Is It Allergies or a Sinus Infection?
Do you ever wonder if it's allergies or a sinus infection? Sometimes it's easy to sort out but most of the time it isn’t because the symptoms of allergies and sinusitis overlap. To further confuse things, uncontrolled allergies make you more susceptible to sinus problems and may lead to recurrent or chronic infections. Allergies are the sixth leading cause of chronic illness in the U.S. (2) We offer allergy testing to help determine how much of your problem is allergy related.
What Are Nasal Allergies?
When you are allergic to something, your immune system produces substances known as IgE antibodies to components of our environment that are harmless. (3) These antibodies are used to misidentify the harmless substances as forgien invaders meant to do you harm. Examples of substances, also known as allergens, are dog dander, cat dander, dust mites and for us South Texans MOUNTAIN CEDAR (4). When you come into contact with the allergen, your immune system overreacts and attacks the allergen by releasing inflammatory hormones that send signals to immune cells to help fight off the harmless substances(7). The most abundant hormone is Histamine(5), which is why antihistamines (medications that block histamine) such as Zyrtec™, Claritin™, Allegra™, etc., help treat allergy symptoms. The immune response causes inflammation and mucus production, which can cause the following symptoms.
Symptoms of Allergies
- Post-nasal drip
- Itchy, watery eyes
- Irritation of the nose and throat
- Dark circles under the eyes
- Sinus pressure
An allergy skin test is used to identify the substances that are causing your allergy symptoms. We apply several common allergens to the skin with a device (Comfort 10) that abrades the skin and then is observed for a reaction. (6) We then measure the reaction/s and record the results. The testing is done on your forearms and takes 20 minutes. You must stop taking antihistamines at least seven days prior to the test, otherwise your test may be falsely negative (antihistamines block the response to allergens). You should expect some itching at the site much like a mosquito bite. The test is almost completely painless, we do not use needles and allergy testing is covered by most insurance plans.
Treatment for Allergies
There are several treatment options for allergies.. First line therapy for treating nasal allergy symptoms includes avoidance and medications. For those with more severe allergies and who have allergies all year, desensitization should be considered, either subcutaneous immunotherapy (allergy shots) or sublingual immunotherapy (allergy drops) are the two methods available.
There are several types of allergy medications that are commonly used to treat allergy symptoms. If you have ever been in the allergy section of your local pharmacy it can be overwhelming and confusing. There is no easy way to navigate through all of the options at the pharmacy, but knowing what each medication does can help you decide. There are also several apps and online resources available that can help you choose which medication is right for your symptoms. One application that we recommend often is OTCMe(8). It is an excellent source of information regarding OTC drugs, the symptoms they treat, and helps you find the best prices in your area. Below is a summary of the medications commonly used to treat allergies.
- Nasal Steroids Sprays - Out of all the allergy medications to help manage symptoms, nasal steroids are the most effective. Inflammation in the nose and sinuses causes the majority of symptoms our patients complain about such as sinus congestion, pressure, trouble breathing through the nose, and sinus headaches. Medications that can target as many of the inflammatory hormones as possible will offer the best relief of symptoms, in this case it is a nasal steroid. Nasal steroids act on the following inflammatory hormones: histamine, prostaglandins, cytokines, tryptases, chemokines, and leukotrienes (13). Because nasal steroids can take up to a week for peak effectiveness, they are best used on a daily basis as a preventative measure, as opposed to only using one when you have symptoms. They are safe to take long-term and have little to no side effects if used as directed. They are also now very easy to obtain because they are over-the-counter and can be found at your local pharmacy or drugstore. Examples of these sprays are Flonase™, Nasacort™, Sensimist™, and Rhinocort™. (14)
- Antihistamines (9) - Histamine is the major hormone responsible for allergic reactions. When someone with allergies comes into contact with their allergen, such as Mountain Cedar, histamine is released by cells in your body called mast cells (10). This is done to activate the immune system because your body thinks your allergen is trying to harm you so it initiates an immune response to fight the allergen. This histamine release is responsible for the itchy, sneezing, runny nose and watery eyes symptoms. Antihistamines, such as Claritin™, Allegra™, Zyrtec™, Xyzal™, Benadryl™, etc., reduce symptoms by blocking histamine from binding to its receptor.
- Antileukotrienes - A leukotriene is another hormone that causes symptoms in patients with allergies. It is usually more of a problem in patients with chronic allergies and asthma. Leukotrienes are released from mast cells, basophils and eosinophils. The release of leukotrienes cause airway constriction (a narrowing of the airways), increased mucus production, swelling and inflammation in the lungs. This causes symptoms such as wheezing, cough, post nasal drip and shortness of breath. An example of an antileukotriene is Singulair™ or montelukast. (11, 12)
- Nasal Antihistamine Sprays and Antihistamine Eye Drops - Like oral antihistamines, these spray/drops target histamine except they are directly sprayed in the nose or dropped in the eyes. They work very well on itchy, sneezing, watery eyes, post nasal drip and runny nose symptoms. They often do not have the adverse side effects of oral antihistamines, such as drowsiness or dry mouth. Some examples of these include Astelin™ (azelastine), Patanase™ (olopatadine), Pataday™, Pazeo™ or Patanol™. An important note, is that these medications must also be stopped prior to allergy testing. Even though their systemic effect is minimal, it may be enough to blunt your allergy response upon testing. These sprays and drops are very effective on acute symptoms, so you may not need to take these on a daily basis to get the full effect. But remember — prevention is always a better approach.
- Nasal Decongestants and Oral Decongestants - These medications work on the blood vessels in the nose if sprayed, and all over the body if taken orally. They work by constricting (shrinking) blood vessels in an effort to make the tissue in the nose less inflamed. This makes the swelling that occurs in an allergic reaction less noticeable. The effects of these drugs are temporary and do not help with the underlying causes of swelling like the other drugs mentioned. It is best to reserve these medications for as-needed use when your symptoms are uncontrolled by other allergy medications. Using decongestants for more than three-to-four days may cause a nasal mucosal addiction. The most common drug to cause this is products like Afrin™ (oxymetazoline) or Neo-Synephrine™ (phenylephrine). If decongestants are used longer than four days, the nasal mucosa can become reliant (addicted) to the medication and when not in use, rebound congestion occurs that is often worse than the original symptoms.
Sublingual Immunotherapy (known as Allergy Drops)
Sublingual immunotherapy, commonly known as “allergy drops” are an alternative to allergy shots. We have been using allergy drops to treat patients since 2007. Allergy drops are done in the convenience of your own home. Allergy drops are placed under the tongue daily. The big advantages are the time savings in not having to come in to the office and get shots as well as the cost savings of not paying for the shot administration. Allergy drops are the safest form of immunotherapy. We follow the AAOA practice and mixing recommendations (16). The crops are custom-made for you in our office. Although not currently covered by insurance, we offer affordable pricing. You can also use your Healthcare Spending Account (HSA) accounts to pay for the drops.
Subcutaneous Immunotherapy (known as Allergy Shots)
Subcutaneous immunotherapy, commonly referred to as “allergy shots” is the most common form of Immunotherapy performed in the U.S. Allergy shots are given weekly in our office. Most insurance cover allergy shots, although each insurance is different and will be verified. We follow the AAOA mixing standards. (16) The injection agent is custom-made for you in our office.Allergy shots are a very effective and safe way to control your allergy symptoms.
When Allergy Patients Have Surgery
Managing allergies is one of the most important things you can do to ensure that your sinus surgery is successful in the long term. Most patients that we see in our clinic have tried and failed many types of allergy treatment. Reasons for failure vary but may include:
- Patients using the wrong medication
- Patients do not have true allergies verified by allergy testing
- Patients have a chronic sinus infection that never goes away
- Patients have anatomical issues with their nose
- Or all of the above
Most patients who have surgery will have such a big improvement in their symptoms, they often forget to treat their allergies. At Atkins Expert Sinus Care, we treat sinus problems and we understand the importance of managing allergies in order to keep your sinuses healthy. After surgery even thought you may be feeling better if allergies are not controlled, the process of inflammation caused by allergies may reverse the improvement the patient gained post-surgery. A very common statement that we hear from patients is, that they had surgery years ago, but it "didn't work". If you have allergies and you have had or are going to have sinus surgery, you should consider following an aggressive allergy treatment plan. Maintenance and prevention are the best approaches when caring for your sinuses.
People with sinus problems fall into several categories. Many of the patients we see are treated for a short time, recover and never need to see us again. Others with underlying allergy or sinus disease problems are able to get back on track with a course of sinus medicine such as antibiotics and take medicine daily to stay well. Remember, our goal is to make you feel better without surgery. About 25 percent of our new patients have surgery in our office and the majority (93 percent) of patients who do undergo balloon sinuplasty report doing well years later. For others, staying well after surgery may require continuing to use medication in order to optimize surgery results. Uncontrolled allergies causes inflammation in the sinus passages which lead to symptoms such as infections, congestion, trouble breathing and sleeping.