Dr Darren’s Thursday surgery
Q: I am a hay fever sufferer and it is really bad this year. I have been using Loratadine and nasal sprays, and recently started with a twice-daily routine of rinsing my nostrils with a saline solution that I bought.
However, I am not feeling well. My head is sore, I feel tired and my voice sounds like I have the flu. Although I am taking all this stuff, I still have thick mucus. Do you have some advice for me?
A: It seems to be one of the worst allergy activation seasons in a long time. Experts blame it on numerous factors. One is the lack of intervention in genetically inherited allergies – research into antenatal modification of allergy tolerance is under way, with global interest in the field.
The second is the multitude of preserved foods and methods of food preparation.
The condition you describe is clearly allergic rhinitis with all the symptoms that make it so frustrating – ranging from recurrent tonsillitis and ear infections to respiratory effects.
Poorly controlled allergies can be debilitating, and it is crucial to understand the mechanisms at play.
Your body has a heightened or overactive immune response to certain triggers. Once that immune response is turned on, a host of inflammatory, chemically active substances or molecules are released into the bloodstream to counter the trigger.
An antihistamine stops the further release of excessive histamine, which causes itching, redness, swelling and sneezing.
Discomfort and irritation follow, and if the effects are severe, the airways are also affected, leading to tightness of the chest or bronchospasm.
The mainstay of management is prevention. This means avoiding the known triggers and strict compliance with medications. There are people who have achieved relief by using homeopathic preparations, but results are variable and science needs substantial research to prove their worth.
Chronic medication would include a good second or third-generation antihistamine like Xyzal, Telfast or Deselex with a Fluticasone nasal preparation or spray.
The benefits are only achieved if used daily.
Drink sufficient fluids, as this helps to keep the membranes of the nasal and oral cavity moist.
Take time to observe where and how food is prepared.
In the event of acute and drastic allergic reactions with systemic signs, visit your closest emergency centre and never take chances when faced with the sudden onset of a rash and a tight chest.
The most common triggers are environment and food. People with bee-sting allergies should carry a Medic Alert bracelet and be taught how to use an adrenalin-injection pen, which can easily save your life when used effectively.
Back to the specific question: I would suggest an assessment for acute sinusitis and immediate treatment if the thick secretions become enriched with colour or present with an offensive smell. Your headaches are of concern and warrant a consultation. Complicated sinusitis requires intravenous antibiotics.
Remember that penetration of the sinuses by antibiotics can be challenging, and we often refer patients to an ear, nose and throat surgeon for an evaluation of the sinuses and drainage canals if this problem is recurrent.
The individual’s nose and sinus structure is then studied in search of a cause for poor drainage.
A lavage or “washout” is done occasionally for complicated sinusitis.
You will also find that people with sinus infections are often obliged to have their adenoids and tonsils removed.
The voice is often hoarse in allergy sufferers due to the post-nasal drip leading to laryngitis and the often irritating cough which damages the vocal cords.
Physiotherapists now use ultrasound devices in treating acute sinus inflammation.
Allergies are worse this season because:
* Plants and pollen are in abundance.
* Pollution can pose problems.
* Crops are being prepared and sprayed.
Other factors are:
* Preservatives in food can play a role.
* Poor public education.
* Prevention requires discipline in treatment.