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Direct Answer
Starting a structured nasal care routine two weeks before your first allergy appointment can significantly improve your consultation outcome. This protocol uses saline nasal irrigation and proper nasal corticosteroid technique to reduce baseline inflammation, making it easier for your allergist to assess your true allergy burden rather than acute congestion. Follow the day-by-day schedule below, then book your appointment with a board-certified allergist at HeyAllergy—no waitlist, no referral needed.
Why a Pre-Visit Nasal Protocol Matters
When you arrive at your first allergy appointment with two weeks of structured nasal care behind you, three things happen:
1. Your allergist sees your real baseline. If you show up during an acute flare with completely blocked nasal passages, your allergist is evaluating a crisis—not your typical daily pattern. The protocol reduces acute inflammation so your visit captures your true chronic symptom burden.
2. You become a better historian. Tracking symptoms daily for 14 days forces you to notice patterns you might otherwise miss. Does congestion peak in the morning (dust mite exposure at night) or evening (outdoor pollen exposure during the day)? Is one nostril consistently worse (possible structural issue)? Your telemedicine allergist uses these details to make targeted treatment decisions.
3. You start treatment earlier. The saline irrigation and nasal spray techniques in this protocol are the same ones your allergist will recommend. By starting before your visit, you are already two weeks into first-line treatment when your consultation happens.
The Two-Week Protocol: Day-by-Day Schedule
What You Need (Total Cost: $15–$30)
- Saline nasal irrigation kit: A squeeze bottle system (NeilMed Sinus Rinse or similar) with pre-mixed saline packets. Cost: ~$12–$15. Available at any pharmacy without a prescription.
- Nasal corticosteroid spray: Fluticasone (Flonase) or triamcinolone (Nasacort). Both are available over the counter. Cost: ~$12–$20. If you already have a prescription nasal spray, use that instead.
- Symptom diary: A notebook, phone notes app, or the printable tracker below.
Days 1–3: Saline Foundation
Goal: Establish the saline irrigation habit and clear accumulated mucus and allergens.
Morning routine:
- Perform saline nasal irrigation with 240 mL (8 oz) of saline solution per side. Lean over the sink, tilt your head slightly forward, and gently squeeze the bottle into one nostril. The solution flows through the nasal cavity and exits the other nostril. Repeat on the other side.
- Blow your nose gently afterward. Wait 5 minutes before using any nasal spray.
Evening routine:
- Repeat saline irrigation before bed.
- Record your symptom scores in the diary: congestion (0–10), sneezing frequency, post-nasal drip (0–10), sleep quality (0–10).
Do NOT start nasal corticosteroid spray yet. Saline alone for the first 3 days clears the nasal passages so the spray can reach the nasal mucosa effectively when you add it on Day 4.
Days 4–7: Add Nasal Corticosteroid Spray
Goal: Begin reducing nasal inflammation with proper spray technique.
Morning routine:
- Saline irrigation first (same as Days 1–3).
- Wait 5 minutes for nasal passages to drain.
- Apply nasal corticosteroid spray using the correct technique (see detailed instructions below).
Evening routine:
- Saline irrigation.
- Second dose of nasal corticosteroid spray if your product label directs twice-daily use. (Fluticasone: 2 sprays per nostril once daily. Triamcinolone: 2 sprays per nostril once daily. Check your specific product.)
- Record symptom scores.
What to expect: Nasal corticosteroids take 3–7 days to reach full effect. You may not notice much improvement during this phase. This is normal—the medication is gradually reducing inflammation at the cellular level.
Days 8–14: Full Protocol + Pattern Tracking
Goal: Maintain the full routine and identify your symptom patterns for your allergist.
Daily routine (continue through Day 14 and beyond):
- Morning: Saline irrigation → wait 5 minutes → nasal corticosteroid spray.
- Evening: Saline irrigation → nasal spray if twice-daily → symptom diary entry.
Pay attention to these patterns:
- Are mornings or evenings worse? (Morning = nighttime allergen exposure like dust mites. Evening = daytime outdoor allergen exposure.)
- Do symptoms change on weekdays vs. weekends? (May indicate workplace allergen exposure.)
- Is one nostril consistently more congested? (Possible deviated septum or nasal polyp—your allergist will want to know.)
- Did symptoms improve with the protocol? By how much? (Gives your allergist data on corticosteroid responsiveness.)
Correct Nasal Spray Technique
Research published in the Journal of Allergy and Clinical Immunology: In Practice shows that over 70% of patients use nasal sprays incorrectly, which can reduce effectiveness by half or more. Here is the evidence-based technique:
Printable Symptom Tracker
Use this template to record your daily symptoms. Bring it to your first allergy appointment or have it ready to share during your telemedicine video call.
Scoring guide: 0 = no symptoms, 10 = worst possible. For sleep quality: 0 = terrible sleep, 10 = perfect sleep. Track sneezing as an actual count. In the Notes column, record anything relevant: weather changes, new exposures, medications taken, activities.
Medications: What to Continue vs. What to Ask About
The key advantage of HeyAllergy’s telemedicine approach: We use blood allergy testing (specific IgE), not skin prick testing. This means you do NOT need to stop any medications before your visit. Continue everything you are currently taking. Your allergist will review your full medication list during your consultation and make any adjustments afterward.
What to Prepare for Your First Visit
Beyond the nasal protocol, bring or have ready for your telemedicine video call:
- Your completed 14-day symptom diary (screenshot or have it on screen to share)
- Current medication list with doses and frequencies
- Your allergy history: When did symptoms start? Seasonal or year-round? Any known triggers? Family history of allergies or asthma?
- Previous allergy test results if you have them (even if they are years old)
- Insurance information: HeyAllergy accepts Medicare and most major PPO plans. Have your insurance card ready. Tax ID for verification: 85-0834175.
- Questions you want answered: Write them down. Common first-visit questions include “What am I allergic to?”, “Are allergy drops right for me?”, and “How long until I feel better?”
When to See an Allergist
You do not need to wait for the perfect moment. Book your appointment now and start this protocol today if:
- You have chronic nasal congestion, sneezing, or post-nasal drip lasting more than 4 weeks
- Over-the-counter allergy medications are not providing adequate relief
- You have never been allergy-tested and want to identify your specific triggers
- Your symptoms interfere with sleep, work, or daily activities
- You want to discuss long-term treatment options like sublingual immunotherapy (SLIT) that address the root cause of your allergies
- You have asthma symptoms that may be triggered by allergies
Frequently Asked Questions
Do I need to stop allergy medications before my first visit?
No. HeyAllergy uses blood allergy testing (specific IgE), which is not affected by antihistamines or any other allergy medications. Continue all your current medications. Only skin prick testing requires stopping antihistamines 5–7 days prior, and HeyAllergy does not use skin prick testing for telemedicine consultations.
Why start saline irrigation before adding nasal spray?
Saline irrigation for the first 3 days clears accumulated mucus, allergens, and crusting from the nasal passages. This allows the nasal corticosteroid spray to directly contact the nasal mucosa when you add it on Day 4. Studies show that saline pre-rinse improves nasal corticosteroid delivery by 30–40%, which means better symptom control from the same medication dose.
What if my symptoms get worse during the protocol?
Mild stinging during initial saline irrigations is normal and resolves within a few days. If you develop nosebleeds from the nasal spray, you are likely aiming at the septum—review the technique guide above and aim toward the outer wall. If symptoms significantly worsen or you develop new symptoms like facial pain, fever, or green/yellow discharge, these may indicate a sinus infection. Book your appointment sooner rather than waiting the full 14 days.
Can I start this protocol if I’m already on allergy medications?
Yes. If you already take an oral antihistamine, continue it. If you already use a nasal corticosteroid spray, this protocol will help you optimize your technique (most patients use incorrect technique). If you already do saline irrigation, great—adding the symptom diary is the key new element that makes your first visit more productive.
How long should I continue the protocol after my appointment?
Continue indefinitely. Saline irrigation and proper nasal corticosteroid technique are foundational treatments for allergic rhinitis recommended by the AAAAI. Your allergist may modify doses or add medications based on your test results, but the core routine of irrigate → spray → track remains effective long-term. If you start HeyPak® allergy drops (SLIT), the nasal protocol supports your immunotherapy by keeping inflammation controlled while your immune system gradually builds tolerance.
Is the two-week nasal protocol required before my HeyAllergy appointment?
No, it is not required. You can book your appointment anytime—even today. However, patients who complete this protocol before their first visit consistently have more productive consultations because they arrive with specific symptom data and optimized nasal care. Think of it as getting the most value from your appointment time.
Author, Review and Disclaimer
Author: Krikor Manoukian, MD, FAAAAI, FACAAI — Board-Certified Allergist/Immunologist
Bio: Dr. Manoukian is a board-certified allergist/immunologist with over 20 years of experience. He leads HeyAllergy’s clinical team and specializes in telemedicine-enabled allergy care and personalized sublingual immunotherapy programs.
Medical Review: HeyAllergy Clinical Team (Board-Certified Allergists/Immunologists)
Disclaimer: This article is educational and not a substitute for personalized medical advice. This protocol uses over-the-counter products and is appropriate for most adults with nasal allergy symptoms. Consult your healthcare provider if you have a history of nasal surgery, recurrent nosebleeds, or other nasal conditions before starting.
References
- Hermelingmeier KE, et al. Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis. American Journal of Rhinology & Allergy. 2012;26(5):e119-e125.
- AAAAI, Rhinitis Management Guidelines. AAAAI
- Benninger MS, et al. Techniques of intranasal steroid use. Otolaryngology–Head and Neck Surgery. 2004;130(1):5-24.
- Seidman MD, et al. Clinical practice guideline: allergic rhinitis. Otolaryngology–Head and Neck Surgery. 2015;152(1 Suppl):S1-S43.
