Nasal allergies

NASAL ALLERGIES FOR BEGINNERS
WHY DID I DEVELOP A NASAL ALLERGY?

Allergic individuals have a familial (genetic) tendency to develop immunologic reactions to certain
protein particles, like dust-mite particles, animal danders, mold spores or pollen grains. Once they are
“sensitized”, these individuals will make allergic antibodies to these substances. Then, future
exposures will trigger an immunologic reaction in the nasal lining tissues. Sneezing, itching, watery
discharge and nasal congestion are the result of locally-released histamine and other allergic
mediators.
Not every allergic person is sensitive to the same protein particles, in fact, each allergic child or adult
has an individual set of allergic sensitivities. The timing of their allergic symptoms may be a clue to
your specific sensitivities.
Year-round or perennial symptoms suggest a common daily exposure like housedust mites, molds, the dander of a household pet, or a common daily food. It could also reflect the daily irritation from domestic cigarette smoke or other indoor air pollutants. Seasonal (spring, summer, or autumn) symptoms are more typical of “Hayfever” and result from the pollens and molds that appear in the outdoor air. In this area, tree pollens are typical of the early spring, grass pollens in the late spring and early summer, and weed pollens in the later summer and early autumn. Many individuals have both year-round symptoms with definite seasonal peaks.
HOW CAN I CONFIRM THAT I HAVE A NASAL ALLERGY?

A nasal allergy can best be confirmed by a careful history, a nasal smear for allergic inflammatory
cells, cal ed eosinophils, and selected skin tests to confirm suspected sensitivities. Skin tests are
miniature allergic reactions that occur when a dust mite, animal dander, mold or pollen extract is
pricked through the surface of the skin. Weakly positive reactions only suggest a possible allergy. A
strongly positive skin test will usually confirm an important allergic sensitivity.
WHAT ARE THE BEST WAYS TO TREAT A NASAL ALLERGY?

The goal of any treatment plan for nasal allergies is to reduce the itching and congestion, and to avoid
the possible complications of recurrent sinus and middle ear infections, and constant nasal
obstruction. There are three treatment options: Avoidance, Medication and Allergy Shots.
1. Avoidance of Environmental Allergens

To decrease your nasal allergic inflammation, it is necessary to identify the specific allergic triggers and to remove them from your household and work environment. The better you are at this strategy, the less you have to consider medications and allergy shots. Several specific avoidance recommendations will be made after your initial allergy consultation.
2. Medications

Many allergic triggers cannot be entirely avoided. Most allergic individuals will also require some medications to treat continuing symptoms. There are five varieties of From the Spokane Allergy and Asthma Clinic
medications: antihistamines, anti leukotrienes, decongestants, mast cell stabilizers,
and nasal steroids.
Antihistamines
Antihistamines are moderately effective for controlling the itch, drip, and sneeze of
allergic rhinitis. With the exception of topical Astelin, the oral antihistamines are
not effective at treating congestion. We recommend that you avoid the “first
generation” oral antihistamines, most of which are now sold “over the counter”.
These can have detrimental effects on daytime alertness, driving, and school and
work performance. The intranasal antihistamine (Astelin) and “second generation”
oral antihistamines (such as loratadine, Claritin, Allegra, and Zyrtec) are associated
with less risk or no risk from sedation.
Anti-leukotrienes
Certain prescription asthma medicines known as anti-leukotrienes (Singulair and
Accolate) have also been shown to improve nasal allergy symptoms. They can be as
effective as antihistamines and are also nonsedating.
Decongestants
Oral decongestants (pseudoephedrine, Sudaphed, phenylephrine, Sudaphed PE) are
available without prescription to treat symptomatic nasal and sinus congestion. They
will not treat the drip, itch and sneeze symptoms. Topical decongestants (Afrin,
Neosynephrine, etc.) are also available without prescription, but their use must be
limited to only a few days at a time. Longer use will lead to “rebound” congestion.
Mast Cell Stabilizers
Nasal cromolyn (NasalCrom) is available without prescription for “pre-treatment” of
allergic exposures. It has a short duration of action and must be used several times
daily for ongoing symptoms. It is also without any significant side effects.
Nasal Corticosteroids
Nasal corticosteroids are the most effective prescription medication for controlling
all of the symptoms of allergic rhinitis. They will often work when the other
medications fail. These agents are generally not associated with significant side
effects. Local nasal irritation and bleeding may occur. This usually resolves after
you stop the treatments for a few days. Then you can resume regular use. In
children, some of the older steroid sprays have been associated with a slight degree
of growth suppression. This has not occurred with the newer preparations.

3. Allergy Shots

If your nasal allergies are not fully treated by avoidance and medications, or if there is an intolerance to the medications, your allergy specialist may advise allergy injection therapy. This form of desensitization therapy can be very effective at reducing your specific sensitivities. It is described in more detail in a separate handout. From the Spokane Allergy and Asthma Clinic

Source: http://www.spokaneallergy.com/Articles/Nasal%20Allergies.pdf