I was recently embroiled in an online discussion with several pulmonary and primary care colleagues regarding the efficacy of Allergen Immunotherapy in the treatment of asthma and the future of sublingual immunotherapy, which I think is worth sharing. Let’s start off with some Frequently Asked Questions: Whare are “Allergy Shots”?
Allergen immunotherapy or “allergy shots” is a form of treatment aimed at decreasing sensitivity to substances called allergens which were identified by allergy testing. Allergen immunotherapy involves injecting increasing amounts of these allergens to a patient over a period of time to decrease the patient’s sensitivity to the allergens, prevent development of new allergies, and in children, prevent progression from allergic rhinitis to asthma. Allergen immunotherapy can lead to long-lasting relief of allergy symptoms after treatment is discontinued.
How does Allergen Immunotherapy work?
Allergen immunotherapy works like a vaccine. Your body responds to injected amounts of a specific allergen by developing immunity or tolerance. There are two phases to immunotherapy: a build-up phase and a maintenance phase.
When will the allergy shots start working and when can I stop my meds?
The benefits of allergen immunotherapy, in terms of reduced allergy symptoms, can begin during the build-up phase but may take as long as 12 months on the maintenance doses. It is important to continue taking allergy medications as prescribed together with the allergy shots during the build-up phase. Later, when your symptoms improve, you may discuss with your doctor whether you can discontinue some of your allergy medications. If you do not get your allergy shots on schedule, it will take longer to reach the maintenance dose and longer for the allergy shots to work effectively.
How long do I have to take the Allergy shots?
With currently available allergen extracts, maintenance treatment is generally continued for 3 to 5 years after the build-up phase, which can take up to 6 to 9 months. The majority of inidividuals experience lasting remission but a minority may relapse after discontinuing immunotherapy, therefore the decision to stop must be individualized.
How effective is allergen immunotherapy?
Immunotherapy is successful in up to 90-95% of patients with seasonal allergies and up to 85% of patients with year-round allergies.
Asthma is a multifactorial disease. Allergic rhinitis/ sinusitis has definitively been shown to contribute to the severity of asthma in patients. One of the modalities used to treat allergic rhinitis/ sinusitis and asthma is allergen immunotherapy (IT). By no means is anyone suggesting that allergen immunotherapy be used INSTEAD OF inhaled steroids, however allergen IT does have solid data to show its efficacy when used in conjunction with other modalities.
This is topic has been addressed by the American College of Allergy, Asthma, and Immunology in its position paper on the Cost Effectiveness of Immunotherapy for Asthma.
Regarding sublingual immunotherapy, there is considerable evidence that sublingual immunotherapy for allergic rhino-conjunctivitis has been effective using high doses of grass extract. This is commercially available and used in Europe, but has yet to have FDA approval in the USA. Some studies showing efficacy are cited below:
1. Calderon M, Essendrop M. Specific immunotherapy with high dose SO standardized grass allergen tablets was safe and well tolerated. J Investig Allergol Clin Immunol. 2006;16(6):338-44. 2. Nelson HS. Advances in upper airway diseases and allergen immunotherapy. J Allergy Clin Immunol. 2007 Feb 8; [Epub ahead of print]
That being said, appropriate dosing and efficacy with multiple SL allergen combinations are still an issue.
The “sublingual immunotherapy” that is pure quackery has been used to treat “idiopathic environmental intolerance” (IEI) by means of “neutralizing” extracts administered as sublingual drops usually at such a miniscule dose that it is really only placebo. See the AAAAI position statement on this.
For a tragic example of the use of these “neutralizing sublingual drops” for treatment of IEI or “multiple chemical sensitivity syndrome” see the “Tragic Example” post on this blog.
HAPPY MOTHER’S DAY! Classic Mr. T video: “Treat Your Mother Right”
from the AAAAI 60th Annual Meeting: NAEPP Expert Panel Report:
Asthma reportedly affects about 7% of pregnant women, and some research has suggested that these women are at an increased risk of preeclampsia or having a child suffer perinatal mortality, preterm birth, or low birth weight.
However, by controlling asthma, those risks are thought to be decreased, noted Michael Schatz, MD, chief of the Allergy Department at Kaiser-Permanente Medical Center in San Diego, California, and coleader of the panel committee. “We can do something about what medicines we use,” Dr. Schatz said during his presentation. “How you control the asthma makes a difference.”
The new guidelines discuss the need to intensely monitor women with asthma once a month during pregnancy, reduce any triggers such as allergens and smoke, and educate patients on the importance of asthma control.
Caution must also be taken in step-down therapy, Dr. Nelson said, with more care taken than usual in preventing flare-ups, or even postponing step-down therapy until the pregnancy is completed.
The new recommendations primarily focus on the pharmacologic treatment of asthma. Researchers reviewed a total of 6,113 articles in the medical literature published between 1990 and May 2003, analyzing 44 in depth.
The new recommendations are as follows:
For mild intermittent asthma, pregnant women should be prescribed short-acting inhaled beta2-agonists, preferably albuterol.; Previously, the recommended drug was terbutaline.
For mild persistent asthma, pregnant women should be prescribed low-dose inhaled corticosteroids (ICS), preferably budesonide. Previously, cromolyn was the initial preferred treatment; now that is an alternative recommended treatment, as well as leukotriene receptor antagonists or theophylline.
“Budesonide is the preferred ICS because safety studies in pregnancy are available and reassuring,” Dr. Nelson said. “There are few or no data on other formulations during pregnancy, but no data indicate they are unsafe, and they may be continued in well-controlled patients.”
If a patient is doing well on a different ICS, the investigators advised against switching to budesonide. “If a person is controlled, that’s important,” Dr. Schatz said. “But for starting on a medication in pregnancy, or for women of childbearing age, you may use this data to make some choices.”
For moderate asthma, there are two equal recommendations: either a low dose of an ICS plus a long-acting inhaled beta2-agonist such as salmeterol, or a medium-dose ICS. Previous recommendations of cromolyn and oral beta2-agonists are no longer recommended.
For persistent severe asthma, pregnant women should be prescribed a high dose of an ICS, preferably budesonide, and oral prednisone as a last resort at a maximum of 60 mg. The risks of not treating severe asthma need to be weighed against the indication that oral corticosteroid use during the first trimester was associated with an increased risk in cleft palate and with preterm birth and low birth weight.
The researchers also made no recommendations regarding omalizumab, an asthma medication approved last June by the U.S. Food and Drug Administration, which has no published data regarding use among pregnant women. “This is the problem with a newer drug, it takes a while to get data,” Dr. Schatz said.
In the past, some physicians stopped asthma medications during pregnancy, but that’s not necessary, said William W. Busse, MD, a professor of medicine and allergy at the University of Wisconsin at Madison, who moderated the session. “There are good and safe treatments.”
from the AAAAI Tips to Remember:
During pregnancy, mothers-to-be may feel uneasy taking medications. However, if a pregnant woman has asthma, it is doubly important that her symptoms be well-managed to increase both her health and her baby’s health. Uncontrolled asthma can be a threat to maternal well-being and fetal growth and survival. The goals of asthma management and treatment during pregnancy are the same as for other patients-to prevent hospitalization, emergency room visits, work loss and chronic disability.
Pregnant women, like others with asthma, should avoid asthma triggers, including specific allergens such as house dust mites and animal dander, and irritants such as cigarette smoke. After discovering you are pregnant, see your allergist/immunologist soon after to discuss the best way to manage your asthma and what medications to take. He or she will be able to prescribe effective asthma and allergy medications that are appropriate to use during pregnancy, and will continue to work with you throughout your pregnancy to ensure your treatment is effective, without side effects.
If you are pregnant and have asthma, you may have questions regarding the best care for both your asthma symptoms and your baby. Following are some common questions and answers to assist you.
Common questions
Can women with asthma have safe, full-term pregnancies?
Studies show maternal asthma that is well-managed during pregnancy does not increase the risk of maternal or infant complications. With appropriate asthma management, you can have a healthy baby. Conversely, there is a direct relationship between lower birth weight and uncontrolled asthma. So, it benefits you and your baby to control asthma symptoms.
Why would uncontrolled asthma affect the fetus?
Uncontrolled asthma causes a decrease in the amount of oxygen in the mother’s blood. Since the fetus receives its oxygen from the mother’s blood, decreased oxygen in her blood can lead to decreased oxygen in the fetal blood. This, in turn, can lead to impaired fetal growth and survival, since a fetus requires a constant supply of oxygen for normal growth and development.
How do asthma medications affect the fetus?
Studies and observations of hundreds of pregnant women with asthma have demonstrated that most inhaled asthma medications are appropriate for patients to use while pregnant. The risks of uncontrolled asthma appear to be greater than the risks of necessary asthma medications. However, oral medications (pills) should be avoided unless necessary to control symptoms.
What effect does pregnancy have on asthma?
Pregnancy may affect the severity of asthma. One study showed that asthma symptoms worsened in 35% of pregnant women, improved in 28% and remained the same in 33% of the pregnant women. These changes in severity are another reason to stay in close contact with your allergist/immunologist so he or she can monitor your condition and alter your medications or dosages if necessary.
During what part of pregnancy will asthma change?
Asthma has a tendency to worsen during pregnancy in the late second and early third trimesters; however, women may experience fewer symptoms during the last four weeks of pregnancy. Troublesome asthma during labor and delivery is extremely rare in women whose asthma has been adequately controlled during pregnancy.
Why does asthma improve for some women during pregnancy?
The exact reason is unknown. Higher levels of cortisone in the body during pregnancy may be an important cause of this improvement.
Why does asthma worsen for some women during pregnancy?
Again, the exact reasons are not known. Because the stomach area is compacted during pregnancy, some women may experience gastroesophageal reflux, a condition that causes heartburn and other symptoms. This reflux can worsen asthma symptoms. Other conditions, such as sinus infections, viral respiratory infections and increased stress, may also aggravate asthma during pregnancy.
Can I continue to receive allergy shots during pregnancy?
Immunotherapy or “allergy shots,” do not have an adverse effect on pregnancy, so they can be continued. As always, your allergist/immunologist will monitor your dose to reduce the risk of an allergic reaction to the shots. These reactions are rare; however, such a reaction could be harmful to the fetus. And, allergy shot treatments should not be started for the first time during pregnancy.
Can women with asthma perform Lamaze?
Most women with asthma are able to perform Lamaze breathing techniques without difficulty.
Can I breast feed if I have asthma?
Breast feeding is a good way to increase your child’s immunity, and is encouraged. The transfer of most drugs into breast milk has not been precisely evaluated; however, there appears to be no evidence that asthma medications adversely affect nursing infants. (However, some infants may become irritable from theophylline transferred by breast milk.) Also, if you have allergy symptoms while nursing, it is appropriate to treat these as well. Again, make sure to see your allergist/immunologist for the best treatment of allergies and asthma while nursing.
Although these are common questions during pregnancy, each patient’s individual treatment varies. Managing asthma and avoiding asthma flare-ups during pregnancy is important to the health of the mother and fetus. It is best if women see their allergist/immunologist regularly during pregnancy so that any worsening of asthma can be countered by appropriate changes in the management program. Make sure to discuss any specific concerns with your doctor to ensure the healthiest pregnancy-for your well-being and that of your baby.
When to see an allergy/asthma specialist
The AAAAI’s How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:
Have a family history of allergies and are interested in identifying prevention strategies for their infant.
Have moderate-severe or uncontrolled asthma.
Your allergist/immunologist can provide you with more information on asthma and pregnancy.
Tips to Remember are created by the Public Education Committee of the American Academy of Allergy, Asthma and Immunology.
From the AAAI Rhinitis Tips:
Do you have bouts of sneezing and itching, or a runny or stuffy nose that do not seem to go away? If so, you may have rhinitis.
Rhinitis is one of the most common illnesses in the United States , affecting more than 50 million people. It often coexists with other respiratory disorders, such as asthma. Rhinitis has a significant impact on the quality of life of those who suffer from it. In addition, it can contribute to other conditions such as sinus problems, ear problems, sleep problems, and learning problems. In patients with asthma, uncontrolled rhinitis seems to make asthma worse.
Allergic rhinitis
Allergic rhinitis is caused by substances that we breathe called allergens. Allergens are usually harmless substances that can cause problems only in some people. These problems are caused because the immune system of people with allergic rhinitis mistakenly identifies these substances as intruders and generates a reaction against them. During this reaction, the immune system cells release substances such as histamine and leukotrienes that cause the symptoms of allergic rhinitis; these and other substances also cause inflammation in the nasal lining that makes the nose very sensitive to irritants such as smoke and strong odors or to changes in the temperature and humidity of the air.
Causes:
1. When allergic rhinitis is caused by common outdoor allergens, such as airborne tree, grass and weed pollens or mold, it is called seasonal allergic rhinitis, or “hay fever.”
2. Allergic rhinitis is also triggered by common indoor allergens, such as animal dander (dried skin flakes and saliva), indoor mold, droppings from dust mites and cockroach particles. This is called perennial allergic rhinitis.
Symptoms
Sneezing
Stuffy nose (congestion)
Runny nose
Itching in the nose, roof of the mouth, throat, eyes and ears
Diagnosis
If you have symptoms of allergic rhinitis, an allergist/immunologist can help determine which specific allergens are triggering your illness. He or she will take a thorough health history, and then test use to determine if you have allergies. Skin tests or blood tests are the most common methods for determining your allergic rhinitis triggers.
What to Do During Pollen Season:
When outdoor pollens are high, remain indoors, particularly in the late morning. Pollen grains can cause significant allergic symptoms like asthma and allergic rhinitis, particularly during the spring and the fall. It is difficult to avoid pollen because it is windborne and can cover wide distances. Short of moving to a different location, here are some tips for avoiding pollen during the season.
1. The pollen count is usually highest in the late morning and early afternoon particularly during sunny, windy days. The pollen count measures the concentration of a specific pollen like birch tree pollen, in the area in a specific area and time. A pollen count is a useful guide for when it is advisable to stay indoors and avoid contact with pollen.
2. Keep the windows and doors closed during the allergy season.
3. Install a room air conditioner with a special filter.The special filter (High Efficiency Particulate Air or HEPA filter) traps airborne allergens. If the house does not have central air, the best spot to put the air conditioner and filter would be the bedroom. Change the filters frequently. An allergic person should also use the car air conditioner to decrease pollen exposure when commuting. Pollen allergic persons should not have a window fan blowing into their bedroom as this will maintain outdoor pollen exposure all night.
4. Avoid working outdoors, if you must wear a special face mask. The face mask is designed to filter pollen out of the air and keep it from reaching the nasal passages.
5. Consider taking a vacation at the height of the pollen season. Preferably at a location where the pollen exposure is minimal, like the seashore.
From the American Academy of Allergy, Asthma, and Immunology patient tips: Atopic dermatitis/eczema
Also see: Allergic Contact Dermatitis
A common allergic reaction often affecting the face, elbows and knees is atopic dermatitis, also known as eczema. This red, scaly, itchy rash is usually seen in young infants, but can occur later in life in individuals with personal or family histories of atopy, meaning asthma or allergic rhinitis (”hay fever”). Eczema may at times ooze, or at times may look very dry. A physician will rarely have difficulty diagnosing atopic dermatitis, based on three factors: an 1) itchy, 2) “eczematous” or bubbly rash in an 3) atopic individual. If one of these three features is missing, your physician should consider other causes.
Identifying the cause of the itch is essential in managing symptoms. Common triggers include overheating or sweating, and contact with irritants such as wool, pets or soaps. In older individuals, emotional stress can cause a flare-up. For some patients, usually children, food can also trigger eczema. Secondary staph infections also can cause a flare-up in children. These patients usually have very dry skin and “allergic shiners”-an extra crease, called a Dennie’s line, across their lower eyelids. They are also more susceptible to other skin infections.
Preventing the eczema itch is the primary goal of treatment. The patient must stop scratching and rubbing the rash. Applying cold compresses is helpful, and lubricating the dry skin with cream or ointment, especially during dry seasons, is essential. Patients should remove all “irritants” that aggravate the condition from their environments. If a food is identified as the culprit, it must be eliminated from the diet.
Topical corticosteroid cream medications are most effective in treating the rash once all preventative measures are taken. Rarely, antihistamines or oral corticosteroids are also prescribed, and if a secondary infection has been introduced by scratching, antibiotics are required.
When to see an allergy/asthma specialist
Whenever you have an unusual rash, make sure to contact your allergist, who will work with you to determine its cause-whether allergies, irritants, or another trigger. Most importantly, your physician and other health care providers can offer a support system and assist you in managing your skin condition.
The AAAAI’s How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:
Need to confirm the diagnosis of atopic dermatitis or contact dermatitis in a patient with dermatitis.
Need to identify the origin of contact dermatitis.
Have atopic dermatitis that responds poorly to treatment.
Need to identify the role of mite allergy in patients with atopic dermatitis.
Need to identify the role of food allergy in patients with atopic dermatitis.
Your allergist/immunologist can provide you with more information on allergic skin conditions.
SAN DIEGO, Dec. 29 — Feline allergies’ nine lives may be up.
A fluffy white cat named Joshua and brethren would have allergic tabby-lovers, long starved of feline companionship, believe the day of the litter box is just $3,950 away. Some allergists are skeptical. Other are taking a wait-and-sneeze approach.
Joshua, now 20 months old, is touted by a company here called Allerca as “the world’s first scientifically proven hypoallergenic cat.” Others lacking a key allergenic protein have been bred since Joshua.
According to the company’s Web site, “These [hypoallergenic] cats allow some of the millions of people with feline allergies to finally enjoy the love and companionship of a household pet without suffering from allergic symptoms.”
Yet some skeptical allergists recommend that anyone who springs for the pricey pets keep their antihistamines at the ready.
Allerca says its cats — Joshua was the index cat — are bred to not express the Fel d 1 protein that is primarily responsible for feline allergy in humans. Although Allerca says that an independently conducted exposure trial it sponsored was promising, allergists decry the lack of any published data.
The small exposure study found that 10 volunteers with severe cat allergies had little or no reaction when exposed to the “genetically divergent” cats, said Ricardo A. Tan, M.D., of the California Allergy and Asthma Group in Los Angeles. He said that:
Two of the participants had significant allergic symptoms with the normal cat but no symptoms with a hypoallergenic cat.
One subject had a mild reaction to both types of cat but showed no allergic symptoms to a placebo room where there was a stuffed animal that felt like a cat.
Others had either mild symptoms with the normal cat and no symptoms to the hypoallergenic cat or no allergic reaction to either type.
Participants were blindfolded during the experiment to control for psychosomatic allergic symptoms. The data have not been peer reviewed or published.
The concept seems like it would work, said Thomas A. E. Platts-Mills, M.D., Ph.D., of the University of Virginia in Charlottesville and president of the American Academy of Allergy Asthma and Immunology. Breeding animals for a specific trait, as in this case for the dominant but rare mutated form of a gene to produce modified protein, is easy compared with trying to create a Fel d 1 knockout, he said.
Evidence is increasingly pointing to Fel d 1 as the dominant allergen among the many proteins produced by a cat and shed in its dander, Dr. Platts-Mills said.
“If you would have asked me two years ago, I would have said that if you take away Fel d 1 [people] would just become allergic to another protein,” he said. “What they’re doing may be more helpful than we expected.”
One of the unanswered questions, though, is whether the modified protein expression by the mutated gene is sufficiently dissimilar or causes low enough Fel d 1 expression to prevent allergic rhinitis, asthma and other symptoms.
“Even if they reduced it by 50% or 40% or 80%, it doesn’t mean somebody with cat allergy is going to have fewer symptoms or need less medication,” said allergist James M. Seltzer, M.D., of the University of California in Irvine.
He cited previous efforts like carpet spray to denature the cat allergy protein and air filters that have clearly shown a reduction in the antigen exposure but been less effective in reducing symptoms.
Furthermore, patients may find they are still experiencing allergic symptoms since Fel d 1 exposure can come from outside the home as well–at school or work or by visitors–said Lisa Vailes, M.S., of Indoor Biotechnologies in Charlottesville, a company that isolates cat allergens to produce recombinant protein for research purposes.
“Even if they do produce [the hypoallergenic cat], people are still going to be exposed to cat allergen from other sources,” Dr. Vailes said. “It would be very difficult to completely isolate a person from it.”
One study in as isolated a location as Antarctica showed that enough cat allergens arrived, presumably on the clothing of staffers, at Scott base to provoke symptoms in allergic individuals (Lancet 1999; 353:1942).
Cats produce also other minor allergens, such as Fel d 3, Dr. Vailes said. While Fel d 1 accounts for probably about 90% of cat allergies, some individuals have a reaction to these other proteins and “it’s possible that some patients may react to [the modified protein found in the hypoallergenic cats],” Dr. Tan said.
Cats are responsible for the majority of animal allergies, according to the American College of Allergy Asthma and Immunology. For allergy sufferers, it recommends:
Washing cats once a week with plain water or a mild veterinary shampoo reduce dander and remove dried saliva.
Keeping pets outside or at least out of the bedroom to reduce exposure to pet allergens, and using central air cleaners to help remove pet allergens in the home.
For the $3,950 (delivery in 2007), Allerca says it will provide cat-lovers a hypoallergenic kitten, plus:
1 x Home Environmental Allergy Test (to check for existing cat allergen in your home)
2 x Allergy Tests (a complete FDA approved home allergy test)
Allerca airline-certified cat transporter
Veterinary Health Certificate (required for travel)
One set of nail caps already applied (these are vinyl nail caps applied to the kitten’s claws that cover the claws so no damage occurs when the animal scratches)
A starter pack (includes premium kitten food, additional nail caps, cat toys and other kitten sundries)
The company reports a two-year waiting list.
Allerca paid for expenses related to Dr. Tan and colleagues’ study.
From the National Jewish Medical and Research Center website:
Christmas Tree Allergies: It’s Everything but the Tree
Christmas trees are often cited as the source of allergy attacks during the holidays, but molds, associated with watering live trees, and the chemicals sprayed on the trees are more likely irritants. “The Christmas tree issue is overemphasized,” Dr. Dan Atkins says. He finds very few cases among allergy patients in which the tree is the culprit.
Allergic reactions usually occur shortly after an encounter with an allergen, such as dust mites or molds. Unpacking the Christmas ornaments can trigger allergic reactions. “Decorations stored for the past year in a damp basement harbor molds, dust mites and other allergens,” Dr. Atkins says. “Moving, carrying and unpacking the Christmas boxes stirs up dust and transfers allergens to the hands and the respiratory system. People are first aware of the symptoms while decorating the Christmas tree and assume that the tree is the cause.
“Keep ornaments and decorations stored in dry areas, off the floor, in plastic bags,” he advises. “Wash your hands after unpacking decorations. If you’re very concerned about allergy symptoms, allow others to trim the tree.”
Artificial trees can be a good alternative, depending on storage. “If it’s in pieces on the basement or attic floor for a year,” Dr. Atkins says, “the tree will collect dust and mold. Just remember to keep it sealed in a plastic bag in an area free of dust and moisture.”
Note: This information is provided to you as an educational service of National Jewish. It is not meant to be a substitute for consulting with your own physician.
I found this shocking video on YouTube. It is a tragic example of what happens when a child is misdiagnosed and the family is given a diagnosis of “Multiple Chemical Sensitivity”.
From the video, I seriously doubt that this child is being treated by a board certified Allergist- Immunologist. Her treatment (sub-lingual drops for food allergy???) is definitely not a scientifically proven therapy. The insurance company is absolutely right. ($2500 a month? Who are they kidding?)
It also does not speak well of Fox News’ fact checking department. A phone call to any trained allergist would have revealed to them that this child’s treatment is bogus.
June 2007 UPDATE: Thanks to Orac and “Respectful Insolence”, we have an insight into Dr. Patel’s finances and the income she has acquired through her practice($30M, dang! there’s gold in them thar neutralizing enzymes!)
What is sinusitis?
Sinusitis is an inflammation of one or more of the paranasal sinuses, the hollow cavities within the cheek bones found around the eyes and behind the nose. The primary functions of these sinuses are to warm, moisten and filter the air in the nasal cavity. They also play a role in our ability to vocalize certain sounds.
Sinusitis can affect the nose, eyes, or middle ear. Symptoms of sinusitis include some or all of the following:
Thick yellow-green nasal discharge
Bad-tasting post-nasal drip
Cough
Head congestion and an accompanying headache
Nasal congestion
Feeling of facial swelling and pressure
Toothache
Constant tiredness
Are there different kinds of sinusitis?
Sinusitis can be divided into acute, chronic and recurrent. The classifications are based on length of symptoms, or the specific sinus involved, or both. The classification is as follows:
Acute sinusitis: symptoms for less than 4 weeks consisting of some or all of the following: persistent symptoms of an upper respiratory tract infection, purulent rhinorrhea, postnasal drainage, anosmia, nasal congestion, facial pain, headache, fever, cough, and purulent discharge.
Chronic sinusitis: symptoms for 12 weeks or longer of varying severity consisting of the same symptoms as seen in acute sinusitis. In chronic sinusitis there should be abnormal findings on CT or MRI. Some patients with chronic sinusitis might present with vague or insidious symptoms.
Recurrent sinusitis: three or more episodes of acute sinusitis per year. Patients with recurrent sinusitis might be infected by different organisms at different times.
Who gets sinusitis?
Sinusitis is one of the most diagnosed diseases in the United States. It affects approximately 16% of the adult population and is responsible for nearly $5.8 billion in health care costs annually.
Although colds are the most common cause of acute sinusitis, it is more likely that people with other allergic diseases such as allergies or asthma, will develop sinusitis. Allergies can trigger inflammation of the sinuses and nasal mucous linings. This inflammation prevents the sinus cavities from clearing out bacteria, and increases your chances of developing sinusitis. The incidence of sinusitis in asthma patients ranges from 40%-75% as well.
If you test positive for allergic disease, your allergist/immunologist can suggest the appropriate treatments to control your symptoms, and thus reducing the risk of developing an infection. People with sinus problems should avoid environmental irritants such as tobacco smoke and strong chemical odors, which may increase symptoms.
Another cause of sinusitis is structural problems in the nose - such as narrow drainage passages, tumors or polyps, or a deviated nasal septum (the bone and cartilage between the left and right sides of the nose) - may be another cause of sinusitis. Surgery is sometimes needed to correct these problems, but only after all other medical treatments have failed.
Who diagnoses sinusitis? Allergist/immunologists diagnose sinusitis based on a combination of clinical history, physical examination, imaging studies, and/or laboratory tests. An allergist/immunologist will be able to help you manage your sinusitis, and will determine if an allergic disease is contributing to your condition. He/she will also determine what triggers your symptoms, as well as other triggers that may be causing sinus obstruction, and recommendations on how to treat that infection. An allergist/immunologist can also determine if a visit with an ENT/Otolaryngologist is needed for consideration of surgery for the sinusitis.
Allergist/immunologists are specialists trained in evaluating for all possible conditions related to sinusitis. These physicians use a management strategy to not only treat current infections, but to also provide management that lowers the risk for future sinus infections. Allergist/immunologists can also help to determine when surgery is indicated as part of the overall management. If you have questions about any of these treatments, be sure to ask your allergist/immunologist for more information.
The AAAAI’s How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:
Have chronic or recurrent infectious rhinosinusitis.
Have other types of chronic rhinosinusitis
Have allergic fungal rhinosinusitis.
What are treatments for sinusitis?
Sinusitis generally requires a combination of therapies. Allergist/immunologists should withhold from prescribing antibiotics for 10-14 days, unless severe symptoms develop such as fever, facial pain or tenderness, or swelling around the eye. An allergist/immunologist may also prescribe a medication to reduce blockage or to control allergies to help keep the sinus passages open. This medicine may be a decongestant, a mucus-thinning medicine or a cortisone nasal spray. Antihistamines, cromolyn and topical steroid nasal sprays help control allergic inflammation. Other treatments that can be helpful to control and reduce symptoms of sinusitis include, breathing in hot, moist air, applying hot packs, and washing the nasal cavities with salt water.
How can sinusitis be prevented?
If you have predisposing conditions that lead to excess mucus and inflammation of the nose, such as allergic disease, structural problems or are in a profession that leads to greater risk for developing these conditions, you are more likely to develop sinusitis and should contact an allergist/immunologist for prevention methods.
Any of kind of predisposing factors makes it important to have a long-term management plan to help control allergic diseases and to keep the nasal inflammation well controlled with medications between sinusitis episodes, and consideration of surgical repair of structural abnormalities, if present and all other medical treatments have failed.
This is my favorite food allergy cartoon. Bart and Principal Skinner engage in an epic “Duel of the Fates” battle ala “Star Wars” with peanut and shrimp instead of light sabers.
Disclaimer: Remember that in real life, food allergy is a dangerous and life-threatening problem. Allergic foods should be avoided (see Food Allergy tips)and always remember to carry your epinephrine injector. That being said, aren’t “The Simpsons” great? and of course, all rights are the property of the creator Matt Groening.
Unfortunately, this video is no longer available on youtube, but you can still see it on: the bigtv
