What's behind a year-round stuffy nose?

Q. My nose is chronically stopped up. Most days when I get up in the morning the first thing I have to do is blow my nose. What can I do about this congestion? What could be causing it? I get hay fever in the summer that makes me sneeze. But I also have problems in the winter.

A. A persistently congested nose is very common. Just look at the variety of products in the cold and allergy section of your local pharmacy. You can get some sense of just how many Americans suffer with this problem from time to time.

Some of the most common causes of nasal congestion include:

• year-round (or perennial) allergies
• persistent sinus infections
• blockage of the nasal passages due to a deviated nasal septum (the bone that makes the bridge of the nose), polyps, or narrowing of the holes that drain the sinuses
• overuse of certain medications such as nasal decongestant sprays (Afrin and many others)
• side effects from a prescription drug such as a beta blocker.

Sometimes there is more than one cause for a congested nose. For example, a sinus infection can make the symptoms of allergies worse.

Even in the winter, you nasal congestion still could be caused by allergies. Many sources of year-round, indoor allergies, such as house dust mites and cat hair, may actually get worse when the windows are closed and the heat is on.

How can you ease your symptoms? Here's a good place to start:

• Limit your exposure to household allergy sources by keeping pets out of your bedroom, covering pillows and mattresses with hypoallergenic bags, and removing heavy rugs and curtains. Consider buying a vacuum with a special allergen filter (and have someone else do the vacuuming).
• Try an over-the-counter antihistamine. There are many to choose from. The newer ones, such as loratadine (Claritin) and fexofenadine (Allegra), cause less sleepiness. Generic versions work just as well.
• Decongestants such as pseudoephedrine (Sudafed) may be used temporarily to relieve congestion. If you have high blood pressure or heart problems, check with your doctor first.
• If you have become "hooked" on a nasal decongestant spray, you will need to ease yourself off of it. Try alternating nostrils for several days before stopping entirely. Symptoms may get worse at first, but should improve within one to two weeks.

If none of these remedies seem to help, see your doctor for a more complete evaluation. He or she may suggest allergy skin testing or a fiber-optic exam of the nasal passages — these may sometimes find your problem. But often all that is needed is a trial of medicine. Allergies that don't improve with over-the-counter medicine may improve with prescription pills or nasal sprays. Rarely, individuals with severely blocked nasal passages may benefit from surgery.

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