Inhalant allergens are airborne particles that cause an inflammatory reaction in susceptible individuals when the particles come in contact with the skin or mucous membranes. Common inhalant allergens include pollen from grasses, trees, and weeds, mold spores, dust mite debris and pet dander. The key term in this definition is that the person must be susceptible. On the contrary, an irritant like cigarette smoke or chemical fumes from a strong household cleaner or perfume, bothers everyone.

Allergies are an inflammatory reaction triggered by allergens. People who suffer from allergies have developed a susceptibility to various allergens. Exposure to the allergens triggers a cascade of events inside the inflammatory cells that line our nasal cavities leading to the release of many chemicals in our tissues. The most well known chemical is histamine. These chemicals cause the allergy symptoms such as itching, sneezing, nasal drainage and congestion by acting on local tissues and vessels.

A widely accepted theory involves the part of our immune system used to fight off parasitic infections. With the advent of sanitation in the modern age, parasitic infections became non-existent. But this portion of our immune system remained and began reacting to inert molecules, ie: pollen, in genetically predisposed persons. After a threshold of exposure is reached, these predisposed individuals will start reacting to the allergen. This threshold varies from person to person, which is why some persons develop allergy symptoms later or earlier in life than others.

There is a genetic factor in the development of allergic disease. If one parent has allergic disease, the estimated risk of a child to develop allergies is 48%; the child’s estimated risk grows to 70% if both parents have a history of allergies.

Allergic individuals can exhibit a variety of reactions depending on the allergen and the way it was absorbed into the body.

• Seasonal allergic rhinitis sometimes called "hay fever" is caused by an allergy to the pollen of trees, grasses, weeds or mold spores. Depending on what you are allergic to, the section of the country and the pollination periods, seasonal allergic rhinitis may occur in the spring, summer or fall and may last until the first frost. The sufferer has spells of sneezing, itching and watery eyes, runny nose, burning palate and throat. Seasonal allergies also can trigger asthma.
• Allergic rhinitis is a general term used to apply to anyone who has symptoms of nasal congestion, sneezing and a runny nose due to allergies. This may be a seasonal problem as with hay fever, or it may be a year-round problem caused by indoor allergens such as dust mite droppings, animal dander, cockroach droppings or indoor molds/mildew. This problem can be complicated by chronic sinusitis.
• Eczema or atopic dermatitis is a non-contagious, itchy rash that often occurs on the hands, arms, legs and neck, although it can cover the entire body. This condition is frequently associated with allergies, and substances to which a person is sensitive may aggravate it.
• Contact dermatitis is a reaction affecting areas of the skin which become red, itchy and inflamed after contact with allergens or irritants such as plants, cosmetics, medications, metals and chemicals.
• Urticaria or hives are red, itchy, swollen areas of the skin that can vary in size and appear anywhere on the body. Approximately 25% of the U.S. population will experience an episode of hives at least once in their lives. Most common are acute cases of hives, where the cause is readily identifiable as a reaction to a viral infection, medication, food or latex. Some people have chronic hives that occur almost daily for months to years, with no identifiable trigger. Angioedema is a swelling of the deeper layers of the skin. It is not red or itchy, and most often occurs in soft tissue, such as the eyelids or mouth. Hives and angioedema may appear together or separately on the body.

People with seasonal allergic rhinitis (hay fever) only experience symptoms during the time of year when certain allergens are in the air outdoors. When most people talk about allergy season, they're referring to springtime, when plants bloom and tree pollen counts soar. However, summer is the season for grass and weed pollen allergies, and autumn is the time for ragweed and mold allergies. Perennial allergies, or year-round allergies, are typically caused by indoor allergies to dust mites, mold, cockroaches, and pet dander.

The main categories of allergy medications include:

• Anti-histamines - Competitively blocks the chemical histamine from binding to receptors on cells and vessels.
• Leukotriene inhibitors - Blocks the production of leukotrienes, another chemical that causes some of the allergy symptoms.
• Decongestants – Topical and Oral - Causes blood vessels to contract, thereby decreasing swelling and improving breathing and congestion.
• Steroids – Topical and Oral - Inhibits the production of all chemicals that cause nasal allergy symptoms and prevent the migration of other inflammatory cells into the area of allergy.
• Saline irrigation - Removes allergens from mucosal surfaces.

It can be very confusing choosing the right allergy medicines. Medications are chosen not only by the symptoms you are trying to control but must also be based on each patient’s other medical conditions. For example, patients with an enlarged prostate should be cautious about taking anti-histamines. Patients with high blood pressure should avoid decongestants. When treating allergies, look at the symptom you are trying to improve and then choose the medication that helps that symptom. The frequency of your symptoms also plays a crucial role in choosing the right medications. Combining medications from different groups affords the best results. Many medicines are formulated with more than one drug to help control the multiple symptoms associated with allergies.

• Anti-histamines – Help with nasal drainage and congestion. They are also very good at stopping itching and sneezing.
• Nasal steroids – help improve all of the symptoms of nasal allergies.
• Leukotriene inhibitors – Helps similar symptoms as do the anti-histamines but not as effectively.
• Saline irrigations – helps decrease all symptoms of allergy.
• Decongestants – help improve congestion and nasal breathing.

Sometimes it can be challenging to determine if a patient has a sinus infection as opposed to a common cold or allergy exacerbation. Patients with bacterial sinusitis have purulent nasal drainage. That is, yellow or yellow/green pus that is seen with nose blowing or during coughing spells. Fever is not common with sinus infections but patients often feel worn out and fatigued. They may experience facial pain, tenderness over the forehead or midface, and facial pressure. Muscles aches and fevers are generally seen with viral illnesses and they typically produce a clear nasal drainage. Allergy exacerbations usually involve increased congestion, sneezing, itchy nose and eyes and clear post-nasal drip.

If it is determined you have a bacterial sinus infection, antibiotics are prescribed to treat the infection. Beta-Lactamase antibiotics like Augmentin and Omnicef are the drugs of choice for most patients with acute, non-complicated bacterial sinusitis. Second-line antibiotics include the Quinolones and Trimethoprim/Sulfamethoxazole. However, in addition to antibiotics, it is also important to practice nasal care. This includes nasal saline irrigations and the temporary use of topical or oral decongestants to help with drainage. Often, this portion of therapy is over-looked.

Simply stated, yes. Immunotherapy helps to decrease symptom severity and decrease medication use.

Over time, chronic high dose exposure to the allergens a person is allergic to will slowly reprogram that person’s immune system away from allergy. The key is that the exposure is high dose and over an extended time period, typically lasting two and one half years.

Allergy avoidance is the best way to avoid allergy symptoms. If you are allergic to cats, don’t go around cats! However, the reality is that it is impossible to completely avoid certain allergens, such as pollen and molds. In some cases, you can limit your exposure to certain allergens to improve your symptoms. Dust mite allergy symptoms can be limited by minimizing carpet or rugs in the home, using HEPA filters, frequent dusting and removal of nick naks in the home that collect dust.

Definitely! Allergens enter your nose with every breath you take. The job of your nose is to warm, humidify and clean the air you breathe. I always ask my patients, what is the first thing they would do if they spilled some bleach on their hand and their skin started to itch and burn. They always reply, “Wash it”. And the same holds true for your nose. You are breathing all day long, continuously filtering out the allergens in the air. So you need to wash out all of those allergens bothering it before you take a spray or pill to help decrease your symptoms. In fact, most patients feel better during a hot shower because the steam helps dilute the allergen load in the nose.

Definitely! If you suffer from asthma, poorly controlled nasal allergies increase the frequency and severity of your asthma symptoms. In fact, 80% of patients who suffer from asthma also have clinically significant nasal allergies. Patients who receive immunotherapy for their nasal allergies can also have improved control of their asthma symptoms.

The short answer is yes, but not that bad. I have many patients who have known an acquaintance or friend who has had sinus surgery in the past and they tell of some horror story. What I can tell my patients with confidence is that after performing sinus surgery on hundreds of patients, it is rare to have a patient have a difficult time with pain after surgery. We do not use any nasal packing and patients are able to breathe through their nose after. I think this makes sense. Consider if you have ever broken a bone or sprained a joint. As long as you don’t move that limb or joint, it doesn’t really hurt much. And thankfully, there are no moving parts in our nose or sinus!

We need to clarify this common misconception. It is not an “addiction”, it is a dependence. By that I mean patients do not go through withdraw symptoms like a person who abuses alcohol or drugs goes through when they stop using the drug or alcohol. Rather, patients who regularly use topical decongestants find that they need the medication more often to get the same benefit as they did when they first started using the medicine (tachyphylaxis). Not only does it not seem to last as long, it doesn’t seem to work as well. In extreme cases, the medicine stops working all together. In fact, as the medicine wears off patients will experience rebound congestion, meaning they are more congested than they were before they started using the medication to begin with!

There is a simple, short office procedure that will provide nasal congestion relief similar to that of Afrin. Topical decongestants work by shrinking the nasal turbinate. Turbinates are structures in the nose which increase the surface area of the nasal cavity allowing the nose to warm and humidify the air. Afrin is a chemical that shrinks the turbinate. Turbinate reduction procedures do the same thing as Afrin, only it does it mechanically instead of chemically. The results are long lasting and eliminates the need for topical decongestants.