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Nasal Allergies and Sinusitis

Nasal Allergies and Sinusitis

Allergic rhinitis

Allergic rhinitis is also known as hay fever. It is very common, affecting about 1 in 5 adults in the USA. Typical signs for having nasal allergies are frequent sneezing, runny nose or stuffiness. People often complain of an irritating cough or a drip in the back of their throat. Some feel popping of their ears, itching of the ears, nose, or mouth. If the congestion gets severe, patients may have headaches. Fatigue and lack of restful sleep at night due to allergies is a major reason why people seek treatment for their allergies. These people may also experience irritability and poor school or work performance.

What are nasal allergies caused by?
Allergies result when our immune system overreacts to substances in our environment. Common triggers for seasonal allergy problems are pollen (from tree, grass, weeds) or mold spores. Indoor allergies are often caused by pet dander, dust mite or mold. Some people may experience year-round symptoms that worsen during peak pollen seasons.

Can nasal allergies lead to any further problems?
People with nasal allergies get sinus and ear infections more easily. Some patients with long-standing allergies can develop nasal polyps or they may develop asthma.

How are allergies diagnosed?
A detailed history of the particular problem is the first step, particularly asking for timing of symptoms compared with exposure to allergens. A physical exam can identify sign of allergy such as nasal congestion, post-nasal drip, polyps, etc. Skin tests can be done on children and adults and can identify the particular allergen causing the nasal allergies. Skin testing is quick and it is extremely reliable.

How can nasal allergies be treated?
There are many ways of treating allergies and each person’s treatment plan must be customized based on the frequency, severity and duration of their symptoms. The first step is to eliminate or reduce allergen exposure.

Avoidance Measures
Dust mite covers for mattress and pillow
Vacuum cleaner with HEPA filter
Air purifiers with HEPA filters
Keep car and house windows closed and use air-conditioning in the summer, if possible.
Do not hang clothing outdoors to dry because pollen may cling to towels and sheets.
Avoid strenuous activity during times of high pollen counts (highest between 5 and 10 am usually), check pollen counts at www.aaaai.org/naib

Allergic Rhinitis Treatments:

  • Antihistamines work by blocking the effects of histamine, a chemical that causes many allergy symptoms. They relieve the itching and sneezing, but are not very strong for congestion. Examples include Claritin, Zyrtec and Allegra. Older antihistamines such as Benadryl can make you drowsy, but work just as well.
  • There are also antihistamine nasal sprays, which are slightly better than oral antihistamines in treating nasal congestion (Astelin, Astepro or Patanase). Antihistamines also can be used in eye drops for allergic eye problems (Optivar, Patanol)
  • Decongestants reduce swelling in the nasal passages, opening up the airways. Oral decongestants may increase blood pressure. Nasal decongestants (like Afrin) are very efficient but should not be used for more than 3-5 days. If used beyond that short time frame, they can lead to worse congestion over time.
  • Steroid nasal sprays work by reducing the swelling in the nasal passages while also treating the itchiness, dripping and sneezing (Flonase, Nasonex, and Rhinocort).
  • Leukotriene modifiers like Accolate, Singulair, and Zyflo can help control nasal allergy symptoms.

While every other treatment for allergic rhinitis is a temporary fix, immunotherapy (allergy shots or sublingual drops) can be almost curative. Through exposure to the allergen by injection in regular intervals, the body’s immunsystem does not react allergic to the allergen anymore and becomes tolerant. It is time intensive (a full course takes five years), but usually worth the effort since allergy shots are effective in about 85% to 90% of people.

Allergic Rhinitis Self-Care
Nasal irrigation can be very effective by flushing allergens out of the nasal passages with saline. Experts say that simple neti pots or squeeze bottles seem to work as well as more expensive devices.


Sinuses are empty cavities within your cheek bones, around your eyes and behind your nose. Their main job is to warm, moisten and filter air in your nasal cavity.
If your stuffy nose and cough last longer than one or two weeks, you may have more than a cold. Sinusitis (pronounced sine-you-SITE-iss) is a swelling of one or more of your nasal sinuses and nasal passages. It is often called a sinus infection.
You may experience pressure around your nose, eyes or forehead, a stuffy nose, thick, discolored nasal drainage, bad-tasting post-nasal drip, cough, head congestion, ear fullness or a headache. Symptoms may also include a toothache, tiredness and, occasionally, a fever.
By learning more about sinusitis, you will have a better understanding of your symptoms.
An allergist/immunologist, often referred to as an allergist, can make an accurate diagnosis and develop a treatment plan that works for you.

Types and Causes of Sinusitis
Acute sinusitis refers to sinusitis symptoms that last less than four weeks. Most acute sinusitis starts as a regular cold from the common cold viruses and then becomes a bacterial infection. Chronic sinusitis is when symptoms last three months or longer. The cause of chronic sinusitis is believed to be a combination of swelling and infection. Recurrent sinusitis occurs when three or more acute episodes happen in a year.
Allergies or “hay fever” put you at risk for developing sinusitis because allergies can cause swelling of the sinuses and nasal mucous linings. This swelling prevents the sinus cavities from draining, and increases your chances of developing secondary bacterial sinusitis.
If you test positive for allergies, your allergist can prescribe appropriate medications to control your allergies, possibly reducing your risk of developing an infection. In rare cases, immune problems that harm your ability to fight common infections may present with chronic or recurrent sinusitis.
Problems with the structure of your nose-such as narrow drainage passages, tumors or a shifted nasal septum (the bone and cartilage that separate the right from the left nostrils)-can also cause sinusitis. Surgery is sometimes needed to correct these problems. Many patients with recurring or chronic sinusitis have more than one factor that puts them at risk of infection. So, an accurate diagnosis is essential.

To diagnose sinusitis, an allergist will take a detailed history and perform a physical examination. He or she may also order tests. These tests can include allergy testing or sinus CT scans (which take exact images of the sinus cavities).
Your physician may also perform an endoscopic examination. This involves inserting a narrow, flexible endoscope (a device with a light attached) into the nasal cavity through the nostrils after local anesthesia. This allows your physician to view the area where your sinuses drain into your nose in an easy, painless manner.

Sinus infections generally require a mix of therapies. Your physician may prescribe a medication to reduce blockage or control allergies, which helps keep the sinus passages open. This medicine may be a decongestant, a mucus-thinning medicine or a steroid nasal spray. If bacterial sinusitis is present, your physician may prescribe an antibiotic. For people with allergies, long-term treatment to control and reduce allergic symptoms can also help in preventing sinusitis.
Several non-drug treatments can also be helpful. These include breathing in hot, moist air and washing the nasal cavities with salt water. If you need surgery to fix the structure of your nose, your allergist may refer you to an otorhinolaryngologist, or an ear-nose-throat physician (ENT).

Sinusitis Versus Rhinitis 
Symptoms of sinusitis and rhinitis are very similar. Rhinitis is a swelling of the mucous membranes of the nose while sinusitis includes swelling of the sinuses in addition to the nasal passages. For this reason, sinusitis is often called rhinosinusitis.
Rhinitis may be allergic or non-allergic. Allergic rhinitis is caused by allergens in the air, which are usually harmless but can cause problems in allergic people. Symptoms of allergic rhinitis often are a runny nose, sneezing, nasal congestion and itchy eyes, nose, throat and ears. People with non-allergic rhinitis usually just have a stuffy nose. It may be caused by irritants such as smoke, changes in barometric pressure or temperature or overuse of over-the-counter decongestant nasal sprays.
Your allergist can perform simple tests to determine if your symptoms are from sinusitis or rhinitis. The American Academy of Allergy, Asthma & Immunology’s brochure on Rhinitis offers also more helpful advice on allergic and non-allergic rhinitis.

Healthy Tips

  • Sinusitis is a swelling of the nose and sinuses.
  • Acute sinusitis occurs when symptoms last less than four weeks.
  • Chronic sinusitis occurs when symptoms last more than three months.
  • People with allergies are at greater risk of getting sinus infections.
  • Treatment for sinusitis is available. See an allergist for help managing your symptoms.

Feel Better. Live Better.
An allergist/immunologist, often referred to as an allergist, is a pediatrician or internist with at least two additional years of specialized training in the diagnosis and treatment of problems such as allergies, asthma, autoimmune diseases and the evaluation and treatment of patients with recurrent infections, such as immunodeficiency diseases.
The right care can make the difference between suffering with an allergic disease and feeling better. By visiting the office of an allergist, you can expect an accurate diagnosis, a treatment plan that works and educational information to help you manage your disease.
 (from AAAAI.org)


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