ABC’s of allergies – Ear, Nose and Throat

By Giulia Criscuolo, Responsible Pharmacist for Litha Pharma

You’re not alone if you suffer from allergies. In fact, millions of South Africans have them. Allergies can appear at any age, and can even disappear in childhood only to reappear in adulthood. Allergies of the ear, nose and throat are often annoying and create some discomfort, but they are rarely life threatening.

What is an allergy?

Allergy or hypersensitivity is an abnormal reaction to protein substances (called allergens) that occur naturally.
If an allergic person is exposed to these substances called allergens, the body’s immune system reacts to them.

White blood cells (B-lymphocytes) produce an antidote (antibody) against the allergen. The antibody sticks to the surface of the allergy cells. Now the body is ready to fight back the next time it is exposed to the allergen. This process is called sensitisation.

After this change, there is an allergic reaction every time the body is exposed to the allergen.

The allergen sticks to the antibodies on the surface of the allergy cells. This coupling causes the granula (little stores in the allergy cells) to release histamine, which causes the symptoms of allergy.

Depending on the size of the exposure to the allergen and where on the body it happens, there will be an allergic reaction.

The histamine dilates the blood vessels, causes the mucous membranes (lining tissues of the nose and airways) to swell due to the liquid leaking and stimulates the glands in the nose and the respiratory passages to produce mucus (phlegm).

Substances that make the muscles of the respiratory passages contract are released along with the histamine. It becomes difficult to breathe and an asthma attack may follow.

What are allergens?

Allergens are microscopic protein substances that are common and provoke allergic people to produce antibodies.
The most common allergy provoking substances are:

  • pollen from weeds, grass and trees
  • mould and mould fungus
  • house dust mites
  • saliva and skin oils from cats, dogs and any animal or bird
  • medicines
  • wasp and bee venom.

What other things provoke attacks?

Many common substances can be allergens. Pollens, food, mold, dust, feathers, animal dander, chemicals, drugs such as penicillin, and environmental pollutants commonly cause many to suffer allergic reactions.

Indoor plants, old books, bathrooms, and damp areas are common sources of indoor mold growth. Mold is also common in foods.

Allergies of the Nose

Why Is Your Nose So Important?

It processes the air that you breathe before it enters your lungs. Most of this activity takes place in and on the turbinates, located on the sides of the nasal passages. In an adult, 18,000 to 20,000 liters of air pass through the nose each day.

Your Nose Protects Your Health By:

  • Filtering all that air and retaining particles as small as a pollen grain with 100% efficiency.
  • Humidifying the air that you breathe, adding moisture to the air to prevent dryness of the lining of the lungs and bronchial tubes.
  • Warming cold air to body temperature before it arrives in your lungs.

For these and many other reasons, normal nasal function is essential.

Inflammation of the nasal mucous membrane is called rhinitis. The symptoms include sneezing and runny and/or itchy nose, caused by irritation and congestion in the nose. There are two types: allergic rhinitis and non-allergic rhinitis.

Allergic Rhinitis: This condition occurs when the body’s immune system over-responds to specific, non-infectious particles such as plant pollens, molds, dust mites, animal hair, industrial chemicals (including tobacco smoke), foods, medicines, and insect venom. During an allergic attack, antibodies, primarily immunoglobin E (IgE), attach to mast cells (cells that release histamine) in the lungs, skin, and mucous membranes. Once IgE connects with the mast cells, a number of chemicals are released. One of the chemicals, histamine, opens the blood vessels and causes skin redness and swollen membranes. When this occurs in the nose, sneezing and congestion are the result.

Seasonal allergic rhinitis or hay fever occurs in late summer or spring. People can be allergic to all kinds of allergens, such as grasses, trees, pollen, plants, etc. etc.

Perennial allergic rhinitis occurs year-round and can result from sensitivity to pet hair, mold on wallpaper, houseplants, carpeting, and upholstery. Some studies suggest that air pollution such as automobile engine emissions can aggravate allergic rhinitis.

Patients who suffer from recurring bouts of allergic rhinitis should observe their symptoms on a continuous basis. If facial pain or a greenish-yellow nasal discharge occurs, a qualified ear, nose, and throat specialist can provide appropriate sinusitis treatment.

Non-Allergic Rhinitis: This form of rhinitis does not depend on the presence of IgE and is not due to an allergic reaction. The symptoms can be triggered by cigarette smoke and other pollutants as well as strong odors, alcoholic beverages, and cold. Other causes may include blockages in the nose, a deviated septum, infections, and over-use of medications such as decongestants.

Allergy as a Cause for Sore Throat

The main culprit in an allergy-induced sore throat is postnasal drip. As unpleasant as it may sound, postnasal drip occurs when congestion drains down an allergy sufferer’s throat, sometimes causing a tickling. That drainage can cause coughing, excess swallowing, and throat irritation.

How do you know if your sore throat is the result of allergies?

Generally allergies are seasonal. Even if you experience symptoms year-round, your symptoms will worsen during seasons of high airborne irritants, like springtime. Allergy symptoms generally include congestion, sneezing, and coughing, but are not accompanied by fever and aches. If you have sore throat symptoms with fever and aches, it is likely the result of a virus, like a cold or flu.

Another way to differentiate between an allergy-induced sore throat and one that has been brought on by a virus is the scratchiness. Postnasal drip isn’t the only cause of a sore throat during allergies. Often particles will directly enter a person’s respiratory system, also causing that scratchy feeling, in addition to the “raw” feeling that results from drainage.

How Allergies affect your Child’s Ear, Nose and Throat

Does your child have allergies? Allergies can cause many ear, nose, and throat symptoms in children, but allergies can be difficult to separate from other causes. Here are some clues that allergy may be affecting your child.

Children with nasal allergies often have a history of other allergic tendencies (or atopy). These may include early food allergies or atopic dermatitis in infancy. Children with nasal allergies are at higher risk for developing asthma.

Nasal allergies can cause sneezing, itching, nasal rubbing, nasal congestion and nasal drainage. Usually, allergies are not the primary cause of these symptoms in children under four years old. In allergic children, these symptoms are caused by exposure to allergens (mostly pollens, dust, mold, and dander). Observing which time of year or in which environments the symptoms are worse can be important clues to share with your doctor.

Ear infections:

One of children’s most common medical problems is otitis media, or middle ear infection. In most cases, allergies are not the main cause of ear infections in children under two years old. But in older children, allergies may play role in ear infections, fluid behind the eardrum, or problems with uncomfortable ear pressure. Diagnosing and treating allergies may be an important part of healthy ears.

Sore throats:

Allergies may lead to the formation of too much mucus which can make the nose run or drip down the back of the throat, leading to “post-nasal drip.” It can lead to cough, sore throats, and a husky voice.

Sleep disorders:

Chronic nasal obstruction is a frequent symptom of seasonal allergic rhinitis and perennial (year-round) allergic rhinitis. Nasal congestion can contribute to sleep disorders such as snoring and obstructive sleep apnea, because the nasal airway is the normal breathing route during sleep. Fatigue is one of the most common, and most debilitating, allergic symptoms. Fatigue not only affects children’s quality of life, but has been shown to affect school performance.

Pediatric sinusitis:

Allergies should be considered in children who have persistent or recurrent sinus disease. Depending on the age of your child, their individual history, and an exam, your doctor should be able to help you decide if allergies are likely. Some studies suggest that large adenoids (a tonsil-like tissue in the back of the nose) are more common in allergic children.

How can allergies be managed?

Allergies are rarely life-threatening, but often cause lost work days, decreased work efficiency, poor school performance, and a negative effect on the quality of life. Considering the millions of rands spent on antiallergy medications and the cost of lost work time, allergies cannot be considered a minor problem.

For some allergy sufferers, symptoms may be seasonal, but for others they produce year-round discomfort. Symptom control is most successful when multiple approaches are used simultaneously to manage the allergy.

When should a doctor be consulted?

The most appropriate person to evaluate allergy problems is an otolaryngologist (ear, nose, and throat specialist). Aside from gathering a detailed history and completing a thorough examination of the ears, nose, throat, head, ENT doctors will offer advice on proper environmental control. They will also evaluate the sinuses to determine if infection or structural abnormality (deviated septum, polyps) is contributing to the symptoms.

When Should You See A Specialist?

Under the following circumstances, the patient should seek consultation with an Otolaryngic Allergist:

  • When the diagnosis of an ear, nose, or throat allergy or cause of an ear, nose, or throat symptom is uncertain
  • When allergy or ear, nose or throat symptoms are not adequately controlled
  • When special diagnostic allergy tests are needed
  • When specialized treatment such as immunotherapy is needed
  • When other related ear, nose, and throat medical problems are present, such as
  • Chronic Sinusitis
  • Nasal Polyps
  • Fluid In The Middle Ear
  • Chronic Ear Infections
  • Deviated Septum
  • Vocal Disturbances
  • Enlarged Adenoids Or Tonsils

When complications associated with treatment or difficulty in controlling allergy symptoms are affecting the patient’s quality of life.

Alternatively, a homeopath, naturopath or complementary medicine practitioner can also be consulted, so as to get to the root cause of the problem, instead of just managing the symptoms.

Why test for allergies?

Many conditions including asthma, hay fever, sinusitis, eczema, hives, stomach aches can be caused by one allergy or another. If the allergic cause can be identified, then the treatment will be easier and ranges from simple avoidance, to desensitisation and symptom control via specific medication. For example if a new kitten is causing your allergy to deteriorate, then it makes sense to find a new home for the cat rather than take medication every day of your life; and if grass pollen is the problem, then being desensitised to grass pollen may induce a state of tolerance and reduce or eradicate the need for antihistamine tablets, eye drops and nose sprays.

Conventional treatment of allergies

Although quite a few medications are available to treat allergies, avoidance is actually a pretty smart way to start treatment for allergic rhinitis — if you’re not around an allergen, you won’t react to it.

For seasonal allergies, this means staying indoors when possible during high pollen days (usually hot, dry, and windy days). For year-round allergies, this could mean using air filters and purifiers in the home, especially in the bedroom because you spend more time there.

Wash bed linens in hot water to kill dust mites, and consider purchasing impermeable mattress and pillow covers to reduce exposure. Either replace carpets with hard flooring or vacuum them frequently, and use blinds instead of drapes or at least clean fabric drapes as often as possible. Of course, to avoid pet dander, you have to either not keep pets or have pets with low or no dander production.

Typical medications given for allergies include the following:

  • Antihistamines: These meds stop histamine production and its symptoms. However, they can cause sedation. Newer options, which are less sedating, exist.
  • Decongestants: These options treat the swelling but should only be used for a few days at a time; otherwise, they can cause rebound swelling and make matters worse. Also, some contain pseudoephedrine, which can raise blood pressure.
  • Nasal corticosteroids: Sprays such as these stop the inflammation, so they reduce symptoms, such as itchy eyes, runny nose, and sneezing.
  • Leukotriene modifiers: Because leukotrienes are inflammatory mediators, blocking their production also decreases itchy eyes, runny nose, and sneezing. Leukotriene modifiers don’t cause drowsiness, and you need to use them only once a day.
  • Cromolyn sodium: This older, over-the-counter medication prevents the release of histamine. It’s best to take this med before symptoms even start (even if you’ve just been exposed or expect to be exposed to something you know you’re allergic to).
  • Nasal atropine: Atropine causes constriction of blood vessels, so it’s useful in stopping severe runny noses. Contraindications include glaucoma or an enlarged prostate.

Also known as desensitization or allergy shots, immunotherapy treatment consists of injection of high-dose allergens to block the allergic response. Although it’s been shown to be about 80 to 90 percent successful for some allergens, it requires up to three to five years of treatment to get relief. Immunotherapy can be associated with severe systemic reactions in some cases and should, therefore, be considered only if medical treatment is ineffective.

Treating allergies the natural way

  • Butterbur. The herb appears to work as a leukotriene inhibitor, which blocks some chemicals that trigger swelling in the nasal passages.
  • Quercetin. Found in wine and many fruits and vegetables, quercetin may work as a mast cell stabilizer. It helps block the release of histamine that causes inflammation and seems to work well for prevention.
  • Stinging Nettle. Often used as an allergy treatment, this botanical contains carotene, vitamin K, and quercetin. There’s some evidence that using stinging nettle after the first sign of allergic symptoms can help a bit. Be sure to choose extracts of stinging nettle (Urtica dioica) leaf, not the root, which is used to treat prostate troubles.
  • Bromelain. Some studies have found that bromelain is helpful in reducing nasal swelling and thinning mucus, making it easier for people to breathe.
  • Other allergy supplements. People use many other supplements to treat allergies, including echinacea, grape seed extract, pycnogenol (pine bark extract), vitamin C, EPA, honey, cat’s claw, albizzia (Albizzia lebbeck), baical skullcup (Scutellaria baicalensis), goldenseal, and spirulina.
  • Probiotics. Probiotics support healthy digestion and they also play a role in keeping your immune system well balanced. Since not all strains of probiotics are beneficial for the same thing, choose brands that contain Lactobacillus rhamnosus GG, Bifidobacterium lactis and Acidophilus.
  • Homeopathic Treatments. Homeopathy uses very diluted amounts of herb and flower essences. Two main for allergies are: Euphrasia, which is especially good for burning, itchy eyes; and Allium cepa, which is good for a drippy nose. Other homeopathic remedies include Sabadilla, Arsenicum album, Arundo, Wyethia, Nat Mur, Gelsemium, Arum Triphyllum and many more.
  • Pop a fish oil supplement. It seems that taking a daily fish-oil supplements lowers your levels of leukotrienes, chemicals that contribute to the allergic reaction.
  • Cook with turmeric. Turmeric, a spice common in curry and Indian cuisine, contains curcumin. It may act as a decongestant, help reduce allergy symptoms, and ward off colds. Many practitioner feel that it seems to be as effective as some drugs for certain conditions.

Other Nondrug Allergy Treatments

Supplements aren’t the only alternative to medications. There are a number of other methods you can try to treat or prevent allergies, some of which have very good evidence backing them up.

  • Environmental control. Reducing the amount of allergens in your home, especially your bedroom, can take a lot of work and vigilance. But the payoff can be tremendous. Wrap your mattress in plastic, vacuum regularly, and follow other suggestions for environmental control.
  • Nasal irrigation. It might seem odd, but there’s good evidence that flushing out the nasal passages with salt water can help allergy symptoms. Some use simple neti pots and others more elaborate devices.

A common “recipe” for the salt-water solution is to mix about a litre of water with two to three teaspoons of sea salt and one teaspoon of baking soda. Store at room temperature in a covered jar or bottle. Don’t use standard table salt, due to the presence of iodine and other additives. Irrigate each nostril with approximately one-half cup of the solution, a few times daily for acute conditions or once daily for maintenance.

To enhance the effect, add a couple of drops of eucalyptus oil to the salt water. The eucalyptus constricts the blood vessels, reducing the inflammation.

  • HEPA filters. A HEPA (high-efficiency particulate air) filter, should trap some of the allergens circulating in your home. Get one for your vacuum cleaner, too. Without it, your vacuum will just shoot the tiny allergens back into the air — and into your nose.
  • Allergy shots. Most allergy treatments are just ways of trying to tamp down the symptoms. But allergy shots, or immunotherapy, offer a permanent solution. By injecting very small but increasing amounts of an allergen under the skin, you can gradually get your immune system used to it. Eventually, even large amounts may not trigger symptoms. This approach does take time — usually months of injections — and it’s not always successful.
  • Protection. If you’re heading out to clean a dusty garage or rake during pollen season, gear up. Don’t just wear a mask over your mouth and nose, but goggles over your eyes too. Most people don’t realize it, but lots of allergens enter the body through the eyes.
  • Acupuncture. Many people who suffer with allergic rhinitis are now turning to acupuncture for relief. The evidence on its effectiveness is mixed. While some studies have found no benefit, others have been promising.
  • Wear a pollen mask when mowing grass or cleaning house (most drugstores sell them).
  • Change your air filters regularly in heating and air conditioning systems and vacuum cleaners and/or install an air purifier. Consider a HEPA filter in your bedroom or other rooms where you spend a lot of time.
  • Keep windows and doors closed during heavy pollen seasons.
  • Wipe down indoor-outdoor animals as they return inside to remove pollen on their fur.
  • Rid your home of sources of mildew.
  • Try not to allow dander-producing animals (i.e., cats, dogs, etc.) into your home and bedroom. However, if you have a pet, ask your ENT for suggestions to allow you to enjoy your pet while also enjoying a life free of allergies.
  • Change feather pillows, woolen blankets, and woolen clothing to cotton or synthetic materials.
  • Enclose mattress, box springs, and pillows in a plastic barrier.
  • Sleep with the head of the bed tilted upward. Elevating it helps relieve nasal congestion.

Conclusion

As you can see, there are many options available in managing and treating allergies of the ear, nose and throat and the aim should be to identify the cause of the problem and treat in an holistic a way as possible, trusting the body’s natural ability to restore the system to homeostasis and balance. As with any chronic condition, care and attention should be given to nutrition, exercise and lifestyle.

Swiss-based Similasan has a long tradition of developing and producing high quality homeopathic medicines. Today, the Similasan brand is among the best known and top selling brands in Switzerland. Conventional products may treat symptoms while Similasan’s unique formulas work to stimulate the body’s natural ability to heal, in line with homeopathic principles. The Similasan range comprises the highest quality natural remedies to treat a variety of eye, nose, throat and ear ailments.

Similasan products are available at health stores, pharmacies, Dis-Chem, Clicks, Pick n Pay, Medi-Rite, Wellness Warehouse andSpringbok Pharmacy.

See www.similasan.co.za and www.otcpharma.co.za or call 011 516-1700.

References
www.webmd.com
Allergy Clinic South Africa
American Academy of Otolaryngology
Allergy Ear Nose and Throat Clinic in Texas, USA

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