Tips for Allergy of the Ear, Nose & Throat

Many patients do not know they have allergies. The symptoms may mimic a cold and flu, or only appear hours or days after being exposed to the allergen. For example, if it is a house dust mite allergy, the symptoms can be a daily occurrence especially in the morning and nights, as it is a non-seasonal but perennial allergy throughout the year in hot and humid Singapore. Many people mistakenly think that dust mites cannot be present if their homes are spotless. Without testing for and understanding how to manage the specific allergens, we will not be able to improve our quality of health.

 

What are symptoms of ear, nose and throat allergy?

There can be itch of the ear, nose and throat; a runny or blocked nose; a chronic cough; sneezing, headaches, sore throat, and puffy, dark circles under the eyes.

sinus, sinusitis

 

Why is it important to treat ear, nose and throat allergy?

In the longer term, allergies increase complications like asthma, recurrent sinusitis, middle ear infections, snoring and obstructive sleep apnea.

 

Is it possible to develop an allergy only as adults?

Allergies can develop at any age, though the incidence of allergic rhinitis is higher in children. If there is a family history of allergic rhinitis, asthma or eczema, there is a 50-75% increased risk of allergy developing for the child. Many adults have allergic rhinitis, but as the symptoms may be milder compared to when they are kid, adults tend to think they are already free of the allergies. With allergies, it is easier to catch nose and sinus infections, and harder to recover from those infections. Many patients also mistakenly think that if they are not taking any new food or exposed to any new environment, they should not develop allergies.

 

Are there other causes of chronic runny and blocked nose?

A third of patients with these symptoms may be having a Non-Allergic Rhinitis (NAR). Non-Allergic Rhinitis however, does not have an identifiable allergen cause. It can be due to vasomotor sensitivities, or sensitivities to temperatures changes or certain smells.

 

What are some common symptoms of nose allergy?

Physical symptoms include: itchy ears, nose and throat; a runny or blocked nose; a chronic cough; sneezing, headaches, sore throat, and dark circles under the eyes. But that’s not all – complications like asthma, recurrent sinusitis, middle ear infections, snoring and obstructive sleep apnea can also result in the long run.

 

How can we test for ear, nose and throat allergy?

Allergies in the ear, nose and throat are usually air-borne inhalant related allergies. There can also be food related allergies. Testing for allergies can be complex, especially for delayed allergy reactions and some food allergies. Debate continues about which are the best tests even in professional circles. Indiscriminate testing and careless interpretation of the results are not helpful, and can give a false sense of alarm or assurance.

1. It is important to get a careful history, and to be able to put positive allergens tested in a proper context when managing their avoidance. Food allergies are different from gluten sensitivity, coeliac disease or lactose intolerance.

2. A simple Skin Prick Test can be done in clinic on the same day, with results available in 20 minutes. It is not painful and both air-borne and food allergens can be identified. Diluted extracts from common local allergens (such as dust mites, animal dog and cat dander, grass and tree pollen, cockroach or mould) is lightly applied onto the skin. Both babies to the elderly can do this. Prior to the test, the patient should not take vitamins, herbal or traditional medicines or supplements, antidepressants, cough, cold or allergy related medications for a week.

3. Blood samples to detect the offending allergen can be done if skin conditions or use of medications make a skin test not possible. The results are usually available in 7 to 10 days.

 

What are non-medical management options for ear, nose and throat allergy?

It is important to avoid exposure to the offending allergens. Specific measures would depend on what the allergen specific to that patient is.

For example, for the common allergen of house dust mites, measures would include using HEPA (high-efficiency particulate air) vacuums, anti-dust mite covers or powder on beddings, washing your sheets and curtains in 60 degree Celsius water, and removing carpets. Air-conditioning reduces the humidity and reduces the burden of dust mites too.

The homes should be kept clean and uncluttered so that cleaning of surfaces is easy. Improving ventilation and reducing humidity also reduces mould allergy – the innocent looking indoor plants, water puddles in kitchens and bathrooms encourage mould growth.

Nose rinses and saline sprays can be done daily, and reduce the allergen count, remove mucus, and improve muco-cilliary clearance.

 

What are the medications available for nose allergy?

The most commonly prescribed are steroid nasal sprays and oral antihistamines. These help to reduce sneezing, itching, congestion and runny nose.

1. Nasal steroid sprays are not associated with the more significant side effects of oral steroids, and can be safely used on kids from two years of age if appropriately dosed. They are not emergency rescue drugs, and optimal effects come only after regular usage of one to two weeks.

2. Second generation antihistamines are not as sedating as first generation ones.

3. Oral decongestants are usually used intermittently for acute and severe symptoms.

4. Leukotriene inhibitors like Monteleukast (Singulair) are helpful especially if the patients have asthma.

5. Immunotherapy boosts the body’s natural defences and desensitizes the body to the allergen. For example, the patient will not over-react to the house dust mite anymore after immunotherapy, though the mite is in the environment. This is helpful as it is hard to avoid dust mites completely when out of the immediate home environment that we can control. Immunotherapy can also gradually reduce the need for daily allergy sprays and oral medications. It’s the only possibility of a cure for one’s allergic rhinitis to a specific allergen.

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