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Severe Allergies

Severe Allergies

June 2, 2012
12:00 p.m. – 1:00 p.m. (EST)

  • Frank Eidelman, MD, FRCPC, FAAAI

Cleveland_Clinic_Host: Welcome to our Online Health Chat "Severe Allergies" with Frank Eidelman, MD, FRCPC, FAAAI. We are thrilled to have him here today for this chat. Let’s begin with the questions.

fedbac: Can you explain to me what rhinosinusitis is? How does it differ from regular sinusitis?

Dr_Eidelman: Rhinosinusitis is a term that reflects the fact that all cases of sinusitis (infection/inflammation of the sinuses) are associated with some degree of rhinitis(inflammation of the nasal lining or mucosa). Many sinusitis symptoms are due to the associated rhinitis. So all forms of sinusitis are rhinosinusitis but rhinitis may occur without sinusitis.

nystrom: My son had a deviated septum. He now suffers from recurring sinusitis, are they related in any way? Thanks.

Dr_Eidelman: A "deviated" septum is one that divides the nasal cavity into unequal parts. So instead of running straight down between the nostrils it leans to one side or the other in various degrees. A deviated septum can sometimes predispose one to recurrent sinusitis if the deviation is sufficient to block one or more sinus openings. In such a case the sinusitis would tend to be one sided. In most cases the deviated septum is incidental to the sinus problem.

lindaRell: Hello Dr. Eidelman: I’ve had a history of ENT issues (recurrent sinus and ear infections) since I was six months old. As I get older, these infections are less frequent however more severe. Do you have any recommendations on how to prevent this? Thank you for your time.

Dr_Eidelman: Recurrent respiratory tract infections starting from an early age may be a sign of an underlying immunological problem leading to this predisposition. Immune deficiency should be considered and ruled out. Allergies may be an underlying factor and should be ruled out. I would recommend an appointment with an allergist/immunologist for a complete assessment.

bklyn: Is the body able to naturally heal itself from a sinus infection

Dr_Eidelman: Most sinus infections are acute and associated with viral upper respiratory tract infections (AKA colds). Most of these are self-limited events and last 5-10 days. No medication is required. The immune system handles these quite well. Medications and other treatments may be taken for symptomatic relief but do not alter the course of the illness. I usually recommend saline(salt water) rinses.

Cleveland_Clinic_Host: For those now joining us, we are currently chatting with Frank Eidelman, MD, FRCPC, FAAAI, who is taking your questions about Severe Allergies. To ask a question, type in the box below and then click 'Ask'

rickjenson: What are the symptoms of acute and chronic sinusitis, what’s the difference?

Dr_Eidelman: Acute sinusitis is often associated with head congestion, facial pressure/pain and nasal symptoms.

Dr_Eidelman: Chronic (>6 weeks) sinusitis is usually more subtle. There is rarely any pain. Post nasal drip, nasal congestion and cough are commonly associated.

ceinvests: What tests do you do to assess sinusitis?

Dr_Eidelman: Most of the time the diagnosis is based on clinical impression (patient history and physical exam) but when a diagnostic test is needed the standard is a CT scan of the sinuses

nance: Good day. I am suffering from chronic sinuses and it seems to get worse each year. Is there any other alternative to helping this beyond nasal sprays and pills? The pills tend to make me fall asleep even though they claim to be non-drowsy.

Dr_Eidelman: It depends what you mean by "chronic sinuses". Sometimes the term means chronic infection/inflammation of the sinuses as defined by CT scan. Other times patients refer to chronic nasal symptoms with or without sinus involvement. A specific diagnosis of the rhinitis (allergic? non-allergic? or mixed?) and the sinusitis should be performed. If there is infection, immunodeficiency should be ruled out.

shana351: What does a physician do to determine the best treatment for acute or chronic sinusitis?

Dr_Eidelman: Deriving the best treatment strategy always starts with a good history of the illness as well as the physical examination. With that information in hand an investigation can be planned out.

Dr_Eidelman: Acute infection - often no investigation is needed.

Dr_Eidelman: Chronic infection.

Dr_Eidelman: Allergies? Then allergy tests.

Dr_Eidelman: Possible immune deficiency? Lab work up.

Dr_Eidelman: CT scan of the sinuses.

billdaws65: What kind of doctor is best to see for constant sinus infections? ENT, PCP?

Dr_Eidelman: Allergy and Immunology of course :)

tcline52: When should I consider sinus surgery as a necessary treatment option? I’ve suffered from sever sinusitis for several years now.

Dr_Eidelman: I am not a surgeon so I will not speak to the specific merits of surgery. I usually refer patients for surgery if medical treatment is insufficient to control symptoms. Chronic sinusitis is not usually cured by surgery so ongoing chronic disease management is required after surgery.

Cleveland_Clinic_Host: We are receiving many great questions so far! Please remember that this chat is for general questions about Severe Allergies. If you have a medical question not related to this condition, or that is diagnostic in nature, please follow-up with your personal health care provider or use our contact link clevelandclinic.org/webcontact to submit your questions.

BarbON: I recently developed a lot of allergies, so many I don't actually know what they are. Is it possible that they are all due to my recent diagnosis of asthma? My breathing problems are so significant, I cannot tolerate the pollution even when it is reported as moderate.

Dr_Eidelman: Allergies are not due to asthma. It is usually the other way around. Asthma is frequently induced by exposure to allergens in an allergic individual.

Dr_Eidelman: You should see an allergist immunologist and determine what your allergies are. Most of the time asthma can be controlled with proper management.

HensleyJam: I teach elementary school and seem to keep a sinus infection according to my family and my ENT physician. He prescribes antibiotics and steroids every time I have an appt. My condition improves within 10 days sometimes two weeks and then returns within a month. I’ve missed countless days of work due to my condition, I feel very ill with terrible head and body aches. Do I have any other options for treatment? Have I been misdiagnosed? Thank you!

Dr_Eidelman: Elementary school teachers are exposed to many viral infections from their students and are therefore at high risk of recurrent upper respiratory tract infections (colds) which can be associated with sinusitis. This usually subsides after the first few years on the job.

Dr_Eidelman: If you are not new to the job then you may have an underlying predisposition to infection (allergy, immune deficiency etc) and should have an evaluation with an allergist immunologist.

Dr_Eidelman: It is hard to know what your treatment options might be without more specific diagnostic info.

dotinal: I come a long line of chronic sinusitis suffers. Are sinus disorders genetic?

Dr_Eidelman: Allergies and immune deficiencies do have a genetic component and may run in families.

raf7659: Do allergies play a role in a sinusitis diagnosis?

Dr_Eidelman: They commonly do. Allergies should be addressed in the treatment of sinusitis.

Cleveland_Clinic_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

agort54: If a sinus infection goes untreated for an extended period of time, what are the consequences?

Dr_Eidelman: Most acute sinus infections are self-limited illnesses due to the common cold. No treatment is required.

Dr_Eidelman: Chronic sinusitis can linger for years causing chronic nasal symptoms (congestion, post nasal drip), cough, poor sleep and affect quality of life but is not usually life-threatening.

Dr_Eidelman: Sinusitis can rarely spread into the eye or brain.

swrobel: What is involved in sinus surgery; is the procedure and/or recovery painful?

Dr_Eidelman: I am not a surgeon. You should speak to an otolaryngology (Ear Nose Throat) specialist.

johnnnita: I have been treated for allergies, which were negative, but every spring I can not breathe through my nose and I feel like I have a terrible cold. The symptoms stay most of the summer to fall and sometimes into winter. However, in the winter when I’m active it is better and I can breathe better. Once I was treated with Augmentin and Medrol and felt normal. How can I stop this allergy all year round?

Dr_Eidelman: There are several conflicting statements in your question. If your allergies are "negative" then you don't have allergies and are suffering from a non-allergic form of rhinitis. If that is the case then I am at a loss to explain why your symptoms are so seasonal. You may have chronic sinusitis and that is why you felt better after the Augmentin and Medrol.

scg367: What are your thoughts on irrigation devices like neti pots, do you recommend them?

Dr_Eidelman: There are several conflicting statements in your question. If your allergies are "negative" then you don't have allergies and are suffering from a non-allergic form of rhinitis. If that is the case then I am at a loss to explain why your symptoms are so seasonal. You may have chronic sinusitis and that is why you felt better after the Augmentin and Medrol.

scg367:: What are your thoughts on irrigation devices like neti pots, do you recommend them?

Dr_Eidelman: I routinely recommend nasal saline rinses. The neti pot is fine but I like the Sinus Rinse squeeze bottle better because you get more control over the flow rate. Be sure to use clean water (distilled or similar), add the correct amount of salt( the Sinus Rinse packets are pre-measured) and keep your head down while irrigating. Do not blow your nose vigorously to remove excess water or your ears will pop.

Cleveland_Clinic_Host: I'm sorry to say that our time with Frank Eidelman, MD, FRCPC, FAAAI is now over. Thank you again, Dr. Eidelman, for taking the time to answer our questions today about Severe Allergies. To make an appointment with Dr. Eidelman, or any other specialist at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.

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