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Allergic disease of the ear, nose, and throat areas
presents itself in many ways. The most common allergic 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 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
increases the risk of heart attacks in folks over 50, causing death
in some.
Simple allergic reactions involve an
allergen (Ragweed, dust mite, cat, etc) finding
an antibody in the
nose, mouth, or throat and creating antigen-antibody
complexes, triggering the immediate release of histamine
which causes congestion, itching, etc. Less common allergic reactions
involve blood compliment or fixed tissue reactions, which are often delayed in onset, prolonged in duration,
and involve parts of the body other than the nose, throat, and lungs.
Mild allergic reactions are usually treated symptomatically with
antihistamines or nasal sprays and don't require identifying the
offending allergens. As allergic reactions get worse and interfere
more with daily life, the need to identify the offending allergens
becomes greater and treatment becomes more prolonged, more complicated,
and more specific. Allergy testing is usually done either as a skin
test or a blood test (RAST). Skin testing involves placement of
a small amount of allergen in the skin of the arm, creating small
wheals (bumps). These wheals are then observed for 10 minutes and
the change in size and color is recorded. Inhaled allergens cause
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, many antidepressants, and certain
anti-acid stomach medications. Ask about your current medications
when scheduling your appointment for skin testing. Check
with the doctor who put you on antidepressants before stopping antidepressant
medications! Make sure toe doctor know if you are on a beta blocker for any reason. Skin testing is not usually done on someone on a beta blocker.
Allergic disease of the head and neck presents itself
in many ways. The most common allergic 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 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
significantly increases the risk of heart attacks in folks over
50, causing death in some. Simple allergic reactions involve an
allergen (Ragweed, dust mite, cat, etc) finding
an antibody in the
nose, mouth, or throat and creating antigen-antibody
complexes, triggering the immediate release of histamine
which causes congestion, itching, etc. Less common allergic reactions
involve blood compliment or fixed tissue reactions. The latter create
symptoms which are often delayed in onset, prolonged in duration,
and involve parts of the body other than the head and chest. Mild
allergic reactions are usually treated symptomatically with antihistamines
or nasal sprays and don’t require identifying the offending
allergens. As allergic reactions get worse and interfere more with
daily life, the need to identify the offending allergens becomes
greater and treatment becomes more prolonged, more complicated,
and more specific.
Allergy testing is usually done either as a skin
test or a blood test (RAST). Skin testing involves placement of
a small amount of allergen in the skin of the arm, creating small
wheals (bumps). These wheals are then observed for 10 minutes and
the change in size and color is recorded. Inhaled allergens cause
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 usually important. Notify your allergist
if you note delayed reactions to skin tests that were placed one
or more days earlier. RAST testing determines the amount of immunoglobulin
E present in the blood for specific antigens. It is less invasive
than skin tests, it doesn’t require the patient to be off
medications, and it does not involve much of the patient’s
time. Not all allergens, especially molds, can be tested accurately
using RAST, so it cannot totally replace skin testing. If 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, many
antidepressants, and certain anti-acid stomach medications. Ask
about your current medications when scheduling your appointment
for skin testing. Check with the doctor
who put you on antidepressants before stopping those medications!
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 the tissue swelling from occurring with an
allergic reaction. The newer ones are non-sedating. Regular use
is required for best. Remember: The
use of 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.
4.Use Cortisone products. Corisone
block the allergic reaction in a different way from antihistamines.
Pill and spray forms are used to treat nasal, throat, and lung problems.
Sprays are not generally absorbed systemically, so they are quite
safe for nasal or pulmonary use. 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 dose of a systemic cortisone product.
5. Take 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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