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When a Stuffy Nose is More Than Seasonal Allergies

Many of us are bothered by seasonal allergies. But how can you tell the difference between allergies or a more chronic sinus problem? If you have a frequent stuffy nose or other allergy symptoms, it is important to understand when to seek out an evaluation with a doctor.

Dr. Arjuna Kuperan, a fellowship-trained Rhinologist and board-certified Otolaryngologist (ENT) in Houston, Texas, explains how seasonal allergies work and what you need to know about nose and sinus conditions.

Dealing with Spring Allergies

Just as you decisively put away that winter jacket, an insidious dusty yellowish-green layer descends on your car… and your life. Tree pollen is a milestone marker that spring has sprung and with it a myriad of frustrating ear, nose, and sinus symptoms. The local pharmacy has readied its shelves with a veritable cornucopia of nasal sprays and allergy pills in preparation for your highly anticipated patronage. While there is nothing fundamentally wrong with some of these medications, they are often ill-fitting band-aids for more significant problems.

What Causes Environmental Allergies and How Can I Treat Them?

When tree pollen plumes, histamine is released in the upper respiratory tract if you are allergic to it. This reaction triggers a cascade of inflammation that we experience as “allergies.” The initial response to pollen produces clear mucus in the nose and sinuses to flush away the offending irritant. This potentiates a stuffy nose, postnasal drip with or without coughing, ear fullness, and an inevitable trip to the apothecary for your relief medication of choice.

Non-sedating cetirizine (Zyrtec) antihistamine tablets to block the histamine response, and fluticasone (Flonase) nasal steroid sprays to reduce inflammation, can be safely used throughout the season. Decongestant tablets and nasal sprays like phenylephrine (Sudafed) and oxymetazoline (Afrin) should be used for a maximum of 1-3 days or will cause severe rebound nasal obstruction. I see a handful of patients every week in my office who are hooked on these decongestants and ironically have the stuffiest noses they can recall. If despite the aforementioned allergy treatments your symptoms progress to a week or more of worsening nasal congestion, facial pressure, discolored yellow nasal drainage, upper teeth pain, plugged ears, or a productive cough you may be developing a bacterial sinusitis.

Sinusitis Caused By Allergies

How then do allergies cause sinusitis? Well, the allergic response to pollen in the nose initiates swelling of the natural sinus drainage pathways resulting in blockage. The mucus that the sinuses naturally produce becomes trapped and stagnant; nitric oxide levels plummet and bacterial overgrowth then follows, causing infectious sinusitis. The standard treatment for a non-viral sinus infection is a prescription broad spectrum oral antibiotic for 10-14 days. A type of x-ray called a computed tomography (CT) sinus scan can be done in-office when it is unclear based on the symptoms and nasal examination alone if sinusitis is present. I frequently see patients needlessly prescribed antibiotics by other providers for a sinus infection they never had. If sinusitis is diagnosed, the best initial treatment option is an in-office nasal endoscopy whereby mucous from inside the nose is suctioned and cultured to determine the specific bacterial type and which antibiotic will eliminate it. Inadequately treated sinus infections can progress to severe bronchitis or pneumonia requiring prolonged antibiotics and respiratory support.

Immunotherapy and Longer Term Sinusitis Solutions

If seasonal allergies are routinely difficult to manage, you may seek out allergy shots to desensitize from allergens. Sublingual (under the tongue) allergy drops are also available, but are less effective than shots. This type of immunotherapy is an extremely prolonged commitment that can take years to stabilize allergic symptoms. Because allergy and sinusitis symptomatology overlap significantly, many patients with positive allergy testing results are falsely led to believe that allergy shots/drops are the only treatment options. In fact, many allergic patients also suffer from chronic sinusitis and nasal congestion better treated with more immediately effective less time-consuming options like balloon sinuplasty or Breatheplasty™. As always, if something doesn’t make sense to you, get a second opinion. I sincerely hope this helps you to better manage the green menace!

Contact Houston Advanced Nose & Sinus

Dr. Kuperan is dedicated to helping people find relief from chronic sinus issues. If you suffer from allergy symptoms or sinus issues, we can help. Contact us with any questions or to schedule an appointment.

Houston Advanced Sinus