By Dr. Gil M. Vicente
If you have the following symptoms: sneezing, nasal discharge, usually watery, nasal obstruction and itchiness of the nose, you may have what you call allergic rhinitis and this may greatly affect your quality of life. You can have difficulty in sleeping at nighttime and this can cause you to be unproductive the next day, either in school or at work because you may feel sleepy and dull. You may also experience severe headache and the continuous sneezing may be very bothersome. Your nose may be clogged and, therefore, you may not breathe normally and may even have difficulty in smelling and tasting, as well.
Allergic rhinitis is due to allergens, which are enumerated below:
1 House dust mites You might have inhaled dust, which may contain house dust mites. Dust mites are tiny microscopic insects that live and breed in your beddings, pillows, blankets and deep inside your beds. It might interest you to know that you are feeding these mites with your own dead skin, which sheds off from your body.
2 Pollens or particles coming from flowering plants, shrubs, grasses like talahib and trees. These living things pollinate most especially in the morning and once they get into your nose, they cause you to sneeze, itch and have watery discharge.
3 Pets Your favorite dogs or cats or even your birds can give you these nasal problems. It is the saliva from the cats, the droppings from the birds, and the hairs and the danders or shredded particles from the skin of the dogs that may irritate your nose.
4 The cockroach that crawls in your home may be the culprit most especially the dead ones.
5 Molds that may appear in any part of your room especially the bathroom may cause your nose to get clogged.
Other important causes but are considered the nonallergic type and not due to the allergens mentioned above are the following:
- Cold weather;
- Changes in temperature;
- Cigarette smoking;
- Pollution and exhaust from motor vehicles, smog, and garbage;
- Strong odor or perfumes; or
- Chemicals that you may be exposed to in your line of work
It is very important that the right diagnosis is arrived at because allergic rhinitis may mimic other diseases. So you have to undergo what is called nasal endoscopy. It is a very simple procedure done under topical anesthesia in the clinic or in an endoscopic center. Nasal endoscopy will help your doctor to give you the best treatment possible.
What should you do in order for your nose not to get these symptoms?
Avoidance
The best thing to do actually is to avoid the things mentioned above as much as possible. If you avoid them, your symptoms may not appear at all. Wearing mask may be done to eliminate direct inhalation.
Bedroom guideline
With regards to the house dust mites, which are common in your beddings, the following can be done. Wash all your beddings, pillows and blankets every one or two weeks. But it should be washed with very hot water (as high as 120 degrees centigrade) in order to kill the mites. In your bedroom, remove all things that will collect dust, like carpets and tapestries. Avoid thick curtains.
Remove all old clothes, old books or paper documents and old shoes. If your mattress is over five years old, you have to change it. An air purifier will be helpful to make sure air is cleansed and the dangerous particulate matters are prevented from being inhaled.
Medicines
The mainstays of treatment are the anti-allergy medicines like oral and topical antihistamines, intranasal and oral steroids, oral and topical decongestants and antileukotrienes. These will afford great relief in a good number of times. Your doctor will be the one to determine, which will be best for you. It can be combination of one or two medicines and sprays depending on the intensity of symptoms
Lately, Nitric Oxide has been shown to be effective in treating these rhinitis symptoms. Nitric oxide are produced inside the paranasal sinuses but when allergy comes in and nasal obstruction occurs and the drainage system inside the nose is blocked, production of this important molecule may be insufficient.
Therefore, we need to replenish this by taking in back to our system the much needed nitric oxide. This is now available in the market and this can be a very helpful supplement for allergic sufferers.
Saline solutions will always be helpful whether it is homemade or the imported sea water nasal solution. As we breathe, a lot of particulate matters, polluted materials from the air, the viruses and the bacteria are entering our nose and goes into our airway.
Remember, we breathe about 25,000 times a day and a lot of these particles may be trapped inside our nose and may stay there for a long period of time. Hence, cleansing the nose with such solutions will eliminate these unwanted particles. Just like brushing our teeth every time we eat, we also should clean our nose regularly.
If the prescribed medicines do not work well with you or your allergic rhinitis keeps on recurring, then other choices may be helpful.
Here are the latest options for treating allergic and the nonallergic type of rhinitis.
Immunotherapy may be the answer. Whereas, the medicines treat the symptoms of allergy, Immunotherapy treats the disease of allergy itself and, therefore, may be permanent. Usually it is the more common house dust mites and pollens that are addressed by this approach.
Immunotherapy has now a different way of delivery. The usual route is through skin injection or shots.
Now, the latest we have is the sublingual route or the Sublingual immunotherapy (SLIT). The sublingual route is delivered underneath the tongue. It can be in tablet form or drops. Now the newer version is applying the solution by spraying under the tongue.
And that makes things a lot easier. Its efficacy is the same as the injectable one but a lot cheaper, safer and easier to apply. It is also so safe for pregnant and breastfeeding women.
For still incurable circumstances and your medicines do not work or immunotherapy is still insufficient, something has to be done to your nose to eliminate the problem. Now we are talking of Surgery, which has been proven to be the ultimate cure.
Surgery is commonly done if you have a crooked nose that makes your nose clogged some of the times or even most of the time. Fixing that nose should be helpful. If you also have polyps or a mass inside the nose that causes obstruction, it is important, therefore, to see if such mass causes symptoms of allergic rhinitis,thus, surgery may be needed.
Having large adenoids may also be addressed, as well, by surgery.
Your persistent sneezing or nasal discharge can be relieved by surgery, too. There are nerves that can be ablated or resected in order to relieve this condition. This could be the vidian nerve, which through surgery on this nerve will give dramatic effect.
Lately, a simpler procedure with less side effects can be done. This is called Posterior Nasal Nerve Neurectomy. The procedure can be done under local anesthesia, or general anesthesia and will just last for a few minutes. Results have been very promising and long lasting. Patients can immediately feel the difference and they may not need the usual medicines or sprays that patients have been using for years.
Allergic rhinitis sufferers may now be relieved of the nasal malady they have experiencing, so do not be depressed or frustrated if your medicine does not work. These latest development and treatments are available that can help you change you quality of life.
Love your nose and let it breathe freely!
Dr. Gil M. Vicente, MD., Ear, Nose and Throat, Head and Neck Specialist, St. Luke’s Medical Center.
Belongs to a group of unique group of specialists whom we can consider as chosen few.
Vicente is currently the chief of the Rhinology Section of the St. Luke’s Medical Center. He is also currently the president of the Philippine Society of Oncologists.
As such, he is committed to providing the best service and care for patients with allergies, chronic sinusitis, or advanced tumors of the sinus cavity.
He is also a Diplomate of the Philippine board of ORL-Head and Neck Surgery; fellow, Philippine Society of Oncology; fellow, International College of Surgeons; president, International Symposium on Rhinosinusitis and Nasal Polyposis (2017); president, Philippine Society of Otolarynology Head and Neck Surgery (2008); president, International Society on Infection and Allergy of the Nose (1999); president, Asian Research Symposium in Rhinology (2005).
His membership with local and international medical groups and exposure in wide range of cases in the field has pushed him to focus on individualized treatment of diseases and disorders affecting the nasal cavity and sinuses. He is also an advocate of globally competitive practice in the field, faithfully promoting excellence and constant advancement in Rhinology.
gmvicentemd@yahoo.com
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