All About Nasal Allergies

Facial pressure, drainage, obstructed nasal breathing, and sneezing are all common with sinus infections however the majority of the time there may be no infection present. We call any more form of nasal inflammation “rhinitis”, and it may be due to a number of causes, but ENVIRONMENTAL ALLERGIES are the most common cause. Structural problems, such as a deviated septum also usually cause some symptoms as well.

Allergic reactions are a type of distorted and exaggerated immune system response of the body. Our own immune system can get accidentally sensitized to normal and otherwise harmless environment triggers. Many of these triggers are proteins or molecules found in pollens, insect, mold, or even medications.

Patients with nasal allergies will feel increased nasal congestion, blockage in breathing, runny nose, postnasal drip, throat clearing, or sneezing. Many patients will feel like their throat or ears are itching. And some patients will develop asthma, chronic cough or skin conditions related to allergies.

Allergic Rhinitis

Nasal allergies are one of the most common disease states in this country. High pollen counts, high humidity and even city smog levels of areas like the Atlanta metro make rhinitis experienced by about half our population at least sometimes. Patients with allergic rhinitis will most commonly have the seasonal variant (Seasonal Allergic Rhinitis or ‘SAR’) due to allergic sensitivities of seasonal blooms of tree, grass or weed pollens. Perennial Allergic Rhinitis (‘PAR’) describes a more year-round condition due to sensitivities to mold, pet dander, cockroaches and dust mites.

Together with your examination and a history of your worst symptoms, we use cutaneous allergy testing to help sort out which environmental triggers may be the culprit at exacerbating your inflammation.

Allergy Testing

Advanced ENT & Allergy has a very busy Allergy department performing skin-prick testing every day of the week. Allergy testing using skin-prick (“scratch testing”) is the standard of care for testing airborne allergies that may be affecting your nasal and sinus health. We run a panel of several dozen common airborne allergens seen in our part of the country, including tree pollen, grass pollen, weed pollens, dust mites, animal dander and molds.

The simple epicutaneous “prick” test is usually followed by a small intradermal dosage to better specify your strength of reaction. Allergy skin testing takes about an hour to perform and results are finalized right away. Usually your doctor will meet with you right after the test to review the results and build a plan. The specific scoring from the skin testing is used in treatment planning and in formulation of allergy therapy if desired.

Allergy skin testing may be done on the arm or the back.

Food Allergies?

Yes, we do test for several food allergies. However, please understand that “food allergies” means a specific kind of medical reaction side effect to foods. Many people have various food intolerances (such as lactose intolerance or alcohol intolerance) that may cause side effects after eating something that is necessarily not a medical allergic response. We test about 24 food items that are linked to nose and throat allergies. We are testing specifically for the allergic immune response, which covers about half of the various food intolerances that exist out there. Currently we are not offering allergy treatment for food allergies (science has not yet cracked the code for reliable food allergy treatment!)

Allergy Treatment

Based on your allergy test results we will make recommendations about treatment following the Otolaryngic Allergy treatment model. Patients with mild allergies, or weak results may be recommended to continue non-specific therapy like allergy pills and nasal sprays; HEPA air purification at the office and bedroom is also very helpful. But if we are getting moderate or strong results, your doctor may talk to you about Specific Allergy Therapy.

Allergy Therapy means taking a specific recipe of what you are allergic to, at a low but continuous and increasing dosage, over a long period of time. Through a variety of mechanisms we see that the body’s abnormal immune response to the triggering allergies can be reduced. Resulting in better breathing, less sniffles and improvement in sinus infections.

Allergy Therapy – Shots or Drops?

We offer Allergy Drop Therapy (or sublingual immunotherapy SLIT) which is a treatment done on your own from home. This avoids burdensome office visits. We also offer Allergy Shot Therapy (aka subcutaneous immunotherapy SCIT) for patients willing to make the office visits and wanting an option with better insurance coverage. Both of these treatments are very effective for airborne allergens. Success is ultimately better for allergy drops because the therapy is easier to continue. At our office we do not treat insect sting allergies or peanut allergies.

We formulate a customized compound for each and every patient based on your allergy test results, real-world exposures, and accounts for chemical crosslinking that can happen between certain combinations. Our antigenic extracts are sourced from the largest pharmaceutical extract companies in the world and are of the highest standards and “freshness”. For each patient we create a unique formula on-site with over forty specific antigenic ingredient possibilities.

Not Allergies: Vasomotor Rhinitis

Many patients without nasal allergies may still get itching, sneezing, or excessive drainage from the nose. The vasomotor rhinitis condition is usually characterized by thin watery drainage from the nose in response to some uncommon triggers – like eating, brushing teeth, certain medications, certain chemical odorants, or rapid temperature change. Many patients with this condition are misdiagnosed for years as having allergies, although allergy testing and a careful discussion of symptoms will make things clear.

Not Allergies: Rhinitis Medicamentosa

A number of medications may worsen nasal symptoms as well. Most notable are the over-the-counter nasal decongestant sprays that practically become “addictive” when taken more than a few consecutive days. Less known however are medications like hormone replacement therapy and pills for erectile dysfunction. All of these medicines cause a swelling of the nasal tissues as a known side effect and can worsen the sense of nasal blockage.

Finally medications that have antihistamine-like side effects, including a number of antidepressants, neurologically-active medications, and medications for overactive bladder can produce extreme dryness in the nose (and mouth) leading to problems with the nasal lining.

Not Allergies: Purely Structural Problems

As the nasal bones and cartilages rapidly develop in the adolescent years a number of problems may occur. Structural problems may also occur from trauma or prior surgery.

The most commonly discussed is a deviated septum, where the bone or cartilage wall in the middle of the nose becomes tilted or spurred. This leads to blockage, usually worse on one side but in severe cases a person may have “serpiginous” deviation that essentially blocks both sides.

Over-growth of the turbinates (‘turbinate hypertrophy’) is probably the single most common problem contributing to nasal blockage. The turbinate tissues are small cylindrial structures in the nose with a bony core and a soft tissue lining. The bony core may be enlarged due to hereditary factors, whereas the soft tissue may be enlarged due to allergies or certain medications.

Nasal valve collapse or stenosis is a problem affecting the openings of the nostrils that may limit airflow. We break down collapse by using classifying the collapse as internal vs external, and dynamic vs static. Failure to address valve collapse thoroughly is the most common finding when we evaluate patients who have had an unsuccessful septoplasty elsewhere.

A slew of other less common nasal conditions such as nasal polyps, concha bullosa, accessory sinus ostia, choanal atresia, cicatrix, and others are also structural causes of nasal issues that we assess in the office at your visit.