Treating persistent runny nose: what helps and what makes it worse

Learn practical steps to distinguish allergy from cold, why nasal decongestant overuse causes rebound congestion, and which treatments are effective for long-term relief

Persistent runny nose: when treatment helps and when it harms

Dr Phillippa Kaye published a discussion on 27/02/ about chronic nasal discharge and common management errors. The conversation highlighted how over-the-counter remedies can sometimes prolong symptoms rather than relieve them.

Patients with a constant runny nose face daily disruption: frequent tissue use, disturbed sleep and social discomfort. Determining whether symptoms stem from allergy or infection changes treatment choices and outcomes.

Clinicians warn that some nasal decongestants, particularly prolonged topical vasoconstrictors, can cause rebound congestion and dependence.

Evidence-based alternatives and appropriate diagnostic steps reduce harm and target the underlying cause.

Before altering any medication regimen, practitioners recommend a medical review. Persistent nasal symptoms have multiple causes, including allergic rhinitis, chronic sinusitis and non-allergic rhinitis; each requires a different approach.

I take a product-focused view based on practical experience: I’ve seen too many teams chase fast fixes while ignoring root causes. The same mistake happens in medicine when symptoms are treated without a clear diagnosis.

Below we explain physiological mechanisms, contrast treatment classes and list daily habits that produce measurable improvement. The guidance synthesizes Dr Kaye’s discussion and prevailing clinical recommendations, with emphasis on safer, evidence-based options.

Understanding why your nose keeps running: allergy vs infection

The guidance synthesizes Dr Kaye’s discussion and prevailing clinical recommendations, with emphasis on safer, evidence-based options. Distinguishing allergic rhinitis from a viral upper respiratory infection is the practical first step for appropriate care.

An allergic reaction is an immune response to harmless triggers such as pollen, dust mites or pet dander. The immune system releases histamine and other mediators. Typical signs include sneezing, nasal itching, watery eyes and a clear, watery nasal discharge.

A viral cold results from pathogens such as rhinoviruses invading nasal cells. Infection causes inflammation and increased mucus production. Secretions are often thicker and may become yellow or green as the illness progresses.

Timing and associated symptoms help clinicians and patients tell the two apart. Allergies often follow exposure patterns and persist while the trigger is present. Colds usually begin with sore throat and progress to congestion, with peak symptoms after a few days.

Colds usually begin with a sore throat and progress to congestion, with peak symptoms after a few days. Key clues help clinicians tell allergy from infection. Itching of the eyes or nose and a predictable seasonal pattern point to allergic rhinitis. Fever, muscle aches and a progressive change in mucus colour more often indicate a viral infection. Duration matters: allergies can persist while the trigger remains, whereas most colds clear within a week to ten days.

Why some over-the-counter decongestants make congestion worse

Topical nasal decongestant sprays such as oxymetazoline and xylometazoline act by constricting blood vessels. The effect reduces swelling and gives rapid relief. Used beyond a few days, the nasal lining adapts and patients can develop rebound congestion. Rebound congestion produces worsening blockage and a need for increasingly frequent dosing.

This cycle can convert intermittent congestion into a near-constant problem. Regular users may feel compelled to keep dosing simply to avoid withdrawal-like nasal blockage.

How clinicians advise safer use

Doctors generally recommend limiting topical decongestant sprays to no more than three days. Saline nasal irrigation and intranasal corticosteroids are safer for longer-term symptoms, particularly allergic cases. Short courses of oral decongestants can help but carry cardiovascular risks for some patients. Persistent or severe symptoms should prompt medical review.

I’ve seen too many startups fail to chase short-term metrics at the expense of sustainability; the parallel in medicine is clear. Quick fixes that create dependence undermine long-term outcomes. Growth data tells a different story: sustained symptom control comes from targeted, evidence-based therapy rather than repeated short-term relief.

Practical takeaways: limit topical decongestant sprays, consider saline or intranasal steroids for ongoing congestion, and seek medical advice when symptoms persist or worsen.

Patients using oral systemic decongestants should be aware of the risks and benefits. Short-term use of pseudoephedrine and similar agents can reduce nasal congestion within hours. Side effects include raised heart rate, elevated blood pressure and insomnia in susceptible individuals. For chronic symptoms, the safest strategy is to avoid relying on topical decongestants long term and to pursue therapies that address underlying inflammation.

Daily habit to ditch now

If you spray a topical decongestant every day, stop and consult your clinician about a tapering plan. Abrupt cessation after prolonged use can initially worsen congestion. Clinicians commonly recommend supervised withdrawal or a short course of intranasal steroids to ease the transition. A taper reduces the risk of rebound congestion and helps identify alternative treatments.

Effective treatments for persistent nasal symptoms

For ongoing congestion, consider daily saline nasal irrigation as a first-line, low-risk option. Intranasal corticosteroids remain the most effective anti-inflammatory therapy for persistent nasal obstruction linked to allergic or nonallergic inflammation. Antihistamines help when itching or sneezing dominate the symptom set. When symptoms fail to improve, refer for specialist assessment to evaluate chronic rhinosinusitis, structural causes or complications.

When symptoms fail to improve, refer for specialist assessment to evaluate chronic rhinosinusitis, structural causes or complications. For longer-term control of allergic inflammation, the most effective option remains nasal corticosteroid sprays.

Nasal corticosteroids reduce mucosal inflammation and swelling. Used consistently, they prevent symptoms rather than simply masking them. Common prescription and over-the-counter agents include fluticasone and mometasone. They typically require several days of regular use to reach full benefit. Patients should be advised to follow dosing instructions and to expect gradual improvement.

Antihistamines are most helpful when itching, sneezing and watery discharge predominate. Second-generation agents such as loratadine, cetirizine and fexofenadine cause less sedation than older drugs. They can ease a runny nose due to allergies but do not cure viral infections.

Mast cell stabilizers, for example cromolyn sodium, are an option for prevention. Their maximal effect occurs when started before predictable allergen exposure. Adherence to the dosing schedule is essential for benefit.

When to see a doctor and testing options

Patients should seek medical review if symptoms persist despite appropriate treatment, worsen, or include high fever or facial pain. A primary care clinician can assess treatment adherence, medication technique and comorbidities.

Referral to an ear, nose and throat specialist is warranted for recurrent or refractory symptoms, suspected structural problems, or complications such as chronic sinusitis. Specialists may recommend diagnostic nasal endoscopy or computed tomography to evaluate anatomy and mucosal disease.

Allergy testing can clarify triggers and guide targeted management. Skin-prick testing provides rapid results for common aeroallergens. Serum-specific IgE testing is an alternative when skin testing is contraindicated or unavailable.

Allergen immunotherapy, offered after confirmation of clinically relevant sensitization, reduces long-term symptom burden for selected patients. Treatment decisions should balance expected benefits against treatment duration and commitment.

I’ve seen too many treatment plans fail for lack of follow-up: ensure clear expectations, review response at defined intervals, and escalate care when objective testing or specialist input is needed.

When to seek medical assessment

Persistent nasal or sinus symptoms require clinical review when over-the-counter measures fail. Primary care clinicians can determine whether referral, tests or targeted therapy are needed.

Clinicians may recommend allergy testing — skin prick or specific IgE blood tests — to identify triggers. They may use nasal endoscopy when structural problems are suspected. For severe allergic disease, immunotherapy is an option to modify the course of illness.

Seek prompt assessment for warning signs such as frequent nosebleeds, new or worsening facial pain, reduced sense of smell or recurrent sinus infections. Children, older adults and people with chronic conditions warrant earlier review and lower thresholds for referral.

Anyone who has launched a product knows that clear metrics guide decisions. Apply the same principle to care: set expected response times, document objective findings, and schedule follow-up reviews.

Ensure follow-up at defined intervals. Escalate care when objective testing or specialist input changes management or when symptoms persist despite treatment.

Manage persistent nasal symptoms with stepped, low-risk measures

When symptoms persist despite initial measures, escalate care based on objective testing or specialist input. Primary clinicians can guide next steps and tailor therapy.

Simple environmental measures reduce symptoms for many people. Minimise exposure to known triggers. Use saline nasal rinses to clear mucus and allergens. Maintain moderate indoor humidity and wash bedding regularly to limit dust mite exposure.

For short-term relief, limit topical sympathomimetic decongestant sprays to three days to avoid rebound congestion. For ongoing symptoms, consider switching to a nasal corticosteroid under medical supervision.

Avoid using daily topical decongestants long term. Seek diagnostic clarification to distinguish allergy from infection, since management differs. Targeted oral antihistamines or anti-inflammatory nasal therapy are appropriate when allergy is confirmed.

I’ve seen too many startups fail to ignore fundamentals; the same applies to symptom control. Growth data tells a different story: modest, sustained measures often outperform aggressive short-term fixes.

If uncertainty remains, consult your clinician to create a safe, individualized plan. Expect follow-up testing or specialist referral if symptoms continue despite appropriate measures or if complications arise.