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07 Dec, 2016
Do your symptoms include:
- Constant drip with throat clearing
- Sinus pressure headache
- Reduced or loss of smell
We can find your triggers and best treatment.
Nasal problems including hay fever and nonallergic rhinitis are among the most common medical problems. Allergic rhinitis in fact may affect 30 to 40% of the population in the United States. It is more common in children than in adults. Although allergic rhinitis related to pollen exposure from the outdoors and indoor allergy exposures from mites, molds and animal dander constitute most of the cases; 35% of patients have nonallergic triggers as well including things like smoke, irritants, odors, particular air pollution that may trigger off symptoms.
It is clear that nasal symptoms of hay fever and nonallergic rhinitis affect the quality of life and aggravate comorbid conditions like in the sinuses, ears and lungs that affect the quality of sleep and add to the significant amount of medical costs. Patients oftentimes have loss of time from working, school or decreased productivity at the workplace or in the school environment as manifested by decreased learning.
We divide causes of nasal stuffiness, congestion, drip, post nasal clearing and reduced smell into allergic and nonallergic triggers that are best defined by allergy skin testing. Skin testing determines whether someone in fact has an underlying allergic predisposition. Skin testing is the most accurate way of identifying allergic sensitization. There are other causes of rhinitis including reactions to medications, exercise, cold air, after eating, infection, associated with hormonal changes like during pregnancy and during menstrual cycles, and oftentimes it can be related to drug use including abuse of nasal vasoconstrictors like Afrin, birth control, antihypertensive medicines, or medicines to improve urinary flow for prostate hypertrophy.
Nasal symptoms may also be part of a more systemic inflammatory immunologic disorder like granulomatous disease, Wegner’s sarcoid, midline granuloma, amyloidosis, thyroid disease, and relapsing polychondritis. Thorough history and examination will oftentimes exclude these other conditions. In addition, it is important to identify other considerations that may affect nasal symptoms including the presence of or absence of septal deviation, adenoid or tonsillar hyperplasia, nasal polyps, nasal tumors, intranasal foreign bodies, evidence of laryngopharyngeal or gastrointestinal reflux (when stomach reflux involves the upper esophagus, voice box, throat, and pharyngeal areas.)
History, physical exam, as well as diagnostic skin testing and upper endoscopy and at times CAT scans may be helpful in evaluation of patients. Appropriately chosen patients for immunotherapy do extremely well over the long term with decrease in medication requirement, improving the symptoms and improving quality of life. Sublingual immunotherapy is a new form of immunotherapy that is not as effective as conventional allergy immunotherapy but may have some role in some limited patients. There are a variety of medication choices for patients who have upper respiratory allergies of seasonal and perennial nature including intranasal or oral antihistamines , intranasal steroids, combination of intranasal antihistamine and nasal steroids, intranasal cromolyn, intransasal decongestants, oral antihistamines with and without oral decongestants, leukotriene modifiers, and intranasal anticholinergic medications. Oftentimes, we will have patients also use nasal lavages to help with clearance of mucus and improve deposition of some medications in the nasal airway.