Allergic disease of the ear, nose, and throat areas presents itself in many ways. The most common symptoms are congestion, runny nose, postnasal drip, watery eyes, and itching of the eyes or throat. Ear infections and sinus infections are often aggravated by nasal allergies. Less commonly, hives, headaches, and Menière's disease can be caused or aggravated by allergies. People who cannot breathe through their noses adequately because of allergies do not sleep well, either. That can cause or aggravate sleep apnea, which also increases the risk of heart attacks.

How Allergic Reactions Work

Simple allergic reactions involve an allergen (Ragweed, dust mite, cat, etc) finding an antibody in the nose, mouth, or throat, creating antigen-antibody complexes. This triggers the immediate release of histamine which causes congestion, itching, etc. Less common allergic reactions involve blood compliment pathways or fixed tissue reactions. These are often delayed in onset, prolonged in duration, and are more likely to involve parts of the body other than the nose, throat, and lungs.

Mild allergic reactions are usually treated symptomatically with antihistamines or nasal sprays. As allergic reactions get worse and interfere more with daily life, the need to identify the offending allergens becomes greater and treatment becomes more complicated. At that point, desensitization to the offending antigens might be considered.

Skin Testing

Allergy testing is usually done either as a skin test. Skin testing involves placement of a small amount of allergen in the skin of the arm or back, creating small wheals (bumps). These are observed for 10 minutes and the change in size and color is recorded.

The acute reactions that go away within a few hours with the exception of molds, which can create acute and/or delayed reactions. Delayed mold reactions, usually dark red bumps that occur 24-72 hours after the skin test was placed, are often important. Notify your allergist if you note delayed reactions to skin tests that were placed one or more days earlier.

When you are scheduled for skin testing, Wear a short sleeved shirt. Make sure you have been off all drugs that might interfere with skin testing for an adequate period of time. This includes antihistamines and other medications with an anticholinergic effect on the body including some antidepressants and certain anti-acid stomach medications. Ask about your current medications when scheduling your appointment for skin testing. Do not arbitrarily stop antidepressants. Check with the doctor who put you on antidepressants before changing those medications and make sure to let the doctor know if you are on a beta blocker for any reason. Skin testing is not usually done on someone on a beta blocker.

RAST Testing

RAST is a blood test that checks for IgE levels of antigens in the blood. It is great for dust mites, cat, and multiple anaphylasis creating food allergens like egg, shrimp, and nuts. It is not accurate for testing most molds, possibly because mold reactions are not always IgE mediated. (even though symptoms from those mold reactions can be controlled sith desensitization.

Treatment of allergic disease is limited to only five choices:

1. Ignore the symptoms. This is fine if the allergic problem is minimal in nature.

2. Avoid the offending allergens. This is accomplished by cleaning up the environment for allergens and avoiding places where allergens occur naturally.

For Pollen: Close windows to keep pollen out and stay indoors as much as possible. Use air conditioning, both in you home and car. Participate in outdoor activities when the pollen counts are lowest.

For Dust Mites: Steam clean carpeting. Replace old or musty carpeting. Use a central vacuum or a regular vacuum with a HEPA filter. Wash pillows, sheets/pillowcases, comforters, bedspreads, stuffed animals, and clothing regularly-- 130ºF soapy water kills mites best. Do not leave piles of previously worn clothing in the bedroom. Cover mattresses and pillows with mite-impermeable covers. Clean out furnace ducts-- place filters over vents in the bedroom especially. Avoid fabric headboards and fancy drapes that require drycleaning.

For Mold: Fix leaky roofs or plumbing. Fix leaky showers and repair/replace moldy walls around showers, tubs, and toilets. Flush out overflow drains for sinks and tubs with bleach. Clean out the drain pan for the self-defrosting refrigerator. Make sure water drains away from your house adequately. Use a dehumidifier in the basement. Hose down concrete areas with dilute bleach or borax. Store items in plastic bins instead of cardboard boxes. Avoid using swamp coolers to decrease the temperature in your house. Dry out the mold in your automobile air conditioning ducts by turning the heat on high for a few minutes before getting in the car and then switching to air conditioning. Avoid dryer sheets and complicated cleaning chemicals. Decrease mold/yeast containing foods in the diet.

For Animals: Bathe pets regularly; give them away if absolutely necessary. Wash with animal shampoo. For cats, Dawn dishwashing liquid can be used to wash most cats. Keep animals out of bedrooms. Avoid sleeping with them.

Cleaning up the environment for allergens takes a fair amount of time and effort, but it is worthwhile.

3. Use antihistamines with or without decongestants. They prevent/decrease tissue swelling from occurring with an allergic reaction. The newer ones are non-sedating. Regular use is required for best. Remember: The use of sedating antihistamines when driving a car is as dangerous as drinking alcohol and driving!! There are only a few antihistamines that are considered to be TRULY non-sedating by the FDA. They include fexofenadine and loratadine.

4.Use Cortisone products. Corisone block the allergic reaction in a different way from antihistamines. Pill and spray forms are used to treat nose, throat, and lung allergic reactions. Sprays are not generally absorbed systemically, so they are quite safe for nasal or pulmonary use. They usually require regular use to obtain maximum benefits.

Systemic cortisone use usually has significant risks only if used for more than several weeks. The rare, random, serious risks of cortisone use, like aseptic necrosis of the hip, can occur after only one dose of a systemic cortisone product.

5. Allergy shots. Desensitization involves having small amounts of the allergens to which a person is allergic injected into the fat of the arm in slowly increasing doses, causing the body to develop a tolerance to these allergens. Starting with a small dose that has been deemed to be low enough so as not to cause a reaction, the dose is increased gradually over several months. During that time, symptoms generally diminish slowly. Treatment is usually necessary for several years (3-10). Shots start at 1 week intervals and gradually are stretched to 3-4 week intervals. The improvement in symptoms and quality of life is generally worth the effort and expense. Patients who have such diseases as chronic sinusitis that has required one or more surgeries generally require desensitization for optimal control. Because there is always a risk of an adverse reaction to any allergy shot (including asthmatic or anaphylactic reactions), a 20-30 minute wait in the office is required after the allergy shot. Shots may be administered in the office of the allergist or the office of most family physicians.


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