Allergy Main: Are You at Risk: How Bad Are Your Sinus Allergy Problems?
One in five adults in the U.S. has nasal allergies, or allergic rhinitis. Yet as common as it is, experts say that allergic rhinitis is underdiagnosed, undertreated, and underestimated.
“ Allergic rhinitis is a trivialized disease,” says Jonathan A. Bernstein, MD, an allergist at the University of Cincinnati College of Medicine. “Obviously, nobody dies from it. But it does cause a tremendous amount of sickness and suffering.”
All that sneezing, congestion, and teary-eyed misery takes a toll. Allergic rhinitis can cause missed workdays, and it can detract from your performance at school or on the job. Because of this, allergic rhinitis costs the country billions of dollars every year.
Nasal allergies can also lead to other conditions such as sinus problems. But they don’t have to.
“Allergic rhinitis is a treatable problem,” Bernstein says, “and when people get diagnosed and treated properly, they do very well.” If you’ve been limping through life with nasal allergies, it’s time to get the best of them.
Nasal Allergies and Sinus Problems
Allergy symptoms are miserable enough on their own. But in many people, allergic rhinitis can cause — or aggravate — other complications or conditions.
What’s the connection between allergies and sinus problems?
Sinuses are hollow pockets in the skull that are connected to the nasal passages. Whenallergies trigger swelling in the mucous membranes, the inflamed tissue can block off the sinuses. The sinuses can’t drain, trapping mucus and air inside. That leads to pain and pressure.
Take Allergy Symptoms Seriously
Despite the misery of allergies and their complications, many people don’t take the symptoms very seriously.
They don’t realize the impact that their allergies are having on their lives, especially when added up over years and decades, says Leonard Bielory, MD, professor of allergy and immunology at Rutgers University.
They get used to the congestion, chronic sinus problems, and mouth breathing. They get used to disturbed sleep and fatigue. After a while, they just don’t remember what life was like before allergies.
When symptoms get bad, they make do. They grab over-the-counter medicines at random at the drugstore. They make guesses at the cause of their allergies and half-hearted attempts to control their exposure, but never get a diagnosis.
That’s not the way to go about it, experts say. Given the impact that nasal allergies can have on your life, you really need to get proper medical evaluation and treatment.
If you have nasal allergies, you may be used to sneezing and congestion that last the entire day. But you don’t have to just put up with it. Whether you’re allergic to dust mites, tree pollen, or animal dander, you can find relief for your nasal allergy symptoms.
“Some people suffer with seasonal allergies for years before they learn that there are effective treatments,” says James Sublett, MD, chief of pediatric allergy at the University of Louisville School of Medicine in Kentucky. But there are good reasons why you shouldn’t wait to treat allergies.
“If allergy symptoms aren’t treated early, they can actually get worse over time,” Sublett says.
Here are five allergy symptoms you shouldn’t ignore and what you can do about them.
Nasal Allergy Symptom 1: Runny or Stuffy Nose
A runny or stuffy nose is one of the most common symptoms. “The best way to treat congestion is to treat the allergy that’s causing it,” says Marshall Plaut, MD, chief of allergic mechanisms at the Asthma, Allergy and Inflammation branch of the National Institute of Allergy and Infectious Diseases (NIAID).
Start by trying to avoid your allergy triggers. If you don’t already know what your allergy triggers are, an allergist can help you identify them.
Although it can be difficult to completely avoid some triggers, you may be able to reduce your exposure to them. For example, if pollen is a trigger, stay inside when pollen counts are high. If dogs or cats make you sniffle, wash your hands and change your clothes after playing with them.
Some people find that nasal irrigation using a Neti pot or a nasal rinse helps clear congestion. Over-the-counter antihistamines, decongestants, and cromolyn sodium nasal sprays can all help control nasal allergy symptoms. Don’t use decongestant nasal sprays for more than three days at a time, however. Be sure to read and follow the directions on the label for any over-the-counter medicine.
If these remedies don’t offer relief, your doctor may prescribe other treatments.
If your symptoms don’t get better within 7 days or get worse after about 5 days, it’s time to see your doctor.
Nasal Allergy Symptom 2: Sinus Pressure
Your sinuses are small cavities behind your forehead, cheeks, and eyes. If mucus builds up in these areas because of allergies, you may feel pressure or pain.
You can help reduce sinus congestion by applying a moist, warm cloth to your face or inhaling steam a few times each day. You can also try using a saline nasal spray. If you feel sinus pain and pressure for more than a week, call your doctor.
Nasal Allergy Symptom 3: Sneezing
If you’ve ever had a bout of uncontrollable sneezing, you know what a nuisance it can be. Some people have such severe sneezing episodes that they interfere with their daily life. But sneezing doesn’t have to be that serious to seek relief.
If you can’t avoid the allergen that’s causing the sneezing, or if doing so doesn’t help, try an over-the-counter antihistamine. Be sure to read and follow the directions on the label for any over-the-counter medicine. If that doesn’t help, your doctor may prescribe a nasal steroid spray.
Nasal Allergy Symptom 4: Itchy Eyes
Itchy or watery eyes are a common allergy symptom. Although they can be annoying, eye symptoms don’t usually cause serious eye or vision problems.
Again, avoiding the triggers that cause your allergies is the best way to help prevent itchyeyes. For example, if you’re allergic to pollen, keep the windows shut when you’re inside and wear sunglasses outside to help protect your eyes. Try not to rub your eyes, since this can irritate them, and avoid wearing contact lenses.
To soothe your eyes, try placing a cold washcloth over them or use artificial tears. Over-the-counter or prescription allergy medications or eyedrops that contain an antihistamine can also help relieve symptoms.
Nasal Allergy Symptom 5: Postnasal Drip
Normally, you swallow mucus without even knowing it. But if your mucus becomes thick, or if you have more mucus than normal, it results in postnasal drip. That’s when you can feel mucus dripping from the back of your nose into your throat. Postnasal drip can also feel like a lump in your throat and can lead to pain or irritation there.
In addition to avoiding your allergy triggers, try drinking extra fluids or using saline nasal spray to thin the mucus. Ask your doctor about other ways to get relief.
Comparing the symptoms
Classic symptoms are congestion, sneezing, itchy and watery eyes, clear nasal discharge, and a scratchy or ticklish throat. They typically start or worsen with the onset of spring or fall, triggered by.exposure to specific allergens, such as mold or pollen from grass or ragweed. Pollen counts in many parts of the U.S. are expected to be extra high this year due to an unusually warm winter.
Other possible symptoms:
• Cough, headache, fatigue.
• Dark circles under the eyes, sometimes called an “allergic shiner.”
Sinusitis can occur anytime, but cases are more likely during cold and flu season. Classic symptoms are congestion plus nasal discharge that has turned yellow, green, or gray, and pain or tenderness in the cheeks, upper jaw, or under or above the eyes. It often worsens when you bend over or turn your head from side to side.
Other possible symptoms:
• Fever (often greater than 101.5˚ F).
• Fatigue or muscle aches linked to the underlying infection.
How to cope with allergies
Figuring out that allergies are the cause of your misery is an important step toward getting relief. But your work isn’t done yet. You still have to choose the right treatment.
That’s important, since allergic reactions in the nose may make the whole airway sensitive to future allergen exposure and vulnerable to infections and possibly asthma.
Here are some proven steps for controlling respiratory allergies:
- Know your triggers. Keep a diary to track when and where allergy symptoms strike. That can help you determine whether they stem from outdoor allergens, such as grass and ragweed pollen, or indoor allergens, such as cockroaches, dust mites, and pet dander.
- Limit exposure. For outdoor triggers, keep the windows shut, stay inside when pollen or outdoor mold counts are high, and wash your hands and face after spending time outside. For indoor allergies, use anair conditioner or a dehumidifier to reduce humidity to below 50 percent. Remove carpeting from bedrooms, wash rugs and curtains often, and vacuum regularly.
- Use the right medication. The best first choice is often a generic version of the antihistamines cetirizine, fexofenadine, or loratadine. All are available without a prescription and cost less than their brand-name versions (Zyrtec, Allegra, and Claritin, respectively). Those drugs are less likely to cause drowsiness than older antihistamines, such as brompheniramine, chlorpheniramine, and diphenhydramine. Some people respond better to one of the newer antihistamines than to others, so some trial and error may be necessary.
- Prescription steroid nasal sprays, such as fluticasone (Flonase and generic) and mometasone (Nasonex), are very effective. But stop taking them if they cause irritation or nosebleeds.
- Consider allergy shots. Also called immunotherapy, they can be an option if the drugs above aren’t sufficient or cause intolerable side effects. Researchers are investigating ways to make the therapy more convenient, such as less-frequent shots. But for now it still requires progressively larger doses of allergens, such as grass pollen, injected by your doctor at least once a month for several years. It also carries a slight risk of anaphylactic shock, so patients are required to stay in the doctor’s office for observation for 30 minutes after an injection.
Sinus Problems: Home Remedies and Tips
Sinus Problems: Getting to the Triggers
First, it’s crucial to figure out why you have sinus problems, says Jordan S. Josephson, MD, a Manhattan ear-nose-throat specialist and author of Sinus Relief Now. ” Allergiesare a fairly common reason for sinus problems,” he says.
Allergies that affect the nose, such as hay fever and indoor allergies, can cause the nasal membranes to swell, and the passages to the sinuses — hollow spaces within the bones around the nose — to become blocked. Mucus, which typically drains from the sinuses to the nose, can’t drain.
Other reasons? “A dry nose leads to more sinus problems,” says Richard F. Lavi, MD, an allergist in Twinsburg, Ohio. “Nasal dryness leads to congestion, thickened mucus, and worsened sinusitis.”
Whatever the trigger, you can pick and choose from these five tips, or adopt all of them.
Sinus Tip 1: Keep Your Cool
“When the heat is on, the membranes get dry,” says Russell B. Leftwich, MD, an allergist in Nashville, Tenn. Mucus isn’t cleared as effectively, boosting the risk of sinus problems.
He can’t recommend a specific indoor temperature range as ideal, but offers this guide: “You are better off wearing a sweater and keeping it cooler than cranking it up so you are comfortable wearing only a T-shirt.”
Let your nose guide your indoor temperature range, suggests Lavi. “If you are not waking up with nosebleeds or congestion, that is probably a good temperature range.”
Sinus Tip 2: Humidify Your Air
Strive for an indoor environment that’s not too dry and not too humid. ” Dust mites love greater than 50% humidity,” Lavi warns. And if you’re allergic to dust mites, that’s bad news for your sinuses.
A too-humid indoor environment can also encourage the growth of mold, which can also set off sinus problems, says Todd Kingdom, MD, professor of otolaryngology–head and neck surgery at the University of Colorado School of Medicine. Some people are more sensitive to this than others are, he says.
Experts are divided on the value of room humidifiers for creating a sinus-friendly home.
Forget them, Leftwich says. “A room humidifier never makes a difference. There is too much air to humidify.”
But Josephson says using humidifiers in the bedroom beginning in October through March or April can make a difference in keeping sinus problems at bay.
Vaporizers can keep you more comfortable if you are in the midst of a sinus problem, Leftwich says. But you need to have it close by. “It doesn’t do any good to have a vaporizer on the other side of the room.” And, he warns, the devices must be cleaned daily to keep bacteria from growing in them.
Breathe the mist coming from vaporizers, but not the steam, he warns. Steam can easily burn you. ”Most vaporizers don’t produce any steam, just a mist,” Leftwich says. “But those vaporizers that do make steam and certainly steam from a tea kettle or pot on the stove must be used with caution.” Steam can burn you, so don’t come into contact with it.
Sinus Tip 3: Ventilate Your House
An energy-efficient house is not necessarily a sinus-friendly one, Leftwich says. “You seal up a house to make it more energy efficient, and you end up with stale air that aggravates sinus problems,” he says.
The solution: “Opening up the house on a warmer day to clear the air is a good thing,” he says, provided it’s not a high- pollen day that will set off your allergies.
The value of having air ducts on your heating and cooling system cleaned is another area of debate among experts. Leftwich calls it a waste of time and money. Some patients told him they got sicker after cleaning the ducts, he says, probably due to aggravating airborne dust. But Josephson says if the air smells dusty or moldy, it might be worth a try. Changing your air conditioner filters on a regular basis is good, too, he adds.
Sinus Tip 4: Be Water-Wise
Drinking a lot of fluids can help keep your sinuses functioning well. “At least a quart a day” is the recommendation of Leftwich. Most of that should be plain water, he says.
“The more the better,” says Josephson. He tells his patients to drink enough water every day so their urine is generally clear.
Salt water nasal rinses for your nose can help, too. You can buy a kit or mix up your own at home. The recipe: Mix about 16 ounces (1 pint) of lukewarm distilled, sterile, or previously boiled water with 1 teaspoon of salt. Some people add 1/2 teaspoon of baking soda to take the sting out of the salt. Using a bulb syringe, flush your nasal cavities to clean out mucus and debris.
Neti pots are another way to irrigate your nasal cavities, Josephson suggests. This centuries-old remedy has gained popularity recently.
The pot looks like a tea pot with an elongated spout. The devices are sold widely, for about $10 to $20, online and in drugstores and health food stores.
To use the pot, typically you mix about a pint of lukewarm distilled, sterile, or previously boiled water with a teaspoon of salt. Next, tilt your head over a sink at an angle of about 45 degrees. Place the pot’s spout into your top nostril and gently pour the solution in.
The salt water will flow through your nasal cavity, into the other nostril, and perhaps into your throat. Blow your nose to eliminate any water, then repeat the steps on the other nostril.
Clean your neti pot regularly.
Sinus Tip 5: Avoid Household Irritants
Cigarette smoke, cleaning products, hairspray, and other materials that give off fumes can all make your sinus problems worse.
“Anything that has a strong odor of fumes can be a problem, especially if you are susceptible,” Leftwich says. “Cigarette smoke is probably the No. 1 offender for sinuses.” He suggests asking family members to smoke outside or, better yet, to give up the habit.
If you’re sensitive to pet dander, bathe or clean your pets weekly, says Lavi. As difficult as it is for pet owners, limiting exposure to your animals at night can help.
Treating sinusitis: Don’t rush to antibiotics
A cup of hot tea or another warm beverage can thin nasal secretions and loosen phlegm.
People with sinusitis due to the common cold or other causes are often prescribed antibiotics. In fact, sinusitis accounts for 15 to 21 percent of all antibiotic prescriptions written for adults in outpatient care.
But most of them probably don’t need the drugs. Here’s why:
- They seldom help. Sinusitis usually stems from a viral infection, not a bacterial one—and antibiotics don’t work against viruses. Even when bacteria are responsible, infections usually clear up on their own within a week. In a study of 166 adults with acute sinusitis in the Feb. 15, 2012, Journal of the American Medical Association, amoxicillin was no better than a placebo at reducing symptoms after three days. In general, consider antibiotics only if symptoms last longer than 10 days, worsen over time, or are very severe.
- They pose risks. Studies suggest that nearly 25 percent of people who take antibiotics experience side effects, such as a rash or, more commonly, diarrhea and stomach problems. In rare cases, they can cause severe allergic reactions, such as anaphylactic shock.
- They can breed super germs. Overuse of antibiotics encourages the growth of bacteria that can’t be controlled easily with drugs. That makes you more vulnerable to antibiotic-resistant infections and undermines the usefulness of antibiotics for everyone.
- They’re a waste of money. Not all antibiotics are expensive, but since doctors continue to write so many prescriptions for them, the total cost to the health-care system is substantial—at least $31 million a year. If you do need antibiotics, the best choice is often generic amoxicillin, which costs as little as $4 for a course of treatment and works as well as more expensive brand-name antibiotics.
Self-help measures and, if needed, over-the-counter drugs can help ease symptoms until sinusitis clears up, typically within a week or so. They include:
- Rest. That’s especially important in the first few days, when your body needs its energy to fight the virus—and when you’re most contagious.
- Warm fluids. Drinking them can help thin nasal secretions and loosen phlegm.
- Humidity. Warm, moist air from a bath, shower, or kettle can loosen phlegm and soothe the throat.
- Gargling. Dissolve half a teaspoon of salt in a glass of warm water to relieve painful swelling in your throat.
- Rinsing. Flushing your nostrils with saltwater might ease congestion. If you use a commercial nasal-rinse device, be sure to thoroughly clean it daily.
- OTC medication, but used cautiously. To reduce the risk of side effects, look for single-ingredient products that target the symptoms you want to treat.
For a stuffy nose, drops or sprays containing oxymetazoline (Afrin, Neosynephrine Nighttime, and generic) work faster and cause fewer side effects than oral decongestants. But they can cause rebound congestion if used for longer than three days. If the stuffiness hasn’t eased by then, ask your pharmacist for pseudoephedrine pills (Sudafed and generic), which are nonprescription but kept “behind the counter” to prevent their use in making illegal drugs. Check with your doctor before taking any oral decongestant if you suffer from anxiety or have diabetes, heart disease, hypertension, or hyperthyroidism.
In general, don’t bother with antihistamines. Older ones such as chlorpheniramine and diphenhydramine might help a little but can cause drowsiness, dry eyes and mouth, and urinary retention, and can worsen narrow-angle glaucoma. Newer antihistamines, such as loratadine (Alavert, Claritin, and generic), work well for allergies but usually don’t help sinus symptoms.