Post details: The Allergy-Sinus Connection


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The Allergy-Sinus Connection

What percentage of sinus patients also have some allergies?

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.

Why is there an overlap in the allergy and sinus conditions?

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.

Are there any kinds of allergies you see connected to sinus conditions more frequently than others?

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).

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 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.

Q. If I have early morning sinus headaches, is it possible there is an allergy component?

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.

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.

Dr. Steve Houser



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