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Dont blame your stuffy head if you cant find your usual decongestant on drugstore shelves. Cold and allergy medications like Sudafed and Claritin-D have been pushed behind the counter because of their pseudoephedrine, a key ingredient in the illegal street drug methamphetamine. And just asking for your favorite remedy may not be enough. In some states, you might need to show ID and sign a form saying how much youre buying. And you may not be allowed to buy as much as you want. As a result, drug companies have launched on-the-shelf decongestants without pseudoephedrine. But do they work as well as the old standbys? We checked with William Soller, PhD, executive director of the Center for Consumer Self Care at University of California, San Francisco. His advice:

Try the new stuff
Most of these remedies contain phenylephrine (look for “PE” on the label), a close cousin of pseudoephedrine that isnt used to make meth. It wont last as long as pseudoephedrine—you may need to take it every 4 hours—but Soller says most people wont notice a difference. People at risk of heart problems should check with their doctor before using either medicine.

Dont forget nasal sprays
Neo-Synephrine 4-hour (which has phenylephrine) and Afrin (with longer-lasting oxymetazoline) will clear your stuffy nose in minutes. Soller says theyre safe for the 3 days or so that cold symptoms peak. But longer use can lead to rebound congestion, so dont overdo it.

Be careful with all-in-ones
Remedies that treat congestion, fever, pain, cough, and allergies (like Comtrex) may seem like wonder drugs, but you might not need so much medicine. Its best to match your medicines to your symptoms, Soller says. If you dont have a cough, why take cough medicine? Plus, by alleviating your congestion, a decongestant may help relieve other symptoms.

Drug-free alternatives might help
The number of options can make your head spin, but most wont unstuff your noggin, Soller says. Your best bet may be saline nasal washes like Ocean or Salinex, which can clear blocked passages and help reduce swelling that makes sinuses ache. (Want to make your own rinse? Mix 1 teaspoon of table salt in a pint of water.) Menthol sprays and rubs wont drain your sinuses or clear your nose, Soller adds, but their cool, numbing sensation will make you feel better. Plus, you can use them as much like. Just remember to be respectful of anyone

At least once a year, Anna Lord, a 32-year-old from Seattle, has “almost unbearable pain” behind her eyes, cheeks, and forehead. Sometimes she has sinus drainage, and occasionally the discomfort arrives with a low-grade fever. Her symptoms often occur after she has had a cold or allergy symptoms. She rarely takes antibiotics, preferring to rest and soldier through her sickness.

Lord is prone to acute bacterial sinusitis, a form of sinus infection. Each year, about 31 million people experience sinus infections, which are usually caused by bacteria growing in the sinuses, the bony cavities found behind the nose, eyes, brows, and cheekbones. Typically, a cold or allergy attack causes mucous membranes in the sinuses to swell and block the tiny openings into the sinuses, which interferes with their ability to drain. The trapped mucus allows bacteria to breed, causing pain and pressure in the head and face.

All told, sinus infections cause 73 million days of “restricted activity” in the United States each year, according to a 1997 report from the Centers for Disease Control and Prevention. People with colds, which are caused by viruses, often mistakenly believe they have a sinus infection. While antibiotics can be helpful for those with sinus infections, they are useless when it comes to fighting cold viruses.

“The distinction can be difficult and no one rule applies to everybody,” says Neil Bhattacharyya, MD, an associate professor of otology and laryngology at Harvard Medical School, in Boston. “Only about 2% to 6% of common colds progress to become a true bacterial sinus infection that could benefit from antibiotics.”

Sinus infection or cold?
While the symptoms may be similar, there are some differences between the two conditions that can help you determine which one you have.

The main difference between the symptoms of a cold and sinus infection is how long they linger. Dr. Bhattacharyya says cold sufferers typically have a runny nose for two to three days, followed by a stuffy nose for two to three days. After that, most people begin to feel better. A sinus infection will hang around for seven days or more.

A fever may also signal a bacterial infection. As Lord can attest, sinus infections are sometimes accompanied by a low-grade fever, while colds typically are not. Other viruses (such as the flu) do cause fevers, however.

Another potentially helpful sign is the color of your nasal discharge. Unlike colds, which generally produce clear mucus, bacterial infections can produce greenish or yellow mucus. However, viruses sometimes produce colorful discharge as well, so this isnt considered a fail-safe test.

Dr. Bhattacharyya says there is no rhyme or reason as to why some people tend to develop sinus infections and others dont. But some people have nasal polyps or other problems, including allergies, which can increase their risk of chronic sinus infections.




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