ALLERGY, ALLERGIC RHINITIS – HOW AND WHY ?
Insight into causes, treatment, and prevention of allergies and hay fever
Allergy tests: This is the method where the patient can find out the actual cause for his problems and hence considered most relevant.
To undergo this you have to avoid all cough cold allergy medicines for one week. However nose , chest sprays, inhalers and antibiotic tablets can be taken . It takes 30 minutes to find out the culprits from a list of 40 air borne and food allergens .
Hay Fever:
It is defined as symptoms of runny nose, itchy eyes and throat, uncontrollable sneezing and sometimes itching of the skin. It is caused by allergy to inhaled materials and not by hay or by fever. This is also termed seasonal allergic rhinitis.
Causes:
Many seasonal “colds” are called as allergic rhinitis and will not respond to antibiotics. Seasonal allergic rhinitis is caused by sensitivity to pollens grass, dust particles or animal dander, mold spores, secondhand cigarette etc., when they come into contact with the lining of the nose, eyes, or throat. The body’s immune system recognizes their presence and starts a reaction to prevent their invasion. In most people this is not a problem. In some the immune system is overactive and identifies normally harmless particles as dangerous, producing an excessive reaction that actually causes inflammation. This is known as allergy and the substances causing it are called allergens. People are allergic to only certain substances, and the reaction does not usually appear until after several exposures to that substance.
Skin prick test for determining reasons for allergy.
CT Scan of patient with long standing allergy. Important: Any patient with untreated allergy will get a postive CT like this unless they are put on anti-allergy will get a postive CT like this unless they are put on anti-allergy medications for 30-45 days. Post treatment CT is only of value in treatment decision making.
Pollen Allergens:
| Early springtime | Late springtime | Colourful |
|---|---|---|
| Hay fever is caused by pollens For example: Trees such as elm, maple, birch, poplar, beech, ash, oak, walnut, sycamore, cypress, hickory, pecan, cottonwood and alder. |
Late springtime pollens from grasses. For example: Timothy, orchard, red top, sweet, vernal, Bermuda, Johnson and some blue grasses. |
Colorful or fragrant flowering plants rarely cause allergy because their pollens are too heavy to be airborne. |
Certain allergens are always present.These include house dust, household pet, Parthenium pollen, danders, foods, wool, various chemicals used around the house, and more. Symptoms are frequently worse in the winter when the house is kept closed.
Mold spores cause as many allergy problems as pollens. Molds are present all year long, and grow outdoors and indoors. Dead leaves and farm areas are common sources for outdoor molds. Indoor plants, old books, bathrooms, and damp areas are common sources of indoor mold growth. Molds are also common in foods, such as cheese and fermented beverages.
Can Allergies Be Serious?
Yes, Allergic patients show reduced resistance to respiratory infections, and more severe symptoms when infections occur. Allergies are rarely life- threatening, but often cause lost work days, decreased work efficiency, poor school performance, and a negative effect on the enjoyment of life. Considering the millions spent in anti-allergy medications and the cost of lost work time, allergies cannot be considered a minor problem.
ENT Specialist examination:
The ENT specialist (otolaryngologist) will do a complete examination of the ears, nose, throat, head and neck. Careful evaluation of the sinuses will enable him to determine if infection or structural abnormality (deviated septum, polyps) are contributing to symptoms.
Treatment:
- A number of medications are useful in the treatment of allergy including antihistamines, decongestants, cromolyn, and cortisone-type preparations.
- The medical management of allergy also includes counseling in proper environmental control.
- Based on a detailed history and thorough examination, the doctor may advise testing to determine the specific substances to which one is allergic. The methods employed by the otolaryngologists will indicate the materials to which one is allergic, and the degree of sensitivity to them.
- The only “cure” available for inhalant allergy is the administration of injections that build up protective antibodies to specific allergens (pollens, molds, animal danders, dust, etc.).
The physician will oversee the progress throughout the course of treatment and care for any other nasal and sinus disorders that may contribute to symptoms.
Prevention Tips:
- Wear a pollen mask or 4 times folded cotton cloth kept moist when mowing grass or house cleaning.
- Clean the air filters monthly in heating and air conditioning systems, and/or install an air purifier.
- Keep windows and doors closed during heavy pollination seasons.
- Rid the home of indoor plants and other sources of mildew.
- Don’t allow dander producing animals (i.e. cats, dogs, etc.) in the home.
- Change feather pillows, silk cotton mattresses, woolen blankets, and woolen clothing to cotton or synthetic materials.
- Enclose mattress, box springs and pillows in plastic barrier cloth.
- Use antihistamines and decongestants as necessary and as tolerated.
- Sleep with the head of the bed tilted upwards. A brick or two placed under bedposts at the head of the bed helps relieve nasal congestion.
- Observe general good health practices; exercise daily, stop smoking, avoid other air pollutants, eat a balanced diet, and supplement diet with vitamins, especially C.
- Consider a humidifier in the winter as dry, indoor heat aggravates many allergies, but beware of possible mold growth in the humidifier.
- Discuss hay fever and allergy symptoms with the physician when experiencing an allergic reaction.
Treatment:
As the problem cannot be removed by any known means one has to use preventive steps and daily preventive topical medication life long.
Pollen allergies may be controlled by use of steroid drops or sprays . Allergy to cotton dust or other substances resent at all times will req regular dosing of topical medication.
It is important that one avoids use of decongestant drops like otrivin etc as they may cause further damage to the nasal membranes. Anti histamine tablets like allegra ,allaspan or zyrtec
Need to be used occasionally in severe cases up to 2 months in a year. Left untreated polyps and infective sinusitis may arise requiring operative treatment. If the nasal septum is grossly bent
It is necessary to correct the septum and if the small ethmoid sinuses are blocked fess surgeries may be reqd.cysts arising within the maxillary sinuses may req attention but are generally innocuous.