and making it difficult to fall asleep;

Waking up to find my mouth dry and bitter, with a throat that feels dry and stinging...

— This is the everyday reality for countless people living with allergic rhinitis—a persistent "old ailment" that returns every year at the same time.

When your nose gets blocked, people often panic. Some rush into pharmacies and grab a bottle at random; others, upon hearing that a certain brand is "especially effective," follow suit and buy it to try; still others go as far as using overseas purchasing agents to acquire certain viral nasal sprays, vowing them to be "miracle cures for nasal congestion."

Once I got my hands on it, I couldn't wait to give it a few sprays—within seconds, my nose was instantly clear. The feeling of breathing freely is simply like a weight being lifted from one's shoulders. Many people then conclude that this product is the "savior" for those with rhinitis.

But you might not have thought that some "saviors" are actually there to "collect debts."

01 The miracle cure that works instantly—what is its working principle?

The nasal sprays available on the market that work quickly are mostly nasal decongestants. Common active ingredients include ephedrine, oxymetazoline, clobenazine, and naphazoline.

Its working principle is straightforward and effective: it forcibly constricts the blood vessels in the nasal mucosa, rapidly reducing mucosal swelling and thereby quickly relieving nasal congestion.

Be careful! This product does not have anti-inflammatory properties, nor does it serve as a cure; instead, it temporarily forces the compressed swollen blood vessels to constrict. For acute severe nasal congestion, it is indeed a first-aid remedy.

However, many people are unaware that these medications have a clear "red line": continuous use should not exceed 7 days; it is recommended to limit usage to within 3–5 days whenever possible.

02 Why does blowing your nose actually make it feel more blocked?

When you use a decongestant continuously for more than 7 days, your body is likely to experience two problematic changes:

The first issue is the development of drug resistance.

When receptors on the nasal mucosal blood vessels are chronically stimulated by medication, they become increasingly desensitized, requiring higher doses to achieve the same vasoconstrictive effect. As a result, you may unconsciously spray more frequently, but at the same time, you will find that this "miracle drug" seems less effective than before.

The second is rebound hyperemia.

This is the most critical issue. After discontinuing the medication, the blood vessels may undergo a rebound vasodilation, resulting in nasal congestion that is even more severe than before taking the medication—this condition is medically referred to as "rebound hyperemia." If your initial nasal congestion score was 3, and you stop the medication after 7 days of use, it may rebound to a score of 8. Unable to tolerate the feeling of suffocation, you will have no choice but to resume medication or even increase the dosage.

As a result, you enter a hellish cycle: using medication for temporary relief of nasal congestion → discontinuing the medication leads to a rebound effect that exacerbates nasal obstruction → resuming medication use → becoming increasingly dependent on it. The more frequently you spray, the more often you do so, and the more dependent you become; this ultimately progresses into drug-induced rhinitis.

03 Drug-induced rhinitis: a more challenging secondary complication than allergic rhinitis

Drug-induced rhinitis refers to an iatrogenic nasal disorder resulting from long-term misuse of topical nasal decongestants.

Its typical manifestations include: worsening congestion with increased nasal discharge, persistent blockage even after discontinuing medication, and the need for continuous dose escalation. What began as seasonal allergic rhinitis may, through indiscriminate use of medication, evolve into a more refractory chronic nasal condition.

Under high-definition video nasal endoscopy, it can be observed that the nasal mucosa in patients with drug-induced rhinitis has undergone extensive morphological changes—with blood vessels losing their normal vasomotor function, the mucosa exhibiting hypertrophy, pallor, and edema, while the nasal tissues have been repeatedly damaged by repeated drug stimulation.

What is even more challenging is that the treatment of drug-induced rhinitis is far more complex than that of common allergic rhinitis.

First, it is essential to completely discontinue the decongestant medication; however, the rebound of nasal congestion during the withdrawal phase can be extremely difficult to endure—manifesting as poor sleep quality and labored breathing. Many patients do not simply refuse to stop the medication; rather, they cannot tolerate the sense of suffocation that accompanies this process. Subsequently, long-term medication use will be required to repair the nasal mucosa, and in some severe cases, surgical intervention may even be necessary.

04 Decongestants – how should they be used?

Decongestants themselves are not inherently dangerous. In clinical practice, physicians may occasionally prescribe these medications for short-term use in cases of acute severe nasal congestion to help patients rapidly alleviate symptoms and improve airway patency. They serve as valuable therapeutic tools; however, the associated risks stem from their duration and frequency of use.

Safe Usage Principles:

l Do not use continuously for more than 7 days; it is recommended to limit usage to 3–5 days.

l When using this product, you must strictly follow the physician's instructions;

l This product is only suitable for short-term relief of acute severe nasal congestion and should not be used for daily care;

l Use with caution or avoid: indicated for atrophic rhinitis; long-term use is not recommended for children; use with caution in pregnant women and patients with hypertension.

The purchase threshold for this type of nasal spray is very low—they can be easily obtained at pharmacies or through overseas shopping platforms without a prescription; this has led to a significant number of patients self-administering these products over an extended period. As the Start of Autumn arrives, the peak season for allergic rhinitis has begun. No matter how uncomfortable nasal congestion may be, please do not self-prescribe or use decongestants for prolonged periods.

Seeking prompt medical attention at an otolaryngology specialty clinic and following standardized medication protocols are the correct approaches to effectively resolving nasal congestion.

The decongestant is part of an emergency kit, not a daily-use product.

Unrestricted use is nothing more than borrowing a few minutes of smooth operation.

The cost is the next more severe traffic jam.

Interest on interest; ultimately, what is owed.

This is a nasal health debt far more difficult to repay than an allergic reaction.

* Image source: Shetu.com, Zcool, BaoTu.com

* This article is for general informational purposes only and should not be used as a basis for diagnosis or treatment; please consult a healthcare professional regarding your individual circumstances.