Introduction - What is sinusitis?
Sinusitis is an infection or inflammation of the nasal sinuses. This inflammation starts when viruses or bacteria infect one’s sinuses. Due to this infection, excessive mucus builds up and irritates the sinuses. The lack of a proper passage to drain this extra mucus, leads to one’s nose to be blocked or stuffy.
One may develop a short-term or acute sinusitis, triggered by bacterial infection such as the common cold. However, untreated allergies, abnormal nose structures, nasal polyps or smoking can give rise to long-term or chronic sinusitis in one.
Allergy testing for sinusitis is performed by an ENT specialists to check whether an allergen is a trigger of frequent sinus infections in one.
What are the symptoms of sinusitis?
The symptoms of sinusitis can be listed as:
- Green or yellow nasal discharge
- Postnasal drip
- Facial pain or pressure
- Blocked nose
- Runny nose
- Sore throat
- Bad breath
- Diminished sense of smell and taste
- Ear pressure or pain
What causes sinusitis?
Sinusitis can be caused by:
- Common cold
- Flu (influenza)
- Streptococcus pneumoniae bacteria
- Haemophilus influenzae bacteria
- Moraxella catarrhalis bacteria
- Nasal allergies
- Seasonal allergies
- Nasal polyps
- Deviated nasal septum
- Cystic fibrosis
What is allergy?
An allergy arises when one’s immune system reacts to a foreign body or substance. One’s immune system is known to produce a substance called antibodies. When one has an allergy, his/her immune system produces antibodies that recognize a specific allergen as dangerous, even though it is not. On coming into contact with the allergen, one’s immune system can react by stimulating his/her skin, sinuses, airways or digestive system.
What are the symptoms of allergy?
The symptoms of allergy mostly depend on the substance involved. It tends to affect one’s airways, sinuses, nasal passages, skin and digestive system. Allergic reactions generally range from mild to severe. In certain critical cases, allergy can cause a life-threatening reaction termed as anaphylaxis.
- Itching (nose, eyes or roof of the mouth)
- Runny nose
- Stuffy nose
- Watery eyes
- Red eyes
- Swollen eyes
- Prickling in the mouth
- Swelling (lips, tongue, face or throat)
- Swelling (edema) at the sting site
- Itching all over the body
- Chest tightness
- Itchy skin
- Facial swelling
- Itchy skin
- Redness of skin
- Flakes or peeling of skin
- Loss of consciousness
- Drop in blood pressure
- Severe breathlessness
- Skin rash
- Rapid pulse
- Weak pulse
What causes allergies?
The causes of allergies are:
- Airborne allergens – pollen, pet dander, dust mites and molds
- Specific foods – peanuts, tree nuts, wheat, soy, fish, shellfish, eggs and milk
- Insect stings – from a bee or wasp
- Medications – specially penicillin or penicillin-based antibiotics
- Latex or other substances one touches
How is sinusitis related to allergy?
Allergy can trigger chronic inflammation of the sinus and mucus membranes. This inflammation occurs, as the passages of the nose and sinuses try to flush out allergens. Allergens are usually described as anything one is allergic to. Some examples of allergens are pollen, pet dander, mold or dust mites. Since this inflammation obstructs the drainage of mucus from the sinus chamber, it increases the possibilities of developing bacterial sinusitis. Hence, if one has allergies, he/she is likely to suffer from sinusitis.
What is allergic rhinitis?
Allergic rhinitis also known as hay fever, is an allergic reaction to microscopic particles in the air termed as allergens. When one breathes in allergens through nose or mouth, his/her body reacts to it by releasing a natural chemical called histamine.
Various indoor and outdoor allergens are known to cause allergic rhinitis. Some of the common causes include pollen from trees, grass and weeds, house dust mites, pet dander, mold, wood dust, flour dust and latex.
In most cases, one tends to inherit allergies from a parent or family member with allergies. Also one who has asthma or eczema is likely to develop allergic rhinitis.
What are the symptoms of allergic rhinitis?
The symptoms of allergic rhinitis are:
- Nasal stuffiness or congestion
- Runny nose
- Itchy (nose, throat or eyes)
- Sinus pain
- Dark circles under the eyes
- Increased production of mucus (in nose and throat)
- Sore throat
- Postnasal drip
- Breathing trouble
What causes allergic rhinitis?
The causes of allergic rhinitis can be listed as:
- Dust mites
- Pollen from trees, grass and weeds
- Pet dander
- Mold spores
- Wood dust
- Flour dust
How is allergy testing for sinusitis done?
If one’s ENT specialist suspects allergy to be accountable for one’s sinusitis, then he/she may be suggested to undergo an allergy test for allergic rhinitis. Even though one’s medical history is crucial for diagnosis, the exact detection of the allergens is carried out through auxiliary diagnostic tests.
Prior to undergoing these tests, one must refrain from taking certain medications like antihistamine (loratadine, chlorpheniramine, cetirizine, etc), corticosteroids (prednisone, cortisone, methylprednisolone, etc) and antidepressants to prevent errors in the diagnosis.
These tests are essential for identifying or ruling out the allergens causing rhinitis. In addition to this, allergy tests also permits the ENT specialist to come up with a specific treatment.
Skin tests are very useful in identifying allergens that cause reactions in one. Taking into consideration that not all rhinitis are allergic in nature, these tests permit an ENT specialist to make a distinctive diagnosis between allergic and non allergic conditions. Skin tests can be categorized based on the time in which the results are obtained:
a. Immediate reaction tests
In this test, a small amount of allergenic extract is put in contact with one’s skin cell. It is done to see if there is any wheal or papule formation that indicates the presence of certain antibodies for the allergen tested.
There are two major types of tests in this group namely the Puncture Type (PT) test and Intradermal (ID) test.
In the puncture type skin test, allergen agents are administered to one’s most insignificant layer of the skin, through a puncture with a lancet 1 mm long. They are normally administered on one’s forearm or back.
The intradermal test is more painful compared to the puncture type. It also has a higher risk of causing adverse reactions. In the intradermal skin test, allergen agents are administered in one’s deepest layer of the skin.
b. Delayed reaction tests
As the allergic reaction is of the cell type (T lymphocytes), these tests are performed over a longer period of time. The results for these tests are obtained after 72 hours of contact of the allergen with one’s skill cells. The test should be administered to an area of one’s skin without any injury and hair.
In rare cases, skin tests can generate false positive results. In such a situation, the diagnosis can be validated using serum test and provocation tests with specific allergens.
The nasal provocation test permits a managed imitation of the reaction of the nasal mucosa to the exposure of the allergen. This test allows an ENT specialist to determine accurately which agent is involved in the development of the signs and symptoms of allergic rhinitis.
What are the treatment options available?
Treatment options for allergies can come in different forms like liquids, pills, eye drops, nasal sprays and injections.
a. Antihistamines – These medications work by stopping the histamine that one’s body releases during an allergic reaction. Antihistamines are available as pills, liquids, eye drops, nasal sprays and inhalers. They include:
b. Decongestants – These medications alleviate congestion in the nose and sinuses. Decongestants are available as pills, liquids and nasal sprays. They include:
- Oxy/xylometazoline nasal spray
- Phenylephrine nasal spray
c. Corticosteroid nasal sprays – These sprays and inhalers work by lessening inflammation. They also aid in reducing the symptoms of allergies.
d. Leukotriene inhibitors – These medications work by blocking leukotriene released during an allergic reaction. They are usually available in the form of pills. The most familiar leukotriene inhibitor is montelukast.
e. Immunotherapy – This treatment works by aiding one’s body to learn to tolerate allergens. It involves a range of injections of unadulterated allergen extracts, usually administered to one over a period of few years. Immunotherapy is also available in the form of pills that are placed under one’s tongue until it dissolves.
f. Epinephrine – An epinephrine shot is given to one in case of severe allergy. It helps in reducing one’s symptoms until he/she receives emergency treatment.
Consult Dr G V K Chaitanya Rao – Best ENT Doctor in Hyderabad.
How can it be prevented?
One can try out the following steps to prevent allergy:
- Avoid touching his/her face
- Avoid rubbing his/her eyes or nose
- Close home or car windows when the pollen count is high
- Wrap pillows and mattresses in dust mite covers
- Keep pets away from couches and beds
- Use filters in vacuum cleaner and air conditioner
- Practice washing hands often
- Wear sunglasses to protect eyes from pollen outside
- Change clothes after coming from outside
- Drink ample fluids
- Practice inhaling steam
- Use a nasal saline spray
- Practice nasal irrigation
- Use a humidifier
- Avoid allergy triggers
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