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Ear, Nose and Throat (ENT), Head and Neck Surgery
What is Allergic Rhinitis (AR)?:
Commonly
called
hay
fever
,
AR
is
an
inflammation
of
the
inner
lining
of
the
nose
that
occurs
when
an
allergic
individual
encounters
an
airborne
allergen
such
as
house
dust
mites
(HDM)
,
pollen, mold, or animal dander like dogs and cats.
Usually
inhaled,
these
triggers
generate
allergy
symptoms
such
as
sneezing,
coughing,
runny
nose,
sore
throat
and
itchy
or
watery
eyes,
phlegm
dripping
into
the
throat
(postnasal
drip),
chronic
cough
and
puffy/red
itchy
eyes.
Those
with
positive
family
history
of
allergy
or
other
forms
of
allergy
eg.
bronchial
asthma,
eczema,
urticaria
are
also
more
likely
to
have
AR.
Although
AR
can
develop
at any age, it usually appears in individuals before the age of 30.
What are the other causes for the symptoms ?
There
are
other
types
of
rhinitis
that
should
not
be
confused
with
AR.
All
types
of
rhinitis
affect
nasal
and
sinus
function.
However,
many
other
types
of
rhinitis
respond
to
different
triggers
but
may
present
quite
similarly
to
AR.
These
fall
into
a
general
category
of
non-allergic
rhinitis
(NAR)
.
Causes may include:
•
Infection, such as the flu or common cold
•
Nasal polyps (frequently present in AR patients)
•
Hormonal imbalance eg. pregnancy
•
Overuse of decongestant nasal sprays
•
Use of certain medications (aspirin, antihypertensives, some painkillers, oral contraceptives)
•
Exposure to cold temperatures, high humidity, chemicals or other irritants
•
Eating spicy or hot temperature foods
However,
nasal
obstruction
can
also
be
due
to
structural
problems
within
the
nose
eg.
enlarged
nasal
turbinates
or
deviation
of
the
nasal
septum
(DNS).
Also,
symptoms
of
nasal
allergies
must
also
be
differentiated
from
cold/influenza
and
sinusitis.
If
blood
is
present
in
the
nasal
discharge,
it
is
imperative
to
exclude
cancerous
growth
in
the
nasal
passage.
Therefore
the
role
of
the
ENT
doctor
is
to
distinguish
between
the
different
possible
causes
from
history,
clinical
examination
and
endoscopy.
Blood
investigation
(allergy
panel
and
IgE
test)
to
identify the allergic triggers can be very helpful
What are the complications of AR?
Uncontrolled,
AR
can
seriously
impair
quality
of
life.
It
can
lead
to
snoring
and
may
interfere
with
sleep
(
obstructive
sleep
apnea
OSA
),
resulting
in
daytime
sleepiness, and affect the ability to learn and perform tasks.
In
addition,
untreated
or
improperly
treated
AR
may
eventually
lead
to
other
complications.
These
include
chronic
sinusitis
,
recurrent
inflammation
or
enlargement
of
the
adenoids
and
tonsils
,
chronic
ear
infections
(otitis
media)
and
ear
dysfunction.
Nasal
polyps
have
also
been
associated with AR, though the connection is unclear.
Treatment- What to do ?
The most important part of treatment is to understand the recurrent and prolonged nature of the disease
process. While symptoms can be improved over the short-term with treatment, commitment to long-term
treatment with follow-up to exclude complications and optimise drug dosage is vital. Stopping the treatment
completely just when symptoms are receding would almost certainly bring them back again. That would bring
the patient and the doctor back to square one !
The best way to treat AR is to avoid or limit exposure to the allergen as much as possible. Therefore, it is
important to identify the allergens. Avoidance techniques will vary depending on the type of allergy. The
principles in the management of AR include:
•
Medication:
this
includes
the
use
of
nasal
steroid
sprays,
topical
decongestants,
antihistamine
tablets,
leukotriene modifiers as prescribed by your ENT doctor.
•
House dust mite (HDM) avoidance:
o
Change bed linen every week, pillow cases daily and wash bedding in hot water to kill mite
o
Remove carpeting, drapes, wall hangings and other dust accumulators
o
Wet mop and vacuum frequently
o
Replace stuff toys (eg. teddy bears) with metal, wooden and plastic ones
o
Dehumidifiers and HEPA air purifiers/filters
•
Pets:
People
allergic
to
their
pets
should
remove
the
animals
from
the
house,
if
possible,
or
at
least
keep
the
animals
out
of
the
bedroom.
Bathe
the
pets
frequently
to
minimize
the
amount
of
allergens
on
their skin.
•
Surgery:
eg.
trimming
of
the
inferior
turbinate
to
relieve
nasal
obstruction
resulting
from
swollen
turbinates
for
the
long
term.
Chronic
rhinosinusitis
and
nasal
polyps
may
need
Functional
Endoscopic
Sinus
Surgery
(FESS) and polyp removal under general anesthesia.
•
Immunotherapy:
Taken
when
allergies
cannot
be
controlled
by
avoidance
or
medications.
Administered
over
a
period
of
months
or
years,
these
drops
below
the
tongue
(sublingual
immunotherapy
SLIT)
can
help
people
build
up
a
tolerance
to
their
allergen
triggers.
This,
in
turn,
can
lead
to
the
prevention
or
reduction
of
allergy
symptoms.
Immunotherapy
holds
the
promise
to
the
‘cure’
of allergies.
Understanding the myths of AR
"Will it turn into a cancer?" NO ! Long term AR or sinusitis has not been linked with cancer.
"Will
it
continue
forever?"
The
severity
of
AR
symptoms
usually
improves
as
a
patient
ages.
While
some
people
eventually
outgrow
the
disease
or
the
disease
improves
over
the
years,
the
condition
can
worsen
over
time
in
some
people.
Therefore,
it
is
best
to
assume
that
you
have
it
for
the
longer term and learn to manage it. In short, one just cannot afford to be satisfied with the success of short-term management.
"It
can't
be
cured.
"
Immunotherapy
offers
hope.
However,
many
researches
are
still
ongoing.
There
are
still
debates
about
the
exact
dosage,
schedule, and frequency. Also, in a person with multiple allergies, this option may not be feasible.
This patient education is provided in good faith to help patients and their families learn more about their medical conditions, the options available to them and the possible consequences of
their decisions. This information is not intended to be used for diagnosis, or treatment of any specific individual. Please consult with your ENT doctor regarding your particular circumstances.
A common house duct mite - so tiny that it is invisible to the
naked eye (source: IMR)
Allergic Rhinitis- 3-fold Pamphlet version (English language)
Allergic Rhinitis- 3-fold Pamphlet version (Chinese language)
Ways to reduce house dust mite exposure
(English language)
HOUSE DUST MITE - READ MORE
(PDF files will open in a new window)
Ways to reduce house dust mite exposure
(Bahasa Malaysia/Malay language)
Cara mengurangkan pendedahan pada hama debu
Enlarged nasal turbinate (arrows)
© Vincent Tan ENT
Soft toys - a cosy place for the dust mite to
thrive
© Vincent Tan ENT
Copyright Vincent Specialist Solutions Sdn Bhd 2016. All rights reserved
...but..the trouble with allergic rhinitis is...
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