Are you fed up with sneezing, nasal blockage, wheezing, itchy eyes nose and throat, dry cough, used all kinds antihistamines, nasal sprays, injections and still suffering, then only need to read this post-
About Nasal Allergy-Allergic Rhintis-An overview
Allergic rhinitis, often called nasal allergy occurs when your immune system overreacts to particles in the air that you breathe. The immune system attacks the particles in your body, causing symptoms such as sneezing and a runny nose. The particles are called allergens, which simply mean they can cause an allergic reaction.
Allergies usually have symptoms for many years, all the year round-Perennial or at some season-seasonal. You also may get other problems such as sinusitis, Nasal polyposis, asthma and ear infections as a result of your allergies.
Allergies are caused by an over-sensitive immune response. The immune system normally protects the body against harmful substances such as bacteria and viruses. Allergy symptoms occur when the immune system reacts to substances (allergens) that are generally harmless and in most people do not cause an immune response.
When a person with allergies breathes in an allergen such as pollen or dust, antibodies are produced. When the antibodies are stimulated by pollen and dust, histamine and other chemicals are released. This causes itching, swelling, and mucus production. Symptoms vary from person to person. Very sensitive individuals can experience skin allergy or wheezing.
Hay fever involves an allergic reaction to pollen. A similar reaction occurs with allergy to mold, animal dander, dust, and similar inhaled allergens
In most cases, when you have allergic rhinitis:
and Sneezing especially after you wake up in the morning.
and Runny nose and postnasal drip. The drainage from a runny nose caused by allergies is usually clear and thin. But it may become thicker and cloudy or yellowish if you get a nasal or sinus infection.
and Eyes are watery and itchy.
and Throat may feel itching
and Dry cough
and At times wheezing-Asthma
and Eczema-Allergic rashes in skin
Allergens commonly cause allergic rhinitis?
You probably know that pollens from trees, grasses, and weeds cause allergic rhinitis. Many people have allergies to dust mites, animal dander, cockroaches, and mold as well. Things in the workplace, such as wood dust, chemicals, or animals, can also cause allergic rhinitis. When these symptoms are caused by pollen, the allergic rhinitis is commonly called hay fever. House hold pets are another cause.
If you are allergic to pollens, you may have symptoms only at certain times of the year. If you are allergic to dust mites and indoor allergens, you may have symptoms all the time.
How is allergic rhinitis diagnosed?
To find out if you have allergies, your doctor will ask about your symptoms and examine you. Knowing what symptoms you have, when you get them and what makes them worse or better can help your doctor know whether you have allergies or another problem.
If you have severe symptoms, you may need to have allergy tests to find out what you are allergic to.
and Your doctor may do a skin test. In this test your doctor puts a small amount of an allergen into your skin to see if it causes an allergic reaction.
and Your doctor may order lab tests. These tests can find substances in your blood or other fluids that may mean you have allergic rhinitis.
Allergy testing may reveal the specific allergens the person is reacting to. Skin testing is the most common method of allergy testing. This may include scratch, patch, or other tests.
If your doctor determines you cannot undergo skin testing, the RAST blood test may help determine which allergens you are sensitive to.
ENT Examination-Nasal endoscopy reveals a pale blue turbinates, polyps, mucus and mucopus if there is associated sinusitis.
CT scan reveals any polyps or sinus infection.
Treatment of nasal Allergy
The best way is to avoid what causes your allergic symptoms in the first place. It may be impossible to completely avoid all allergens to which you are sensitive, but you can often take steps to reduce exposure. Try to find what triggers the allergy.
and Medications- short acting antihistamines can relieve mild to moderate symptoms, but can cause drowsiness. A pediatrician should be consulted before using these medicines in children, as they may affect learning. Loratadine (AlaspanÂ®), Rupatidine (RupanexÂ®) are now used for nasal allergy giving good result without drowsiness.
and Longer-acting antihistamines are available – Cetirizine (ZyrtecÂ®) and Levocetrizine are also very effective.
and Nasal corticosteroid sprays work very well for people with symptoms not relieved by antihistamines alone. These prescription medications include fluticasone (Nasocom, Flixonase etc), mometasone (momeflow) etc.
and Asselstine is a new, nasal antihistamine that is used to treat allergic rhinitis. It is available n Spray form.
and Injection Depomedrol (Methyl Prednisolone) or Deflazacort in severe cases used with caution.
and Decongestants may also be helpful in reducing symptoms such as nasal congestion, but they should not be used for long periods.
and The most appropriate medication depends on the type and severity of symptoms. Specific illnesses that are caused by allergies (such as asthma and eczema) may require other treatments.
and Allergy shots (immunotherapy) are occasionally recommended if the allergen cannot be avoided and if symptoms are hard to control. This includes regular injections of the allergen, given in increasing doses (each dose is slightly larger than the previous dose) that may help the body adjust to the antigen. It is not very practical and poor patient compliance
Complications of Nasal allergy
and Drowsiness and other side effects of antihistamines
and Side effects of other medications
The Laser cautery is performed under local anesthetic, spraying lidocaine and xylometazoline. If any septal spur to be removed, inject 4% Xylocaine with adrenaline.
Patient is kept semi sitting in an ENT chair (as seen in picture) and Co2 CW at 6 watts setting, the turbinates are cauterized. The procedure takes 10-15 mnts on each side. There is hardly any bleeding and patient goes home after few hours. This gives very good results
Post operative-Nasal decongestants, analgesics and antihistamines are given for a week or two. Nasal wash with saline helps healing. There is no crusting. How Laser work? The pathogenesis is actually type I hypersensitive reaction of nasal mucosa. Agger nase is one of the trigger points and sensitive areas of this disease, and anterior ethmoidal nerve is the major nose-innervating parasympathetic nerve, the abnormal excitation of which plays an important role in the pathogenesis. Anterior ethmoidal nerve is distributed at the supra-anterior portion of nasal cavity, where gland density is high. Irradiation of anterior ethmoidal nerve, lateral branch and septal branch in this area will not only damage inflow of parasympathetic nerve, but also decrease acetylcholine released from nasal cavity, thereby alleviating symptoms. Meanwhile, anterior ethmoidal nerve is also a sensory nerve of supra-anterior portion of nasal cavity; the sensory function will be weakened after laser cauterization.
Laser cautery will decrease sensitivity of external nose to adverse chemical or physical stimuli. The effect of CO2 laser irradiation is as follows:
and The excitability of anterior ethmoidal nerve is decreased, and thereby vascular permeability and nasal secretion are also decreased.
and Some of sensory nerves have been cut, the sensory-parasympathetic nerve reflex is weakened, and at the meantime release of vascular-origin intestinal peptide as well as substance P is also decreased.
and Scar formation of nasal mucosa will prevent hypersensitivity.
Advantages of Co2 Laser
CO2 laser has got good flexibility, high focus of energy and minimal injury to the surrounding normal tissue. It will cause coagulation, degeneration and atrophy of protein, and cause damage of varied degree to certain branch of anterior ethmoidal nerve and sphenopalatal nerve. Moreover, laser therapy will destroy glands in this area, decreasing secretion and sensitivity of nasal mucosa to adverse external stimuli, suppressing reflex of sneezing. Thus nasal discharge and obstruction will be lessened and symptoms alleviated.
CO2 laser has such advantages as precise targeting, easy manipulation, causes no bleeding, fewer complications, good response and quick recovery. During the treatment, power output and coagulation time are to be strictly controlled, and surrounding normal tissue is to be well protected in order to ensure both efficacy and safety of treatment.
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