This article is published in the May 2008 issue of EzyHealth contributed by Dr. Pang YT.

Allergy or Hypersensitivity is an often seen problem. With changes in our lifestyles, diet and environment up to 40% of the population may be affected in one way or another. Depending on where it affects you, it is called by different names. For example allergic conjunctivitis (eyes), allergic Rhinitis (nose), allergic asthma (lungs), ezcema / urticaria (skin) and the gut can also be affected.

This article focuses on allergies affecting the nose and sinus. Allergy of the nose or allergic rhinitis (AR) troubles us with runny nose, itchy nose, blocked nose, sneezing and a post nasal drip. Often this is associated with eye symptoms.

If one has a cold frequently (more than once a month), or any of the above symptoms regularly, then allergy should be suspected. If a child often falls ill from colds, or has regular runny nose, mouth breathing, noisy breathing or snoring then he or she should be evaluated for allergies.

Seeing a Doctor

When one sees an ear, nose and throat doctor, a thorough history is taken. This may be followed by a nose examination and or an endoscopy. If allergy is suspected, skin or blood test will be done.

The commonest allergen in this part of the world is the house dust mite.

Management of Allergic Rhinitis

Avoidance:

if there was no exposure to the allergens, then symptoms will not occur. By reducing the exposure load, the symptoms can be minimized. This is however not entirely possible with dust mite allergy

Medication:

If avoidance does not resolve the symptoms sufficiently, medication may be needed.

A. Nasal Spray

Steroid Nasal Spray – effective in controlling symptoms and is the most effective of the medication. They are available in both the aqueous or power form eg Rhinocort (both forms).
Anti Histamine Nasal Spray – quick and effective, has bitter after taste, not widely available in Singapore
Decongestant Spray – Over the counter medicine for blocked nose, need to be used sparingly eg oxymethazoline. Side effects of dryness, rebound effects and cardiac effects on prolonged use.

B. Oral Medication

Antihistamine – effective in reducing symptoms. The newer generation are less sedating and well tolerated. This can be used for long term without much side effects eg Telfast, Aerius, Clarityne, Zyrtec.

Antihistamine with Decongestant – if blocked nose is significant, this combination medication can be helpful,eEg Clarinase, Zyrtec D. One should avoid taking this in the evening, as the side effect is hyperactivity.

Decongestant Tablets – Effective for blocked nose (eg pseudoephedrine) but has similar side effect of hyperactivity and palpitation. Should not be taken for long term due to cardiac effects

Steroids – effective but has side effects with prolonged use. This should be taken with the advice of a doctor.

Cromolyn – Safe but benefit takes a while to occur. Works by decreasing the activity of the mast cells. More useful in allergic eyes than nose.

Anti-Leucotriane – useful when asthma is present as well eg Montelukast, Pranlukast

C. Immunotherapy (Specific)

This works like a vaccine to induce a tolerance by the body to protect against the allergen effects usually given in the injection or oral form. In recent years, the oral form (sublingual immunotherapy, SLIT) has made a great impact in the management of allergy. This is given under the tongue for and over time, the body reacts less to allergens. This has shown to be effective against dust mite, pollens, cats and dogs. After a period on the SLIT (usually one year), allergy symptoms can be controlled upwards of 10 years.

With appropriate use of some of the mentioned medication and immunotherapy, patient can now regain control of their quality of life for the long term.

Book an appointment with HealthSense Specialist Dr. YT Pang to look at your ENT problems and get cured.