We all take for granted that breathing through the nose is normal for everyone. However, there are several million people who do not have the luxury of breathing through their nose. When we breathe through the nose, the air circulates through the sinuses and while passing through the sinuses the air is humidified, filtered, and brought to body temperature. The sinuses also give resonance to our voice.
Anyone with nasal obstruction, either functional or mechanical, has rhinitis. A major symptom of rhinitis in adults can be sinus headaches. These headaches are usually caused by sinus pressure and will not be shown on x-rays or CAT scans. If rhinitis persists the sinus problem can lead to fluid collection in the sinuses and ultimately turn into a sinus infection. Most people who have sinus problems do in fact have nasal obstruction, either partial or complete. Unless the nasal symptoms are cleared, the sinus problems will persist.
The most common complications of rhinitis in children include recurrent fluid collection in the ears and middle-ear infections. In this group of children, hearing loss may be significant which, in turn, can lead to learning problems in early childhood.
Patients who have chronic rhinitis also have constant post-nasal drip and frequent sore throats. Children may have an upset stomach in the morning hours because of the swallowing of mucous and increased gastric acidity.
Nasal obstruction also causes tear-duct obstruction and teary eyes. In extreme cases of nasal obstruction, people experience a loss of smell and taste. Chronic mouth breathing may cause orthodontic problems. The well-known cause of allergic shiners is due to nasal obstruction and venous congestion in the lower eyelids. A crease across the nose can be caused by constant rubbing of the nose.
Cold symptoms that last more than 10 – 14 days, often with green or yellow nasal discharge, may be due to a sinus infection.
Chronic sinusitis can cause a flare-up of asthma and bronchitis. Keeping the upper airways clear is very important in asthmatics.
There are several causes for this nasal blockage and some of the most common are described as follows:
- Allergic Rhinitis – this is the most common cause of nasal blockage, more common in children and young adults. Allergies are less common in older people.
- Non-Allergic Rhinitis with Eosinophils – These people have similar symptoms as people with allergies, however, the symptoms are present all year long. They respond well to the usage of steroid nasal sprays.
- Vasomotor (non-allergic) Rhinitis – Patients with vasomotor rhinitis basically have very sensitive nasal linings and any irritants like smoke, dust, perfumes, hair sprays, cold air, temperature changes, and barometric pressure changes can aggravate symptoms. They have chronic nasal congestion and constant postnasal drip. Most of these people ultimately end up with chronic sinus problems
- Nasal Polyps – Nasal polyps are growths of extra tissue in the nose and allergies can aggravate them. Nasal polyps never become cancerous. These patients should be on cortisone nasal sprays to prevent recurrence.
- Mechanical Blocking – such as nasal septal deviation, enlarged adenoids or any foreign bodies.
- Rhinitis Medicamentosa – caused by excessive use of decongestant nasal sprays. This condition is most common in patients with vasomotor rhinitis.
- Rhinitis due to infection – Rhinitis, secondary to the common cold, usually lasts 10 to 14 days and gets better.
- Antihypertensive medications and oral contraceptives sometimes cause nasal stuffiness.
ALL PATIENTS WHO HAVE CHRONIC RHINITIS SHOULD BE EVALUATED FOR ANY OF THE ABOVE CONDITIONS. BY TREATING THE NASAL SYMPTOMS AGGRESSIVELY, WE CAN PREVENT CHRONIC SINUS PROBLEMS.
Treatment of Allergies
Once we find out what a person if allergic to, avoidance is the best measure. Based on the targeted organs, we either treat the nasal symptoms, eye symptoms, or asthma problems. Allergy injections reduce the specific IgE antibody levels, and build up IgG antibody levels.
The most common treatment for nasal symptoms are nasal sprays. There are two major classes of nasal sprays. The first class is “relief” medications which helps within a few minutes. The most common is the non-prescription, over-the-counter decongestant sprays. Long-term use of this is not recommended as it can be habit forming. The other type of relief nasal sprays are antihistamine nasal sprays, i.e.: Astelin, and anticholinergic nasal sprays such i.e.: Atrovent.
The second major class of nasal sprays are “control” medications for nasal symptoms. Most common in this group are the nasal steroids. They do not have any systemic side effects as we use them in minute amounts. The most common side effects are nose bleeds, dryness, and irritation. These nasal sprays must be taken on a regular basis in order to work. There is also a control nasal spray, cromolyn sodium, which is very safe to use; but this nasal spray must be taken at least three to four times a day on a regular basis.
The relief-type medications (antihistamines, decongestants, or a combination) can be taken on an as-needed basis, mostly by mouth.
In the long run, avoiding exposure to allergens, taking medications on a regular basis, and getting allergy injections will prevent nasal symptoms. If nasal symptoms are not well controlled, complications of chronic sinusitis, chronic ear infections, postnasal drip, chronic mouth breathing, and in some instances, lacrimal-duct obstruction and venous congestion in the lower eyelids (dark circles under the eyes), can occur.
Asthma, Allergies, and Eczema
Asthma, allergies, and eczema usually runs in the family. If you have all three of these diseases, we will sometimes refer to you as an “atopic individual”. However, all three diseases are different. Approximately one-third of the people who have allergies also have asthma problems, and about one-third of those also have eczema problems.
If you check your family history for two or three generations, some family members may have just had allergies, some of them may have had both allergies and asthma, and some may have had all three. Allergic tendencies run in families. Once a person has a tendency, he must be exposed to potential allergens for a period of time. The greater the exposure, the greater the chance of developing allergies. Once a person has been exposed to a potential allergen long enough, his or her immune system produces a specific IgE antibody to that allergen.
Normally, we all make antibodies which belong to the classes of immunoglobulin A, G, and M, which we need for protection from infections. However, the IgE response is an abnormal response which actually causes the allergic reactions. The IgE antibodies are very specific to each antigen. For example, if you are allergic to cats, you make an IgE antibody very specific to cat proteins. Once these IgE antibodies are made, they affix to the surface of a mast cell. The mast cells are located in the nasal linings, conjunctivae, lungs, GI tract, and skin. These mast cells are loaded with histamine and other inflammatory chemicals. Once there is re-exposure to the antigen, all these chemicals are released and together create an inflammation.
Inflammation in the nose is called rhinitis, inflammation in the eyes is called conjunctivitis, and if there is a tendency for asthma, inflammation in the airways within the lungs causes asthma. If a sensitive person is exposed to a food allergen, he or she can develop hives and angioedema with swelling of the lips and throat, wheezing, or anaphylaxis.
When we do skin testing, we put the antigen on the surface of the skin, and if the person has an IgE antibody to that antigen, a small local reaction, redness and swelling at the site of the skin test occurs.
