Allergic rhinitis, or hay fever, is your body's response to specific allergens. It causes uncomfortable symptoms like sneezing and itchy eyes.
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COVID and sinus infections share several symptoms like nasal congestion, fever, and coughing. But there are some important differences. Suffering from a sinus infection? We've rounded up the seven best decongestants to help relieve your pressure, pain, and congestion. Is it the heat, the humidity, or your mask? Experts weigh in. Health Conditions Discover Plan Connect. Medically reviewed by Alana Biggers, M. Allergic Rhinitis One in five people in the United States suffer from hay fever, also known as allergic rhinitis.
Sinusitis Symptoms of sinusitis can include nasal congestion, discolored nasal drainage, sinus pressure, headache, and fever. Distinct Symptoms To distinguish between the two conditions, take note of the distinct symptoms.
Allergy Experts in Tampa Our team of board-certified allergy and immunology specialists at Allergy Tampa will work with you to determine the underlying cause of your nasal congestion, as well as put you on the path toward recovery by making an accurate diagnosis of your condition.
Related posts: No related posts. Patient Education Learn more about your condition in our extensive online library. Lockey, MD Mark C. Cho, MD Amber N. Pepper, MD. Miller: Hi. I'm here with Dr.
Jeremiah Alt. He is an ENT surgeon. That's an ear, nose and throat surgeon. He's a member of the Department of Surgery here at the University of Utah. Jeremiah, how does one tell the difference between an allergic symptoms of nasal discharge versus a common cold or sinusitis? Is there a way to sort of know if you have one or the other? Alt: Yeah. That's very difficult. Even very difficult for the physician to figure that out in many cases and requires a thorough history with the patient to figure some of these things out.
In general, allergic rhinitis if it's seasonal will occur during the season, where if you have hay fever, you'll get itchy eyes and a runny nose. Miller: Right? So people are scratching the corners of their eyes and they're blowing and sneezing. Miller: The back of the throat is kind of scratchy. Sometimes when I think of the common cold or sinusitis that doesn't feel very itchy. That's [inaudible ]. Alt: Right. So the common cold will have some of the similar symptoms, as there's definitely overlap where you can have increased congestion and nasal blockage.
You'd probably be more likely, though, to have some facial pain and pressure. We commonly talk about the loss of smell occurring with sinusitis. But this can also occur with allergies as the inner lining inside your nose is swollen and angry, and inflamed and it can block off some of the ability to smell. One of the big differences though, is we commonly think of discharge.
So if the discharge is yellow or green, this is more signs that this is more severe than just an allergic reaction. Miller: So one goes to the store to self-remedy what they would consider to be a fairly short course of this problem. Desensitization involves the administration of increasing doses of relevant allergen extract by subcutaneous injection over a period of months and has been shown to effectively diminish symptoms of allergic seasonal rhinitis to grass pollen, ragweed, and birch pollen.
Some studies also suggest efficacy to house dust mite and some animal danders. Desensitization has largely been superseded by the success of effective medical therapy in the suppression of allergic inflammation and so is reserved for nonresponders with severe disease.
It is not always effective, and concerns have been raised regarding occasional anaphylactic reactions and deaths after the procedure, so it must be undertaken by well-trained individuals in a hospital setting with cardiorespiratory resuscitation facilities at hand.
Safer sublingual approaches have now been demonstrated to be effective, and grass pollen tablets will become available in the United Kingdom in The first sublingual dose needs to be under medical supervision; after this, each dose is taken every day at home. Eight weeks preseasonal therapy followed by continuation throughout the pollen season is suggested.
Trials are in progress to assess the long-term effects of 3 years regular treatment. When medical treatment is only partially successful, a full otorhinolaryngologic assessment is performed because correction of a deviated nasal septum or reduction of hypertrophied mucosa may improve the symptoms. With coexistent chronic sinus infection, functional endoscopic sinus surgical techniques FESS may be necessary to facilitate sinus drainage, aeration, and access for medications, although a recent study showed that medical therapy with corticosteroid and long-term macrolide use was equally effective.
Both improved concomitant asthma. Treatment is essentially symptomatic with analgesics, antipyretics, rest, and broad-spectrum antibiotics if secondary infection is present. Oral or topical nasal zinc may decrease symptoms and their duration. Most cases resolve spontaneously. Analgesics and antipyretics provide symptomatic relief, but aspirin must be avoided in those who may be hypersensitive.
Acetaminophen paracetamol and codeine are satisfactory alternatives. Decongestants such as oxymetazoline and xylometazoline reduce edema and may improve sinus drainage.
Broad-spectrum antibiotics are appropriate but must have activity against the most common pathogens, namely S. Amoxicillin, trimethoprim-sulfamethoxazole co-trimoxazole , or a macrolide such as clarithromycin are appropriate. Amoxicillin-clavulanate has the added advantage of activity against S. If anaerobic infection is suspected, a combination of amoxicillin-clavulanate and metronidazole or clindamycin is appropriate.
The aims of treatment are to remedy any underlying cause e. Nasal douching with saline improves symptoms and endoscopic appearances. Topical corticosteroids may help to reduce mucous membrane swelling and improve drainage. Initially, betamethasone drops taken in the head-down position are briefly used, but no absorbed Fluticasone nasules are safer in long-term use. Prolonged courses of macrolide antibiotics produced improvements equivalent to FESS surgery, possibly because of their antiinflammatory activity.
Amphotericin douching is ineffective. Better demonstration of the nasal and sinus anatomy is achieved with CT scans, as well as of the important ostiomeatal complex, the vital region where sinus drainage by mucociliary clearance occurs.
Obstruction in this zone is very important in the generation of chronic sinus disease. The main aim of FESS is to restore adequate drainage for the frontal, maxillary, and ethmoidal sinuses see Figure When this fails, more radical sinus surgery may be needed, but complete investigation for underlying medical factors e. Anticholinergics ipratropium bromide are useful for troublesome rhinorrhea, particularly when eosinophils are absent from nasal secretions.
When eosinophilia is present, a response to topical corticosteroid therapy is usual. Surgical procedures may help if nasal obstruction is predominant.
Occasionally, topical corticosteroid therapy may ameliorate structural defects, but normally surgical correction is required. Therapy of immune defects is directed toward correction of the immunologic defect. It is not possible to correct the underlying mucus clearance defect, so therapy relies on regular douching, improved drainage and aeration, and prevention of secondary infection. Appropriate, specific antimicrobial therapy is required for infectious causes of granulomatous disease.
Sarcoidosis that involves the nose responds to either local or systemic glucocorticoid therapy. A careful drug history must be taken and the incriminated drug excluded. Treatment of polypoid rhinosinusitis. Symptoms and signs on visual analogue scale. See Figure Unilateral nasal polyps must be referred to exclude transitional cell papilloma, squamous cell carcinoma, encephalocoele, or other sinister pathology. When there are no contraindications and no suspicions about the nature of the polyp, a medical polypectomy by use of prednisolone 0.
This should be followed by long-term corticosteroid drops—initially betamethasone for 2 weeks, then nonabsorbed fluticasone. Subsequently, a trial of a leukotriene receptor antagonist should be undertaken for 2—4 weeks, with continuation if beneficial.
Other measures being evaluated include regular saline douching and topical lysine aspirin in patients sensitive to this on nasal challenge. Failure of medical treatment is an indication for surgery. Patients with aspirin-exacerbated respiratory disease should be warned to avoid all Cox-1 inhibitors and to watch for exacerbation by similar substances: E numbers, preservatives, high-salicylate foods.
Most can tolerate mg paracetamol or Cox-2 inhibitors. The clinical course is variable. With good compliance, allergen avoidance, and regular pharmacotherapy, symptoms are usually minimal.
Understandably, patients want a cure. Immunotherapy remains of limited value, but with development in understanding of the mechanism of generation of IgE responses and of ways in which this can be modulated, it may become more useful. Unfortunately, avoidance of the common cold is virtually impossible, and prevention by immunization has so far been a failure. However, colds are self-limiting and normally last approximately 5 days. Clinical trial data support the value of zinc in reducing the duration and severity of symptoms of the common cold when administered within 24 h of the onset of common cold symptoms.
Synergy between allergen sensitization, exposure, and rhinoviral infection leads to an almost fold likelihood of an asthmatic child needing hospital admission. Other complications include acute sinusitis, pharyngitis, otitis media, mastoiditis, and tonsillitis. The common cold frequently leads to lower respiratory infection, including laryngotracheitis, bronchitis, and occasionally pneumonia.
Those who have other cardiorespiratory diseases may also experience exacerbations. Before the antibiotic era, acute sinusitis had a significant morbidity and mortality because of spread of bacterial sepsis beyond the sinuses.
Osteolysis of the sinus wall occurred often, with abscess formation and direct spread to neighboring structures, in addition to local spread and thrombophlebitis. These local complications include orbital cellulitis with or without abscess formation, cavernous sinus thrombosis, sagittal sinus thrombosis, intracranial abscess, meningitis and encephalitis, osteomyelitis, and septicemia.
Complications are now rarely seen, because most patients are prescribed broad-spectrum antibiotics. Intrinsic rhinitis often has an onset in middle age or later and is often refractory to treatment. Combinations of therapy may prove helpful. National Center for Biotechnology Information , U. Clinical Respiratory Medicine. Published online May Glenis K.
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Open in a separate window. Figure Table Classification of Rhinitis. Table Differential Diagnosis of Rhinitis. Pediatr Allergy Immunol ; 8[4]— Genetics Risk factors for allergic rhinitis are both genetic—with an affected parent or sibling being associated with increased risk—and environmental.
Allergy Allergic Rhinosinusitis Apart from viral colds, allergic rhinosinusitis is the most common cause of nasal symptoms; it results from IgE-mediated immediate hypersensitivity reactions that occur in the mucous membranes of the nasal airways. Table Pathophysiology of Rhinitis and Asthma. Nonallergic Rhinosinusitis Infectious Rhinosinusitis The nasal and sinus mucosa can be infected by all types of organisms: viruses, bacteria, fungi, and protozoa.
Acute Coryza—The Common Cold Most people have approximately three colds per year, but small children have from six to eight. Acute Sinusitis Although the nose harbors bacteria, the sinuses are normally largely sterile, possibly because of the nitric oxide concentrations therein and continuous mucociliary clearance.
Hormonal Rhinitis Hormonal rhinitis is seen in pregnancy, occasionally in relation to menstruation, and at puberty. Food-Induced Rhinitis Much rarer than popularly supposed, food allergy rarely causes isolated rhinitis, but in small children, milk or egg allergy can cause it as part of a spectrum that can include atopic dermatitis, gut symptoms, asthma, and failure to thrive.
Animal material Cross-reacting foods House dust mite Shellfish Snails. Atrophic Rhinitis Atrophic rhinitis is characterized by atrophy of mucosa plus the bone beneath.
Other Causes Emotional stimuli such as sexual arousal and stress have powerful effects on the nasal mucosa through the autonomic system. Nonallergic, Noninfectious Rhinitis Patients with none of the aforementioned causes are usually divided according to the presence or absence of nasal eosinophilia. Noneosinophilic Nonallergic Rhinitis Autonomic Rhinitis In autonomic rhinitis, there is no evidence of nasal inflammation, but of autonomic dysfunction.
Idiopathic or Intrinsic Rhinitis Idiopathic or intrinsic rhinitis is a diagnosis of exclusion with no evidence for any of the aforementioned causes.
Structural Causes Variant anatomy was thought to predispose to rhinosinusitis as a result of interference with normal drainage and aeration of the paranasal sinuses Figure at the ostiomeatal complex, the crucial point at which the maxillary, frontal, and anterior ethmoid sinuses drain into the nose. Immune Defects Panhypogammaglobulinemia is a severe condition with variable absence of all classes of immunoglobulin; it presents with bacterial and other infections at many sites.
Mucus Clearance Defects The nose and paranasal sinuses are lined with ciliated epithelium, which in a coordinated fashion moves a mucus blanket toward the nasopharynx.
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