Ineffective OTC Decongestants

Dr. John Overholt • October 28, 2015

Avoid Wasting Time, Money and Treatment



Back in the day there were three main options for over-the-counter oral decongestants: phenylpropanolamine (PPA), pseudoephedrine (PSE), and phenyephrine (PHE). PPA was removed from the market after it was associated with several cases of stroke, probably from people abusing it as a “diet aid”. PSE is still available, but has been moved behind the counter and the amount available for purchase is limited due to its use in illicit methamphetamine production. This leaves us with PHE which has been included in an increasing number of OTC medications since the restrictions on PSE went in to effect. Unfortunately, a new study suggests that oral PHE is not effective as a decongestant.



Researchers looked at several different doses of oral PHE, from 10-40mg every four hours, and compared them to placebo. While there were some short-term increases in heart rate and blood pressure with PHE, there was no improvement in nasal congestion from PHE compared to placebo.

First, you need to be a label reader. All OTC medications will contain a list of their active ingredients.

So what should you do with this information? First, you need to be a label reader. All OTC medications will contain a list of their active ingrediants. If one you are using or considering contains PHE, you should consider an alternate preparation. Second, for control of nasal congestion, consider switching from oral medications to nasal sprays. Nasal decongestant sprays such as Afrin, Neosynephrine, etc. are very effective for short term relief of severe nasal congestion. However, if they are used for more than a few days they will cause rebound nasal congestion-making your problem worse than when you started. Nasal steroid spays such as Flonase, Nasacort, etc are also very effective at controlling nasal congestion without causing rebound. They do take some time to work, though. A good strategy is to start by combining both types of sprays. After three days, drop the nasal decongestant spray and continue the nasal steroid. This provides good immediate relief, minimizes rebound, and gives the nasal steroid some time to work.


Finally, if all of this isn’t helpful, if you are on year-round medications or if you are having complications from your allergies, contact a board-certified allergist for help.

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If you spend any time browsing the internet or social media, you’ve likely seen advertisements for mail-in allergy kits. They promise to test for hundreds of food intolerances and environmental sensitivities using just a few strands of your hair or a quick saliva swab. It sounds incredibly convenient, painless, and comprehensive. But if it sounds like a gimmick, it probably is. While these mail-in tests are heavily marketed, they often lack scientific backing and can leave patients feeling more confused than comforted. The Science of Allergy Testing. What Are We Looking For? To understand why hair and saliva tests don't work, we have to look at how the immune system reacts to allergens. When you have a true allergy, your body produces a very specific type of antibody called IgE (Immunoglobulin E) . These antibodies bind to mast cells (allergy cells), which are on high alert to protect you from perceived invaders like pollen, dust mites, or specific food proteins. The fundamental flaw with mail-in hair and saliva kits comes down to basic biology: Wrong Locations: Mast cells and IgE antibodies are not traditionally found in your hair follicles or saliva. Unreliable Results: Because these testing methods are looking in the wrong place, they are highly unstandardized and unvalidated. You are highly likely to get a flood of false positives or false negatives that are impossible to interpret accurately. What the Experts Say: Major medical organizations strongly advise against these methods. The National Institute of Allergy and Infectious Diseases (NIAID) explicitly recommends against using hair analysis for food allergy evaluations due to a lack of diagnostic value. Furthermore, the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma & Immunology (ACAAI) have issued strong practice guidelines stating that hair analysis should not be used to evaluate food allergies. The Big Misconception: IgE vs. IgG Many mail-in companies charge anywhere from $150 to upwards of $600 for "sensitivity" panels. When patients produce these multi-page reports, the testing is almost always checking for IgG (Immunoglobulin G) antibodies, not IgE. There is a massive difference between the two: