Allergies of the Ear, Nose and Throat
Allergies cause runny noses, congestion and sneezing, right? So what’s the big deal? Just take an over-the-counter sinus and allergy medication and wait for the first freeze. While that may work for you, what you may not know is the extent to which allergic diseases affect Americans. Over 50 million Americans suffer from allergic rhinitis (inflammation of the nose due to allergies). But, allergies cause much more than runny noses. They may also cause more non-specific symptoms including chronic fatigue and malaise. In fact, when administered questionnaires on quality of life, allergy sufferers score lower than healthy individuals in almost all categories. This includes their ability to perform their daily tasks, making it more difficult for them to concentrate at work or in school.
Allergies and the Nose
We all recognize that allergy has an effect on the nose. It goes far beyond just drainage and congestion though. Most people with chronic sinusitis have allergy as a part of their disease. In fact, it may be the allergic problems that lead to the chronic infections. If left untreated, the disease may develop into nasal polyposis, making the treatment much more difficult with a higher likelihood of recurrence even after surgery. The good news is that with treatment of both the allergies and the sinusitis, the outcome can be greatly improved.
Allergies and the Ears
Allergies also play a role in chronic ear problems. In young children, it is common to prescribe anti-allergy medications for patients with recurrent infections. It should be one of the first things thought of when treating adults as well. Chronic ear pain, hearing loss or recurrent infections are frequently contributed to by allergy. The allergies cause swelling of the eustachian tube (the tube leading from the ear to the back of the throat) causing difficulty with pressure and making it easier for fluid to back up in the ear. Correction of the eustachian tube dysfunction by treating the allergies can help improve the ear disease.
Allergies and the Throat
Allergies can also affect the throat, voice box and airway. Many people have chronic post nasal drainage causing them to cough or clear their throat frequently. This can lead to chronic hoarseness and loss of voice. Even without the drainage, the allergic response can cause swelling of the lining of the vocal cords leading to voice disorders. Then there is asthma. The same allergic response causing the nose to become congested can cause swelling in the lower airways. This swelling makes the tubes that carry air into and out of our lungs smaller, causing wheezing and shortness of breath. Treatment of allergies can greatly benefit asthma sufferers and reduce the effects of the disease.
Diagnosing and Treating Allergies
The diagnosis of allergic disease is usually suspected after a careful review of the patient’s symptoms and a thorough examination. Many times, the patient knows what things provoke their symptoms (i.e. cats, ragweed, grass). In these instances, good results may be obtained by avoiding the offending substances. Many times, patients are started on medication when the diagnosis is presumed to be allergy. There are a number of classes of such medications including anti-histamines, steroids, decongestants and leukotriene modifiers. Many patients respond well to these medications and need only take them when they notice a flare up of their symptoms.
When the diagnosis is in doubt or a patient does not respond as expected, allergy testing is sometimes recommended. This is traditionally done via skin testing. Sometimes, a blood test is used to diagnose allergies. While often preferable for young children or in selected patients who cannot undergo skin testing, blood testing is not as sensitive and does not have the proven track record of skin testing. The results of the testing give a better understanding of the cause of the patient’s symptoms and why other treatments may have failed or provided only partial relief. It is often recommended that the patient start immunotherapy. Commonly referred to “allergy shots”, the patient is given small injections of the allergens to which they reacted. This type of treatment is the most effective allergy treatment and provides long-term relief. As an alternative to injections, the allergens may be administered sublingually (under the tongue) as drops. Sublingual immunotherapy is not commonly used in the United States as it is not approved by the FDA, but it is widely used in Europe with good results. It can be useful in young children or those with a severe aversion to needles.
Allergic disease is very common, not only in patients with ear, nose and throat disorders, but in patients with a wide range of chronic symptoms. If you believe you have allergic disease that is not being adequately controlled, you should discuss this with your physician. It may be that you would benefit from evaluation by a physician with advanced training in the treatment of allergic diseases.