Sinus & Allergy Awareness -- August 23, 2010 -- Dr. Stephen Mitchell & Dr. Jim Lancaster - | Nashville News, Weather & Sports

Sinus & Allergy Awareness -- August 23, 2010 -- Dr. Stephen Mitchell & Dr. Jim Lancaster


Sinus & Allergy Awareness
August 23, 2010
Stephen Mitchell MD, Otolaryngology
Jim Lancaster MD, Internal Medicine

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What Causes Sinus Problems?

What to do when good sinuses turn bad.

If you are plagued by sinus problems, take a moment to consider these valuable parts of your head. What can turn good sinuses into problem sinuses?

Your sinuses are hollow air spaces within the bones between your eyes, behind your cheekbone, and in the forehead. They produce mucus, which helps keep the inside of your nose moist. That, in turn, helps protect against dust, allergens, and pollutants.

Interesting Sinus Facts

No one is completely sure why we have sinuses, but some researchers think they keep the head from being too heavy.

Sinuses are also are responsible for the depth and tone of your voice. This explains why you sound like Clint Eastwood when your sinuses are all stuffed up.

If the tissue in your nose is swollen from allergies, a cold, or environmental triggers, it can block the sinus passages. Your sinuses can't drain, you may feel pain, and you will be at much higher risk of sinus infections.

There are eight sinus cavities in total. They are paired, with one of each in the left and right side of the face.

  • Two sinus cavities are located in the forehead.
  • Two are behind each cheekbone.
  • Two sinus cavities are within the bones between your eyes.
  • Two are behind each eye.

Common Sinus Problems

Sinus Blockages

Each sinus has a narrow spot, called the transition space (ostium), which is an opening that's responsible for drainage. If a bottleneck or blockage occurs in the transition of any of the sinuses, you're at risk of developing a sinus infection. Mucus backs up behind the blockage, and acts as a breeding ground for bacteria.

An Extra Sinus

About 10% of people have an extra sinus, which raises their risks for sinus infections. The extra sinus "effectively narrows that transition space," says Ford Albritton, MD, FACS, chairman of otolaryngology at Presbyterian Hospital of Dallas.

Deviated Nasal Septum

Another common issue is a deviated nasal septum, the thin wall of bone and cartilage inside your nasal cavity that separates your two nasal passages. Ideally, your septum is situated in the center of your nose, equally separating the two sides. But whether from genetics or trauma (like a 6th grade fist fight), in about 80% of people, the nasal septum is displaced to one side, making one nasal passage smaller than the other. A deviated septum is one reason some people have chronic sinus issues. A deviated septum can also lead to obstructed breathing and snoring.

Narrow Sinuses

More widely, certain people just have variations in their anatomy that creates a longer, narrower path for the transition spaces to drain. "It's pure genetics, since it's the way we've inherited how our sinuses are put together and how easy or difficult it is for them to stay open or become blocked," Albritton says.

Sinus Sensitivity and Allergies

Finally, there are certain people who have sensitivity to things in the environment and to the foods they eat. This sensitivity triggers a dilation of blood vessels in the nose, and sometimes releases chemicals from cells in the nose that cause swelling.

Does drinking red wine or eating certain foods cause your nose to swell? This is a type of allergic reaction or food sensitivity that can make the sinuses ripe for infection. The inflammation causes tissue swelling that prevents the sinus cavities from clearing out bacteria. The blocked mucus creates a breeding ground for bacteria, which increases your chances of developing a sinus infection.

If you test positive for allergies, your physician can prescribe medications to control your symptoms and reduce the risk of developing an infection. People with sinus problems and allergies should avoid environmental irritants such as tobacco smoke and strong chemical odors, which may increase sinus problems.

Who Is Prone to Sinus Problems?

People who have very narrow sinus cavities can have a bottleneck for drainage so that any swelling or infection creates a blockage that causes sinus infection. "If your sinus passageways are narrow to begin with then what happens is if you get any kind of inflammation whether it's from pollution, allergy or infection, the sinus shuts down, the mucus sits there and pools, and you become infected," says Jordan Josephson, MD, author of Sinus Relief Now (Penguin), and an attending physician at Lennox Hill Hospital in New York City.

Those with allergies and food sensitivities are predisposed to sinus infections since the offending allergens like cigarette smoke, pollution or food triggers enter the body and turn on cells, make proteins and release chemicals that cause the sinuses to swell.

Also, those with lowered immunity (as when you've had a cold) may be at higher risk for developing sinusitis. Since your immune system helps fight infection, when its lowered from any cause they can't keep bacteria or viruses away. Then bacteria have an easier time coming in and causing a full-fledged infection.

Protecting Your Sinuses

Try these tips to reduce inflammation and prevent sinus problems:

  • Apply a warm, moist washcloth to your face several times a day to help open the transition spaces.
  • Drink plenty of fluids to thin the mucus.
  • Inhale steam 2 to 4 times per day (sit in the bathroom with the hot shower running).
  • Use a nasal saline spray several times per day.
  • Wash the nose with a salt water solution from a neti pot.
  • Try a humidifier to moisten the air you breathe and help open sinuses.

If your sinus problems are related to allergies, consider these steps:

  • Avoid your allergy triggers.
  • Take antihistamines.
  • Try nasal steroid sprays.
  • Consider allergy immunotherapy (shots).
  • If you develop a sinus infection that does not clear after 10 to 14 days, talk to your doctor about antibiotics.
  • Lastly, if you have recurrent sinus problems, you might talk to your doctor about surgery to clean and drain the sinuses.
  • "Surgery is designed to take care of the anatomic issues and to remove the areas that are narrow and causing the blockage," Albritton says. The newest methods are less invasive and use a balloon catheter like an angioplasty to dilate the opening of the sinuses and create wider spaces.
  • Remember, most sinus infections can be treated with a combination of self-care measures, controlling allergies, and medical treatment. If self-care measures don't prevent sinus problems further testing or a referral to an ears nose and throat specialist maybe in order.



Allergy Basics: What is an Allergy?

Allergies are an abnormal response of the immune system. People who have allergies have an immune system that reacts to a usually harmless substance in the environment. This substance (pollen, mold, animal dander, etc.) is called an allergen.

Allergies are a very common problem, affecting at least two out of every 10 Americans.

What Happens During an Allergic Reaction?

First, a person is exposed to an allergen by inhaling it, swallowing it, or getting it on or under their skin. After a person is exposed to the allergen, a series of events create the allergic reaction:

  1. The body starts to produce a specific type of antibody, called IgE, to bind the allergen.
  2. The antibodies attach to a form of blood cell called a mast cell. Mast cells can be found in the airways, in the intestines, and elsewhere. The presence of mast cells in the airways and GI tract makes these areas more susceptible to allergen exposure.
  3. The allergens bind to the IgE, which is attached to the mast cell. This causes the mast cells to release a variety of chemicals into the blood. Histamine, the main chemical, causes most of the symptoms of an allergic reaction.


What Are the Symptoms of an Allergic Reaction?

Common symptoms of an allergic reaction to inhaled or skin allergens include:

  • Itchy, watery eyes
  • Sneezing
  • Itchy, runny nose
  • Rashes
  • Feeling tired or ill
  • Hives (a rash with raised red patches)

Other exposures can cause different allergic reactions:

  • Food allergies. An allergic reaction to food allergens can also cause stomach cramps, vomiting, or diarrhea.
  • Insect stings. The allergic reaction to a sting from a bee or other insect causes local swelling, redness, and pain.

The severity of an allergic reaction's symptoms can vary widely:

  • Mild symptoms may be almost unnoticeable, just making you feel a little "off."
  • Moderate symptoms can make you feel ill, as if you've got a cold or even the flu.
  • Severe allergic reactions are extremely uncomfortable, even incapacitating.

Most symptoms of an allergic reaction go away shortly after the exposure stops.

The most severe allergic reaction is called anaphylaxis. In anaphylaxis, allergens cause a whole-body allergic reaction that can include:

  • Hives and itching all over (not just in the exposed area)
  • Wheezing or shortness of breath
  • Hoarseness or tightness in the throat
  • Tingling in the hands, feet, lips, or scalp

Anaphylaxis is life-threatening and requires immediate medical attention. Symptoms can progress rapidly, so head for the emergency room if there's any suspicion of anaphylaxis.

Does Everyone Have Allergies?

No, not everyone has allergies. People inherit a tendency to be allergic, although not to any specific allergen. When one parent is allergic, their child has a 50% chance of having allergies. That risk jumps to 75% if both parents have allergies.

Allergic Reaction Causes

Almost anything can trigger an allergic reaction.

  • The body's immune system has a patrol of white blood cells, which produce antibodies.
  • When the body is exposed to an antigen, a complex set of reactions begins.
  • The white blood cells produce an antibody specific to that antigen. This is called "sensitization."
  • The job of the antibodies is to detect and destroy substances that cause disease and sickness. In allergic reactions, the antibody is called immunoglobulin E, or IgE.
  • This antibody promotes production and release of chemicals and hormones called "mediators."
  • Histamine is one well-known mediator.
  • Mediators have effects on local tissue and organs in addition to activating more white blood cell defenders. It is these effects that cause the symptoms of the reaction.
  • If the release of the mediators is sudden or extensive, the allergic reaction may also be sudden and severe.
  • Your allergic reactions are unique to you. For example, your body may have learned to be allergic to poison ivy from repeated exposure.
  • Most people are aware of their particular allergy triggers and reactions.
  • Certain foods, vaccines and medications, latex rubber, aspirin, shellfish, dust, pollen, mold, animal dander, and poison ivy are famous allergens.
  • Bee stings, fire ant stings, penicillin, and peanuts are known for causing dramatic reactions that can be serious and involve the whole body.
  • Minor injuries, hot or cold temperatures, exercise, or even emotions may be triggers.
  • Often, the specific allergen cannot be identified unless you have had a similar reaction in the past.
  • Allergies and the tendency to have allergic reactions run in some families. You may have allergies even if they do not run in your family.
  • Many people who have one trigger tend to have other triggers as well.
  • People with certain medical conditions are more likely to have allergic reactions.
  • Severe allergic reaction in the past
  • Asthma
  • Lung conditions that affect breathing, such as chronic obstructive pulmonary disease (COPD)
  • Nasal polyps
  • Frequent infections of the nasal sinuses, ears, or respiratory tract
  • Sensitive skin

Finding the Cause of Allergies

How do people find the cause of allergies? Most learn to recognize their allergy triggers; they also learn to avoid them in the name of allergy prevention.

An allergy specialist (allergist) may be able to help you identify your triggers. Several different types of allergy tests are used to identify triggers.

  • Skin testing is the most widely used and the most helpful in finding the cause of allergies. There are several different methods, but all involve exposing the skin to small amounts of various substances and observing the reactions over time. 
  • Blood tests (RAST) generally identify IgE antibodies to specific antigens, or allergy triggers.  
  • Other tests involve eliminating certain allergens from your environment and then re-introducing them to see if a reaction occurs.

People with a history of serious or anaphylactic reactions may be prescribed an auto-injector, sometimes called a bee-sting kit. This contains a premeasured dose of epinephrine (EpiPen is one brand name). You carry this with you and inject yourself with medication immediately if you are exposed to a substance that causes you to have a severe allergic reaction.

There is some evidence that breast-fed infants are less likely to have allergies than bottle-fed infants.


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