For the allergic, spring can be a roller coaster ride as pollen counts dip, then spike, sometimes in reaction to changing weather.
The seasonal trek is especially bumpy for those who have more than allergies – people who often have no idea they have another problem. How do you tell if your allergy-like symptoms are being caused by allergies, another condition or both?
With allergies, the body’s immune system produces excess antibodies that attack what it perceives as invaders. This response causes inflammation and irritation of the eye and/or nose, among other symptoms, said Michael Kletz, an allergist/immunologist whose practice has offices in McLean, Va., and Washington.
Jill King, a 38-year-old Gaithersburg, Md., resident, had allergies for years. Her symptoms worsened during her pregnancy, then improved a little after the baby was born. But by her second pregnancy she had to use an inhaler.
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The allergist who later prescribed antihistamines for King noticed a polyp, so it was on to an ear, nose and throat doctor.
Two steroids did little to shrink the growths. King bit the bullet and had surgery – a six-hour procedure to remove the clusters of polyps that were completely filling her nasal passages.
“My congestion and the asthma I was diagnosed with disappeared. Now I just do nasal rinse and take Allegra for allergies. My garage is no longer filled with Sam’s Club-size tissue boxes. And I can breathe.”
Symptoms may overlap
King’s surgeon, Suzel Hall, sees many patients with persistent nasal and sinus complaints.
“A lot of them tell me they have horrible allergies. This time of year we strongly expect this to be the case, but it is not unusual to find another medical condition,” said Hall, of ENT Specialists of Shady Grove in Rockville, Md.
Figuring out what is driving many allergy-like responses takes some digging. Symptoms may overlap. Sometimes one problem triggers another. And even when a condition other than an allergy is found, the question may remain: Are allergies still part of the equation?
For instance, rhinitis, an inflammation of the nasal lining, can be allergic. But it can also be nonallergic, where patients are sensitive to environmental irritants such as chemical fumes and cigarette smoke. Both types can cause runny nose, congestion, decreased sense of smell, headache and facial pressure.
“We tease out disease states by looking at differences in symptoms. With allergies, patients might have watery eyes and sneezing,” Hall said. “With sinusitis, there may be fever, facial pain or cloudy nasal drainage. If these symptoms last longer than 10 days, or improve and then worsen in that time, this could suggest something other than allergy, such as sinusitis.”
Hall said that sinus infections could be secondary to allergic or nonallergic rhinitis. The nasal cavity swells, as do the sinus passages, which open into the cavity. They can’t drain, leading to infection.
Many patients have complaints suggestive of abnormal physical structures, such as persistent congestion on one side of the nose, or congestion following a trauma. So the investigation typically starts with rhinoscopy or a CT scan.
“With rhinoscopy, we place a pencil-size instrument into the nasal passage to view the nasal cavity. It happens in the office in a few minutes,” Hall said. The test may reveal a deviated septum (cartilage that divides the nostrils). Or obstructions caused by bones on the side of the nose or by nasal polyps.
A CT scan of the sinus cavity may uncover abnormalities such as underdeveloped sinuses or blocked sinus openings.
The good news is that surgery typically corrects these anatomical problems. Unless there is allergy, too, it’s usually the end of the back-and-forth trips to the pharmacy and doctors’ offices.
What to do
Kletz tells people to start with over-the-counter antihistamines if symptoms suggest allergies.
“You will know within a few days if nasal sprays are helping, and within about half an hour with eye drops that have antihistamine. Pills should work within a couple of hours,” he said.
If you don’t get relief, visit your doctor to determine if you should see an ENT, ophthalmologist or allergist, he said.
“In the case that it is allergy, allergy shots (immunotherapy) work in 80 percent of patients. But first, avoid irritants. Then try over-the-counter medications. If they don’t work, that is when I would try allergy shots.”