| Q. |
What
percentage of sinus patients also have some allergies?
|
| A. |
According
to a recent report, allergic rhinitis is an underlying condition
in 56% of patients with chronic rhinosinusitis. (McNally PA,
White MV, Kaliner MA. Sinusitis in an allergist's office:
analysis of 200 consecutive cases. Allergy Asthma Proc 1997;
18: 169-76. From my own practice, I believe this is a pretty
accurate percentage. It is absolutely essential to treat allergy-rhinosinusitis
patient for both conditions at the same time in order to provide
the best patient outcomes. A pure surgical or pure medical
approach may not be the best therapy.
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| Q. |
Why
is there an overlap in the allergy and sinus conditions?
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| A. |
There
is an overlap in these conditions because allergic rhinitis:
1) produces mucosal edema that may obstruct the outflow tract,
resulting in stagnation of secretions and overgrowth of bacteria,
or rhinosinusitis; 2) a reduction in mucociliary clearance
is seen in perennial allergies-poor evacuation of secretions
can produce the effects seen in (1) as well.
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|
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| Q. |
Are
there any kinds of allergies you see connected to sinus
conditions more frequently than others?
|
| A. |
Perennial
allergies seem to predispose patients to chronic sinus disease
due to the constant swelling/inflammation taking place in
their nose/sinus outflow tracts. Dust allergy seems to be
a particularly bothersome one, though the high prevalence
of dust allergy might make it appear frequent anyway. Mold
allergy is associated with allergic fungal rhinosinusitis.
Seasonal allergies alone can precipitate an acute rhinosinusitis
event, though these patients typically can be treated successfully
medically with attention to the acute infection (i.e., antibiotics),
and perhaps more importantly, their underlying allergies (e.g.,
ragweed, grass).
|
|
|
| Q. |
How
does this connection manifest itself in systems?
|
| A. |
Patients
with allergy symptoms frequently complain of nasal congestion,
clear rhinorrhea, itchy eyes/nose, and watery eyes. The eye
complaints frequently help to differentiate an allergic rhinosinusitis
patient from a non-allergic rhinosinusitis patient. When the
nasal discharge changes to yellow, green, or brown, and the
patient's symptom complex worsens (i.e., new onset/worsening
of major and/or minor symptoms of rhinosinusitis: see www.entnet.org
for listing), then an infection has possibly complicated their
condition. A physical examination, possibly involving an endoscopic
evaluation, is then warranted. A CAT scan might be needed to
help diagnose the condition as well. |
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|
| Q. |
If
I have early morning sinus headaches, is it possible there is
an allergy component? |
| A. |
Yes.
Patients with morning complaints frequently are found to have
a dust allergy. The patient is lying on a pillow and mattress
that are literally crawling with dust mites; the patient breathes
the dust allergens all night and wakes up with symptoms. Keep
in mind though that morning headaches are also associated
with obstructive sleep apnea, a potentially life threatening
condition.
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| Q. |
How
would I know the difference between a real sinus headache and
one caused by allergies? |
| A. |
A reasonable home approach would be to treat the headache and
to see what improves the condition. Antihistamines, available
over the counter, would provide an allergy patient some relief.
A decongestant (oral or topical) would improve a headache that
is of nasal origin (i.e., allergies, sinus disease, etc.). Non-steroidal
anti-inflammatory medications will provide pain relief for any
of these situations, but work best in cases of tension headache.
Of course, allergy evaluation and testing is a successful way
to identify the cause of headache.
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|
| Q. |
Do
patients with an overlapping sinus-allergy condition suffer
from congestion and headaches worse during the pollen season? |
| A. |
Yes.
Their particular allergy season will intensify their underlying
symptoms associated with chronic rhinosinusitis. This is due
to the edema and inflammation associated with pollen exposure.
|
|
|
| Q. |
If
I am allergic to indoor allergens-mold , dust-mites , dander
and the like, does a Hepa filter in the bedroom prevent
a sinus headache?
|
| A. |
A
HEPA filter is a useful adjunct in allergen reduction/avoidance.
This is the first tier of allergy treatment (i.e., (1) avoidance,
(2) pharmacotherapy, (3) allergy immunotherapy). HEPA filters
are best used in a room that has had maximal allergy reduction
techniques employed already. HEPA filters clear lighter allergen
particles better than heavier ones that may not float far enough
to be "sucked into" the filter (e.g., cat dander may be cleared
more effectively than dust mite allergen). |
|
|
| Q. |
Do
you see sinus headaches effected by weather of menstrual cycles? |
| A. |
The
weather can affect sinus headaches: pressure changes may not
be able to be quickly equalized in a patient with minimal egress
for the air within the sinuses caused by allergies or sinus
disease. This is referred to as osteomeatal obstruction. Unequal
pressure leads to pressure/pain symptoms that mimic an acute
rhinosinusitis; this is sometimes called barosinusitis. These
patients have particular problems while flying: the descent
is painful, as the pressure within the sinuses becomes more
negative. Spraying the nose with oxymetazoline prior to the
descent or flight will help these symptoms. If medical measures
do not sufficiently control the symptoms, then surgery may be
warranted. The menstrual cycle can affect a sinus headache as
the body cycles through water retention; this may lead to increased
edema at the osteomeatal complex region within the nose, and
intensify underlying symptoms. |
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|
| Q. |
If
allergies are a disease of a compromised immune system how do
you recommend to your patients they build up their immune system? |
| A. |
Allergy
patients actually have an "overactive" immune system, but it
is figuratively "wasting time and energy" to fight non-threatening
items (i.e., pollen grains). Allergy patients have a shift in
their T helper cell profiles from Th1 (fight infection) to Th2
(promote allergic disease). We do not understand why this shift
takes place, though it seems to be genetic along with other
factors. Nor do we understand fully how to shift the process
back. Allergen immunotherapy may help to blunt the Th2 response.
The average American diet provides enough of the RDA to avoid
deficiency diseases, such as scurvy, but it probably does not
provide enough nutrients of the proper levels. The overfarming
of land with minimal replacement of micronutrients within the
soil compound this issue. The food that our grandparents ate
provided them with more nutrients than a similar meal today.
I believe everyone should take a multivitamin with vitamins
C, E, B complexes, micronutrients, and antioxidants. We should
reduce our use of trans-fatty acids while switching to more
polyunsaturated fats. I cannot claim any significant training
in this area, but this is a personal conviction. A reliable
source for hypoallergenic nutritional supplement is: Biotech:
800-345-1199; www.BIO-TECH-PHARM.com. I have no financial interest
in this company; they are simply the company I buy supplements
from for my (presently pregnant) wife and myself. |
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|
| Q |
Any
general treatment or preventative suggestions for allergy and
sinus sufferers? |
| A. |
The
nutritional information above is valuable for anyone, allergic
or not. Avoidance techniques are a useful adjunct in allergy
care, and in mild cases, may be all the treatment that is necessary.
Find a physician that will spend the time necessary to evaluate
your individual situation, and who will work with you to define
an individualized treatment plan. Antihistamine X may not be
the right medication for everyone; an allergist (either otolaryngic
allergy or general allergy) understands the nuances of the drugs
to pick and choose appropriately. Do not present to a physician
when your symptoms have become unbearable; the benefits of therapy
will take some time to manifest. |
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Visit
Dr. Houser's web
site.
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