Allergies/Allergic Rhinitis

Allergies play a significant role in many patients that suffer from sinusitis or nasal obstruction. Allergic response to environmental allergens leads to inflammation or swelling of the lining of the nose and upper airways. This swelling then manifests itself as nasal obstruction, increased production of mucous leading to post nasal drip, facial pressure and headaches. Long-standing allergies if left untreated can lead to sinus infections, ear infections and even lung infections.

As part of our Allergy Program, Mount Sinai offers patients same day allergy screening and counseling for those diagnosed with sinus disorders. This is a component of the comprehensive diagnostic evaluation used to create personalized treatment plans for each patient seen in the Division of Rhinology, Sinus Surgery and Allergy at Mount Sinai.

A variety of symptoms are associated with allergies and these include:

• Itchy or red eyes
• Sneezing
• Post nasal drip
• Headaches
• Nasal obstruction
• Sore throat
• Difficulty sleeping
• Hoarse-voice
• Asthma

Causes of Allergies

Allergies are actually an increased response or sensitivity to triggers that are encountered in our everyday environment. These can range from pollen or grass, to dust mites or mold. Each individual has a unique response to these environmental triggers.

To evaluate a patient for potential environmental allergies the workup starts with a complete patient history paying specific attention to the location and time period in which a person experience their allergy symptoms. A physical exam that focuses on the ears, nose and throat will give the physician key information to determine what is causing the patient's symptoms. Many times a special type of camera or endoscope will be placed into the nose and throat that will allow the specialist to closely assess this area. Depending on the severity of disease and history additional testing that would include allergy skin (link )testing and CT imaging (link and pic) of the sinuses may be warranted.

Allergy Treatments

A patient diagnosed with sinonasal allergies has multiple initial treatment options at Mount Sinai, depending on the severity and type of allergic response of each individual patient. These treatment plans can be customized to accommodate a patient's lifestyle in order to maximize the benefit each patient receives.

• Avoidance: several environmental allergies can be successfully treated by simply avoiding the allergic trigger. It is imperative that the physician spend time with the patient to carefully outline and educate the patient on how to avoid the trigger. In addition, the patient must be motivated enough to be compliant with the recommendations.
• Immunotherapy:
• Medical Therapy: There are multiple treatments available to the patient both prescription and over the counter (OTC)

Antihistamines

Antihistamines are a common medical therapy for allergies and these are available as a pill both prescription and over-the-counter. This class of medications block the action of histamine, a chemical mediator that is released by our cells during an allergy attack. The release of histamine causes the nasal obstruction, sneezing, itching, and mucous secretion. The blocking effect of antihistamines can decrease these symptoms temporarily. However, these medications can also have some significant side effects including dry mouth, drowsiness, urinary retention, reduced performance. Examples of antihistamines include fexofenadine (Allegra), loratidine (claritine), cetereizine (zyrtec).

Decongestants

Decongestans are also popular treatments that is available over the counter. These medications work by decrease the swelling in the nasal tissues. The medication acts primarily on the blood vessels and reduce the amount of bloodflow to these tissues and causes them to shrink. These medications are popular because they tend to work well in a short amount of time however their effect tends to lessen after several days of constant use. Side effects of these medications include insomnia, and urinary retention.

Mucus Thinners

Many patients with allergies complain of thick nasal discharge due to the chronic inflammation of nasal tissues. A physician may direct a patient to take a mucous thinner to allow the mucous to drain from the nose easier and so that the patient is less aware of it. In addition to taking a mucous thinner such as Mucinex, drinking plenty of water to stay hydrated will also dilute the mucous so it is not excessively thick

Leukotriene Inhibitor

Sometimes physicians will prescribe whats called a leukotriene inhibitor such as montelukast or Singulair. These drugs are typically given to help treat asthma as well as seasonal allergies. In the setting of allergic rhinitis it can help relieve symptoms of nasal congestion, nasal drip, itchy eyes, and sneezing. It is used in asthma patients to help dilate the airways in the lung.

Nasal Sprays

Nasal saline sprays are commonly prescribed in patients with allergic rhinitis. These sprays deliver essentially salt water and work by moisturizing the nasal cavity and also augment the drainage crust and debris from the nose. Nasal sprays work best if used properly. The best way to do this is to direct the spray into the nose and slighly tilted to the outside or towards the eye. Directing the spray to the middle may cause irritation and nosebleeds. All nasal sprays work best if directed into the nose and slightly tilted toward the outside or lateral portion of the nose. Do not direct the nasal spray toward the center of the nose or septum as this increases the chance of irritation and nosebleeds.

Nasal Steroid Sprays

Nasal steroid sprays are topical treatments that work be delivering steroids to the inflammed nasal tissues. Over time, the steroid acts to help decrease the infammation in the nasal cavity and relieve symptoms of congestion, runny nose, sneezing and itchy eyes. There are many formulations available. Studies have shown that these steroids sprays do not enter the bloodstream in significant amounts. They are commonly prescribed because there is minimal side effects. For nasal steroid sprays to work effectively they need to be taken consistently over a long period of time before the local effect of the steroid can take place.

Antihistamine Nasal Sprays

Antihistamine nasal sprays are the latest type of topical medication that can help alleviate the symptoms of allergic rhinitis. These sprays work to decrease the local effect of inflammatory mediators called histamines. Patients often report an immediate effect in decreasing nasal congestion, sneezing and itching. Generally these sprays are tolerated very well however some patients complain of taste and there are rare reports of drowsiness.

Decongestant Sprays

Some patients will often take over-the-counter (OTC) nasal sprays such as afrin to relieve the symptoms of allergic rhinitis. These sprays are widely popular because they offer immediate relief from nasal congestion. However, prolonged use longer than three to four days will lead to “addiction” to these decongestants. The patient experiences increased tolerance to the decongestant and require higher doses for relief to the point where they cannot breathe without using the decongestant spray.