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. Rhinitis (nasal inflammation) may be due to a number of causes, the most common being environmental allergies. Lifelong or developed structural problems also usually play some role in symptoms as well. We try not to focus on a “single” cause for problems as it is probably more effective in the long run to look at the relative impact of various “contributors” that may be present in you.
Nasal allergies are one of the most common disease states in this country with an overall economic impact in the billions of dollars. 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.
Advanced ENT & Allergy has a very busy Allergy department performing skin-prick testing every day of the week. Allergy testing using skin-prick or “epicutaneous” 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.
Allergy skin testing takes about an hour to perform and results are finalized right away. About 90% of patients get meaningful results (sometimes surprising) from these tests. Usually your doctor will meet with you right after the test to review the results and build a plan.
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 really not a medical allergy. We test about 24 food items that are linked to nose and throat allergies. Currently we are not offering allergy treatment for food allergies (science has not yet cracked the code for reliable food allergy treatment!)
Based on your allergy test results we will make recommendations about treatment. 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.
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.
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.