What is the difference between allergies and sinus problems

American Rhinologic Society

Through research, education, and advocacy, the American Rhinologic Society is devoted to serving patients with nose, sinus, and skull base disorders. Their website’s thorough coverage of sinus-related issues includes rarer conditions, such as fungal sinusitis, which are often excluded from other informational sites. It also provides a valuable search tool to discover a doctor, as well as links to other medical societies and resources that are useful for patients.

Cleveland Clinic

Their website contains an exhaustive guide on sinusitis and an easy-to-use «Find a Doctor» search tool.

ENThealth

ENThealth provides useful information on how the ear, nose, and throat (ENT) are all connected, along with information about sinusitis and other related illnesses and symptoms, such as rhinitis, deviated septum, and postnasal drip.

As part of the American Academy of Otolaryngology — Head and Neck Surgery, this website is equipped with the ability to assist you discover an ENT specialist in your area.

Common symptoms of sinus infection include:

  1. Pain in the teeth
  2. Tenderness of the face (particularly under the eyes or at the bridge of the nose)
  3. Postnasal drip
  4. Coughing
  5. Frontal headaches
  6. Fever
  7. Discolored nasal discharge (greenish in color)
  8. Nasal stuffiness or congestion
  9. Fatigue
  10. Bad breath

Sinus infection (sinusitis) is often confused with rhinitis, a medical term used to describe the symptoms that accompany nasal inflammation and irritation.

Rhinitis only involves the nasal passages. It could be caused by a freezing or allergies.

Allergies can frolic an significant role in chronic (long-lasting) or seasonal rhinitis episodes. Nasal and sinus passages become swollen, congested, and inflamed in an attempt to flush out offending inhaled particles that trigger allergies. Pollen are seasonal allergens. Molds, dust mites and pet dander can cause symptoms year-round.

Asthma also has been linked to chronic sinus infections.

Some people with a chronic nasal inflammation and irritation and/or asthma can develop a type of chronic sinusitis that is not caused by infection. Appropriate treatment of sinus infection often improves asthma symptoms.

Signs and symptoms

Acute bacterial sinusitis in adults most often manifests with more than 7 days of nasal congestion, purulent rhinorrhea, postnasal drip, and facial pain and pressure, alone or with associated referred pain to the ears and teeth.

There may be a cough, often worsening at night.12 Children with acute sinusitis might not be capable to relay a history of postnasal drainage or headaches, so cough and rhinorrhea are the most commonly reported symptoms.13 Other symptoms can include fever, nausea, fatigue, impairments of smell and taste, and halitosis.

Chronic sinusitis can cause more indolent symptoms that persist for months. Nasal congestion and postnasal drainage are the most common symptoms of chronic sinusitis. Chronic cough that is described as worse at night or on awakening in the morning is also a commonly described symptom of chronic sinusitis.

Clinical evidence of chronic sinusitis may be subtle and less overt than in acute sinusitis unless the patient is having an acute sinusitis exacerbation. Because this diagnosis may be more hard to make in the primary care setting or in a setting without radiographic or rhinoscopic capabilities, Lanza and Kennedy own proposed14 a major and minor classification system to define chronic sinusitis by the manifesting symptoms (Box 2).

Box 2: Symptoms Associated with the Diagnosis of Chronic Sinusitis
Facial pain or pressure
Facial congestion or fullness
Nasal obstruction or blockage
Nasal discharge, purulence, or postnasal drip
Hyposmia or anosmia
Headache
Fever
Halitosis
Fatigue
Dental pain
Cough
Ear pain, pressure, fullness

Reprinted from Otolaryngology-Head and Neck Surgery, Vol , Donald C.

Lanza, MD and David K. Kennedy, MD, Adult rhinosinusitis defined, pp S1-S7. Copyright , with permission from the American Academy of Otolaryngology&#x;Head and Neck Surgery Foundation, Inc.

Surgery

If medical therapy fails or if complications are suspected, an otolaryngology consultation is warranted. This may start with a nasal endoscopy for better visualization of the nasal cavity and ostiomeatal complicated. The otolaryngologist can also act out endoscopically guided sinus culture. If surgical therapy is being contemplated, newer techniques of functional endoscopic sinus surgery are performed to clear sinuses of chronic infection, inflammation, and polyps.

This may be combined with somnoturboplasty (i.e., shrinkage of the turbinate using radiofrequency waves). Endoscopic sinus surgery is commonly performed on an outpatient basis using local anesthesia and has less morbidity than traditional open surgery for chronic sinus disease.1 Special consideration should be given to patients who own chronic sinusitis and nasal polyps and who also own aspirin-induced asthma. This is commonly referred to as the aspirin triad of aspirin sensitivity, asthma, and polyposis.

Although most of these patients undergo sinus surgery and polypectomy, additional therapy with nasal steroids, leukotriene modifiers, and aspirin desensitization, followed by  mg aspirin twice daily, should be considered.17

Treatment of Chronic Sinusitis

Antibiotic therapy for chronic sinusitis is controversial and may be most appropriate for acute exacerbation of chronic sinusitis. Medical therapy should include both a broad-spectrum antibiotic and a topical intranasal steroid to address the strong inflammatory component of this disease. Antibiotic therapy might need to be continued for 4 to 6 weeks.12 The antibiotics of choice include agents that cover organisms causing acute sinusitis but also cover Staphylococcus species and anaerobes.

These include amoxicillin-clavulanate, cefpodoxime proxetil, cefuroxime, gatifloxacin, moxifloxacin, and levofloxacin. Currently used topical intranasal steroids such as fluticasone (Flonase), mometasone (Nasonex), budesonide (Rhinocort AQ), and triamcinolone (Nasacort AQ) own a favorable safety profile and indications for the pediatric age group. A short course of oral steroids may be used for extensive mucosal thickening and congestion or nasal polyps.

Physical Findings

Typical physical signs include bilateral nasal mucosal edema, purulent nasal secretions, and sinus tenderness (however, this is not a sensitive or specific finding).

The location of sinus pain depends on which sinus is affected.

What is the difference between allergies and sinus problems

Pain on palpation of the forehead over the frontal sinuses can indicate that the frontal sinuses are inflamed; however, this is also a extremely common area for tension headaches. Infection in the maxillary sinuses can cause upper jaw pain and tooth sensitivity, with the malar areas tender to the touch. Because the ethmoid sinuses are between the eyes and near the tear ducts, ethmoid sinusitis may be associated with swelling, tenderness, and pain in the eyelids and tissues around the eyes.

The sphenoid sinuses are more deeply recessed, and sinusitis there can manifest with vague symptoms of earaches, neck pain, and deep aching at the top of the head.

However, in most patients with a suspected diagnosis of sinusitis, pain or tenderness is found in several locations, and the perceived area of pain generally does not clearly delineate which sinuses are inflamed. Purulent drainage may be evident on examination as anterior rhinorrhea or visualized as posterior pharyngeal drainage with associated clinical symptoms of sore throat and cough.

The nose should be examined for a deviated nasal septum, nasal polyps, and epistaxis.

Foreign bodies and tumors can mimic symptoms of sinusitis and should be in the differential diagnosis, especially if the symptoms are unilateral. The ears should be examined for signs of associated otitis media and the chest for the presence of asthma exacerbation, a common comorbid condition.

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Pathophysiology

The most common cause of acute sinusitis is an upper respiratory tract infection (URTI) of viral origin. The viral infection can lead to inflammation of the sinuses that generally resolves without treatment in less than 14 days. If symptoms worsen after 3 to 5 days or persist for longer than 10 days and are more severe than normally experienced with a viral infection, a secondary bacterial infection is diagnosed.

The inflammation can predispose to the development of acute sinusitis by causing sinus ostial blockage. Although inflammation in any of the sinuses can lead to blockade of the sinus ostia, the most commonly involved sinuses in both acute and chronic sinusitis are the maxillary and the anterior ethmoid sinuses.7 The anterior ethmoid, frontal, and maxillary sinuses drain into the middle meatus, creating an anatomic area known as the ostiomeatal complex (Fig.

3).

The nasal mucosa responds to the virus by producing mucus and recruiting mediators of inflammation, such as white blood cells, to the lining of the nose, which cause congestion and swelling of the nasal passages. The resultant sinus cavity hypoxia and mucus retention cause the cilia&#x;which move mucus and debris from the nose&#x;to function less efficiently, creating an environment for bacterial growth.

If the acute sinusitis does not resolve, chronic sinusitis can develop from mucus retention, hypoxia, and blockade of the ostia.

This promotes mucosal hyperplasia, continued recruitment of inflammatory infiltrates, and the potential development of nasal polyps. However, other factors can predispose to sinusitis (Box 1).8

Box 1: Conditions that Predispose to Sinusitis
Allergic rhinitis
Nonallergic rhinitis
Anatomic factors:

  1. Ethmoid bulla hypertrophy
  2. Paradoxical middle turbinate
  3. Septal deviation
  4. Choanal atresia
  5. Adenoid hypertrophy
Hormonal conditions (e.g., progesterone-induced congestion of pregnancy, rhinitis of hypothyroidism)
Gastroesophageal reflux
Primary immune deficiency:

  1. Selective IgA deficiency
  2. Common variable Immune deficiency
Acquired immune deficiency

  1. Cystic fibrosis
  2. Transplantation
  3. Human immunodeficiency virus
  4. Primary ciliary dyskinesia
  5. Chemotherapy
  6. Kartagener&#x;s syndrome

© The Cleveland Clinic Foundation.

When bacterial growth occurs in acute sinusitis, the most common organisms include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.9 In chronic sinusitis, these organisms, plus Staphylococcus aureus, coagulase-negative Staphylococcus species, and anaerobic bacteria, are the most likely involved organisms.

Organisms isolated from patients with chronic sinusitis increasingly are showing antibiotic resistance. In fact, penicillin resistance rates for S. pneumoniae are as high as 44% in parts of the United States.10 These resistant organisms commonly happen in patients who own received two or more recent courses of antibiotics.

A distinct entity, allergic fungal sinusitis (AFS), occurs in immunocompetent patients and results from an immunologic reaction to fungi that colonize the sinuses.11 Most people tolerate exposure to mold spores in the air because they are ubiquitous in our environment.

However, people with AFS develop a hypersensitivity reaction involving an intense eosinophilic inflammatory response to the fungus that has colonized the sinuses. Common fungi associated with this syndrome include Bipolaris specifera and Aspergillus, Curvularia, and Fusarium species.11 This is an allergic noninvasive response to the fungus that should be distinguished from invasive fungal sinusitis, which is more common in diabetic and immunocompromised patients. The diagnostic criteria for AFS include findings of chronic sinusitis on computed tomography (CT) of the sinuses (such as mucosal thickening, opacification, polyps, and high-intensity signaling from the high protein content in the mucus) or low signaling of fungal concretions in sinus cavities on MRI.

On sinus culture, fungi can be isolated with associated allergic mucin, which is mucus loaded with degranulated eosinophils. Allergy skin testing can verify that these patients own an immunoglobulin E (IgE)-mediated reaction to molds.

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How is sinus infection diagnosed?

Diagnosis depends on symptoms and requires an examination of the throat, nose and sinuses. Your allergist will glance for:

  1. Tenderness of the face
  2. Swelling of the nasal tissues
  3. Redness
  4. Discolored (greenish) nasal discharge
  5. Bad Breath

If your sinus infection lasts longer than eight weeks, or if standard antibiotic treatment is not working, a sinus CT scan may assist your allergist diagnose the problem.

Your allergist may examine your nose or sinus openings. The exam uses a endless, thin, flexible tube with a tiny camera and a light at one finish that is inserted through the nose. It is not painful. Your allergist may give you a light anesthetic nasal spray to make you more comfortable.

Mucus cultures: If your sinus infection is chronic or has not improved after several rounds of antibiotics, a mucus culture may assist to determine what is causing the infection. Most mucus samples are taken from the nose. However, it is sometimes necessary to get mucus (or pus) directly from the sinuses.

Knowing what helpful of bacteria is causing the infection can lead to more effective antibiotic therapy.

A fungus could also cause your sinus infection. Confirming the presence of fungus is significant. Fungal sinus infection needs to be treated with antifungal agents, rather than antibiotics. In addition, some forms of fungal sinus infection – allergic fungal sinus infection, for example – do not reply to antifungal agents and often require the use of oral steroids.

Your allergist may consider ordering a sinus CT.

This test can assist to define the extent of the infection. Your allergist may also send you to a specialist in allergy and immunology. The specialist will check for underlying factors such as allergies, asthma, structural defects, or a weakness of the immune system.

Biopsies: A harm of more serious types of fungal sinus infection is that the fungus could penetrate into nearby bone.

What is the difference between allergies and sinus problems

Only a bone biopsy can determine if this has happened. Biopsies involving sinus tissue are taken with flexible instruments inserted through the nose.

Biopsies of the sinus tissue are also used to test for immotile cilia syndrome, a rare disorder that can cause people to suffer from recurrent infections, including chronic sinus infection, bronchitis and pneumonia.

Definition

Sinusitis is inflammation of the sinuses, which are air-filled cavities in the skull.

The etiology can be infectious (bacterial, viral, or fungal) or noninfectious (allergic) triggers. This inflammation leads to blockade of the normal sinus drainage pathways (sinus ostia), which in turn leads to mucus retention, hypoxia, decreased mucociliary clearance, and predisposition to bacterial growth.

Sinusitis can be divided into the following categories:1

  1. Subacute sinusitis, defined as symptoms of 4 to 8 weeks&#x; duration;
  2. Acute sinusitis, defined as symptoms of less than 4 weeks&#x; duration (Fig. 1);
  3. Chronic sinusitis, defined as symptoms lasting longer than 8 weeks (Fig.

    2);

  4. Recurrent acute sinusitis, often defined as three or more episodes per year, with each episode lasting less than 2 weeks.

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Diagnosis

In a primary care setting, a excellent history and physical examination to detect the presence of most or every of the commonly manifesting signs and symptoms can provide a dependable diagnosis of acute sinusitis. The presence of purulent secretions has the highest positive predictive worth for diagnosing sinusitis clinically.

Differentiating it from a common viral URTI is most significant. Mucus in URTIs is typically not described as persistently purulent.

Nasal congestion is a predominant symptom without persistent or worsening head congestion, headache, or facial pain or fatigue. URTI symptoms would be expected to peak on about day 3 to 5 and resolve within 7 to 10 days. Most other diagnostic modalities, described later, aid in the differential diagnosis of persistent nasal symptoms.

Summary
  1. The presence of purulent secretions has the highest positive predictive worth for clinically diagnosing sinusitis.
  2. Differentiating bacterial sinusitis from a common viral URTI is most important.
  3. CT of the sinuses is the imaging procedure of choice.

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Therapy

Additional Evaluations

Nasal Smear

By examining the cellular contents of the nasal secretions, one might discover polymorphonuclear cells and bacteria in sinusitis.

In a viral infection, these would not be found, and in allergic disease, one would expect to discover eosinophils.

Radiographic Evaluation

The two modalities most commonly used include the plain radiograph and CT scan. Plain radiography does not adequately represent the individual ethmoid air cells, the extent of mucosal thickening in chronic sinusitis, or visualization of the ostiomeatal complicated. Magnetic resonance imaging can be considered for evaluation of suspected tumors but is not recommended for acute sinusitis because it does not distinguish air from bone.

For these reasons, CT scanning of the sinuses is the imaging procedure of choice (Fig. 4). In numerous centers, the cost is similar to that of plain radiographs because of the availability of limited coronal views (usually comprising approximately six coronal views of the maxillary, ethmoid, sphenoid, and frontal sinuses) that are optimally sufficient for ruling out sinusitis. More detailed coronal slices are useful for viewing the ostiomeatal complicated and for surgical mapping.

Laboratory Evaluation

Laboratory evaluation may be necessary to glance for an underlying disorder that can predispose to sinusitis.

The evaluation may include a sweat chloride test for cystic fibrosis, ciliary function tests for immotile cilia syndrome, blood tests for HIV, or other tests for immunodeficiency, such as immunoglobulin levels.

Sinus Puncture

The most precise way to determine the causative organism in sinusitis is a sinus puncture. After anesthetization of the puncture site, generally in the canine fossa or inferior meatus, the contents of the maxillary sinus are aspirated under sterile technique, and bacterial cultures are performed to identify the organism.

Culture specimens obtained from nasal swabs correlate poorly with sinus pathogens found by puncture because of contamination of the swab with normal nasal flora. However, because sinus puncture is an invasive procedure, it is not routinely performed. More recently, studies own shown a shut correlation between organisms found by sinus puncture and by endoscopically guided aspiration of the sinus cavities through the middle meatus. Although this needs to be done by an otolaryngologist trained in the procedure, it may be necessary for defining the pathogenic organism when standard therapy has failed or in an immunocompromised patient who is at high risk for sequelae of untreated sinusitis, such as orbital or central nervous system complications.

Allergy Consultation

Any patient with recurrent acute or chronic sinusitis should own an allergy consultation to law out allergy to dust mites, mold, animal dander, and pollen, which can trigger allergic rhinitis.

An allergy consultation will provide immediate hypersensitivity skin testing to delineate which environmental aeroallergens exacerbate allergic rhinitis and predispose to sinusitis. Medical management and environmental control measures are discussed. Treatment options such as medications, immunotherapy, or both (allergy shots) are considered. Additional evaluation for comorbid conditions such as asthma, sinusitis, and gastroesophageal reflux are addressed and treated.

Allergists are also trained in aspirin desensitization for treatment of patients with the aspirin triad.

Transillumination

A common practice before plain radiographs and CT scans were widely available, transillumination is of limited use and ahs a high rate of error.

Ultrasonography

Ultrasonography has not been proved precise enough to substitute for a radiographic evaluation. However, it may be considered to confirm sinusitis in pregnant women, for whom radiographic studies could pose a risk.

Treatment of Complications of Sinusitis

Orbital extension of sinus disease is the most common complication of acute sinusitis.

This complication is more common in children. Immediate management includes broad-spectrum intravenous antibiotics, a CT scan to determine the extent of disease, and possibly surgical drainage of the infection if there is no response to antibiotics. Extension to the central nervous system can also happen. The most common intracranial complications are meningitis (usually from the sphenoid sinus, which is anatomically located closest to the brain) and epidural abscess (usually from the frontal sinuses).

Treatment of Allergic Fungal Sinusitis

Because of the extent of sinus blockage and the strong association with polyps, surgery is generally indicated to remove the inspissated allergic mucin and polyps, followed by systemic corticosteroids to decrease the inflammatory response.7 Treatment guidelines are based on the use of systemic steroids in allergic bronchopulmonary aspergillosis, in which steroids are tapered to daily or every-other-day dosing to control the disease.

Commonly, nasal steroids are also added for topical treatment. Studies are currently being conducted to establish the role of antifungal agents or inhalant allergen immunotherapy for the treatment of AFS.

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Adjunctive Therapy

To temporarily alleviate the drainage and congestion associated with sinusitis, decongestant nasal sprays oxymetazoline (Afrin) and phenylephrine hydrochloride (Neo-Synephrine) may be used for 3 to 5 days.

Long-term use of topical decongestants can cause rhinitis medicamentosa, which is rebound congestion caused by vasodilatation and inflammation. Oral decongestants (pseudoephedrine) may be a reasonable alternative if the patient has no contraindication such as hypertension. Mucolytic agents (guaifenesin) can assist to decrease the viscosity of the mucus for better clearance and are often found in combination with decongestants. Some mucolytics are now available over the counter. Saline spray or irrigation can assist clear secretions. Topical corticosteroids are not indicated for acute sinusitis but may be helpful for chronic sinusitis, nasal polyps, and allergic and nonallergic rhinitis.

What is the difference between allergies and sinus problems

Antihistamines are not indicated for sinusitis but may be helpful for underlying allergic rhinitis.

Summary

  1. Dykewicz MS. The microbiology and management of acute and chronic rhino-sinusitis. Curr Infect Dis Rep. , 3:
  2. Ivker R.

    What is the difference between allergies and sinus problems

    Respiratory disease: Sinusitis, upper respiratory infection, otitis media. Clin Fam Pract. , 4:

  3. The antibiotic of choice for acute sinusitis must cover S. pneumoniae, H. influenzae, and M. catarrhalis.
  4. Doern GV, Pfaller MA, Kugler K, et al: Prevalence of antimicrobial resistance among respiratory tract isolates of Streptococcus pneumoniae in North America: Results from the SENTRY antimicrobial surveillance program. Clin Infect Dis. ,
  5. Winstead W. Rhinosinusitis. Prim Care. ,
  6. deShazo RD, Swain RE.

    Diagnostic criteria for allergic fungal sinusitis. J Allergy Clin Immunol. ,

  7. Medical therapy for chronic sinusitis should include a topical intranasal steroid to address the strong inflammatory component of this disease.
  8. Allergy consultation should be considered in any patient with recurrent acute or chronic sinusitis to law out allergy as a contributing factor for sinusitis.
  9. Sinus and Allergy Health Partnership. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Executive summary. Otolaryngol Head Neck Surg. , (1 Pt 2):
  10. Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg.

    , (3 pt 2): S1-S7.

  11. Spector SL, Bernstein IL, Li JT, et al: Parameters for the diagnosis and management of sinusitis. J Allergy Clin Immunol. , SS
  12. Agency for Health Care Policy and Research: Evidence Report/Technology Assessment no. 9. Diagnosis and Treatment of Acute Bacterial Rhinosinusitis. Rockville, Md: U.S. Dept of Health and Human Services, Agency for Health Care Policy and Research. AHCPR Publication no. EO
  13. Centers for Disease Control and Prevention: Vital and health statistics: Current estimates from the National Health Interview Survey, U.S.

    Dept of Health and Human Services, Centers for Disease Control and Prevention/National Middle for Health Statistics.

  14. Ray NF, Baraniuk JN, Thamer M, et al: Healthcare expenditures for sinusitis in Contributions of asthma, rhinitis, and other airway disorders. J Allergy Clin Immunol. ,
  15. The antibiotics of choice for chronic sinusitis include agents that cover organisms causing acute sinusitis but that also cover Staphylococcus species and anaerobes.
  16. American Academy of Pediatrics, Subcommittee on Management of Sinusitis and Committee on Quality Improvement.

    Clinical practice guideline: Management of sinusitis. Pediatrics. ,

  17. Hoban DJ, Doern GV, Fluit AC, et al: Worldwide prevalence of antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the SENTRY Antimicrobial Surveillance Program Clin Infect Dis. , (suppl 2): SS
  18. Spiegel JH. Sinusitis [entire issue]. Otolaryngol Clin North Am. , (2):
  19. Slavin RG. The diagnosis and management of sinusitis: A practice parameter update. J Allergy Clin Immunol. , (6 Suppl):
  20. Wald ER. Microbiology of acute and chronic sinusitis in children and adults.

    Am J Med Sci. ,

  21. Hamilos DL. Chronic sinusitis. J Allergy Clin Immunol. ,
  22. If medical therapy fails or if complications are suspected, an otolaryngology consultation is warranted.
  23. Szczeklik A, Stevenson DD. Aspirin-induced asthma: Advances in pathogenesis and management. J Allergy Clin Immunol. ,

Treatment of Acute Sinusitis

Antibiotics, such as amoxicillin for 2 weeks, own been the recommended first-line treatment of uncomplicated acute sinusitis. The antibiotic of choice must cover S. pneumoniae, H. influenzae, and M. catarrhalis. Because rare intracranial and orbital complications of acute bacterial sinusitis are caused by S.

pneumoniae (most commonly in the immunocompromised host), adequate coverage for this organism is significant. Amoxicillin-clavulanate (Augmentin) is also an appropriate first-line treatment of uncomplicated acute sinusitis. The addition of clavulanate, a beta-lactamase inhibitor, provides better coverage for H. influenzae and M. catarrhalis.15 Because of S. pneumoniae resistance, higher doses of amoxicillin (90 mg/kg/day to a maximum of 2 g/day) should be considered. These higher doses are effective against S. pneumoniae because resistance is related to alteration in penicillin-binding proteins, a mechanism distinct from the beta-lactamase enzymatic inactivation of H.

influenzae and M. catarrhalis.

Other options include cephalosporins such as cefpodoxime proxetil (Vantin) and cefuroxime (Ceftin). In patients allergic to beta-lactams, trimethoprim-sulfamethoxazole (Bactrim), clarithromycin (Biaxin), and azithromycin (Zithromax) may be prescribed but might not be adequate coverage for H. influenzae or resistant S. pneumoniae.16 Penicillin, erythromycin (Suprax), and first-generation cephalosporins such as cephalexin (Keflex, Keftab) are not recommended for treating acute sinusitis because of inadequate antimicrobial coverage of the major organisms.

If treatment with one of these first-line agents has not shown a clinical response within 72 hours of initial therapy, more broad-spectrum antibiotics should be considered.

These include the fluoroquinolones, gatifloxacin (Tequin), moxifloxacin (Avelox), and levofloxacin (Levaquin), especially if amoxicillin-clavulanate, cefpodoxime proxetil, and cefuroxime were previously prescribed.

Outcomes

URTIs of viral origin should run their course, with gradual improvement in symptoms daily until finish resolution of symptoms occurs by day 7 to 10, with supportive treatment only and no antibiotics.

When a secondary bacterial infection is suspected and antibiotics are given for acute sinusitis, the expected clinical outcome would be resolution of the infection and associated symptoms.

This was shown in a study by Wald, in which symptoms resolved in 79% of patients who had clinically and radiographically diagnosed sinusitis and who had been treated with amoxicillin or amoxicillin plus clavulanic acid.18

The data on outcomes of medical management of chronic sinusitis are showing that we can control symptoms to a degree, although with a high rate of recurrence. Hamilos reported a retrospective series of patients treated medically for chronic sinusitis.

Treatment included systemic steroids for 10 days, antibiotic coverage for aerobic and anaerobic organisms for 4 to 6 weeks, nasal saline irrigation, and topical steroid nasal spray. There were symptomatic and radiographic improvements in 17 of 19 patients, but 8 of 19 had persistent ostiomeatal complicated abnormalities. In addition, relapse of sinusitis has been significantly associated with nasal polyposis and a history of prior sinus surgery.7

Overall, we own numerous treatment options for the sinusitis patient: antibiotics for the bacterial infection; steroids, systemic or topical, for the inflammatory component; and surgery for the anatomic and structural abnormalities that can predispose to sinusitis.

Although these own helped with initial improvement, we still see a high rate of recurrence of sinus disease. This forces us to address the role of comorbid conditions such as allergic rhinitis, environmental irritants (e.g., cigarette smoke), or the need for newer and better treatment modalities for this disease.

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Prevalence

The prevalence of acute sinusitis is on the rise, based on data from the National Ambulatory Medical Care Survey (from % of diagnoses at office visits in to % of diagnoses at office visits in 2).

In , sinusitis represented million outpatient visits according to the U.S. Centers for Disease Control and Prevention (CDC).3 Approximately 40 million Americans are affected by sinusitis every year, and 33 million cases of chronic sinusitis are reported annually to the CDC.4

When sinusitis is considered together with commonly associated comorbid conditions such as allergic rhinitis, asthma, and chronic bronchitis, exacerbation of these diseases affects more than 90 million people&#x;nearly one in three Americans.5 The socioeconomic impact of this translates to more than $ billion dollars spent on the treatment of sinusitis.6

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References

  • deShazo RD, Swain RE.

    Diagnostic criteria for allergic fungal sinusitis. J Allergy Clin Immunol. ,

  • Winstead W. Rhinosinusitis. Prim Care. ,
  • Slavin RG. The diagnosis and management of sinusitis: A practice parameter update. J Allergy Clin Immunol. , (6 Suppl):
  • Spector SL, Bernstein IL, Li JT, et al: Parameters for the diagnosis and management of sinusitis. J Allergy Clin Immunol. , SS
  • Doern GV, Pfaller MA, Kugler K, et al: Prevalence of antimicrobial resistance among respiratory tract isolates of Streptococcus pneumoniae in North America: Results from the SENTRY antimicrobial surveillance program. Clin Infect Dis.

    ,

  • American Academy of Pediatrics, Subcommittee on Management of Sinusitis and Committee on Quality Improvement. Clinical practice guideline: Management of sinusitis. Pediatrics. ,
  • Agency for Health Care Policy and Research: Evidence Report/Technology Assessment no. 9. Diagnosis and Treatment of Acute Bacterial Rhinosinusitis. Rockville, Md: U.S. Dept of Health and Human Services, Agency for Health Care Policy and Research.

    AHCPR Publication no. EO

  • Centers for Disease Control and Prevention: Vital and health statistics: Current estimates from the National Health Interview Survey, U.S. Dept of Health and Human Services, Centers for Disease Control and Prevention/National Middle for Health Statistics.
  • Wald ER. Microbiology of acute and chronic sinusitis in children and adults. Am J Med Sci. ,
  • Sinus and Allergy Health Partnership. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Executive summary. Otolaryngol Head Neck Surg. , (1 Pt 2):
  • Dykewicz MS.

    What is the difference between allergies and sinus problems

    The microbiology and management of acute and chronic rhino-sinusitis. Curr Infect Dis Rep. , 3:

  • Ivker R. Respiratory disease: Sinusitis, upper respiratory infection, otitis media. Clin Fam Pract. , 4:
  • Hamilos DL. Chronic sinusitis. J Allergy Clin Immunol. ,
  • Lanza DC, Kennedy DW. Adult rhinosinusitis defined.

    What is the difference between allergies and sinus problems

    Otolaryngol Head Neck Surg. , (3 pt 2): S1-S7.

  • Spiegel JH. Sinusitis [entire issue]. Otolaryngol Clin North Am. , (2):
  • Hoban DJ, Doern GV, Fluit AC, et al: Worldwide prevalence of antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the SENTRY Antimicrobial Surveillance Program Clin Infect Dis. , (suppl 2): SS
  • Ray NF, Baraniuk JN, Thamer M, et al: Healthcare expenditures for sinusitis in Contributions of asthma, rhinitis, and other airway disorders. J Allergy Clin Immunol. ,
  • Szczeklik A, Stevenson DD. Aspirin-induced asthma: Advances in pathogenesis and management.

    J Allergy Clin Immunol. ,

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Emergence of microbiome — a new role for bacteria

Increased appreciation of the role of the microbiome in human health and disease is contributing to a revolution in our understanding of chronic diseases and has significant implications for physicians.

While traditional physician training concentrates on management of acute infection and its attendant complications, the significant role of bacteria and pathogens in chronic disease is increasingly appreciated, often in unexpected fashion. Over the past decade there has been an increased understanding of the importance of the bacterial communities present on every body surfaces and cavities.1 These bacterial communities, consisting of trillions of individual bacteria form diverse species, form bacterial communities of interacting bacterial species which we term the microbiome. Fuelled by the revolution in sequencing technology, researchers now use specific DNA signatures to identify bacterial organisms without having to culture them in the laboratory using conventional methods. These culture independent techniques permit identification of bacteria which grow poorly in culture conditions and own opened up a new treasure trove of knowledge on how bacteria contribute to development and persistent of chronic diseases.

It is now understood that every surface and cavity of the body contains its own specific microbiome, Early work began in the gut, with the realisation that altered bacteria balance in the microbiome (microbiome dysbiosis) contributes to persistence of disease. Surprisingly, this has been not so much about forming an abundance of pathogens and attendant toxins, but more a lack (loss) of healthy bacteria required for the maintenance of health.

Our understanding of how bacteria paradoxically contribute to health maintenance is growing exponentially. Healthy bacteria are associated with regulation of immune responses, defense against pathogenetic bacteria, and epithelial regeneration or repair of epithelial surfaces.2 Proof of the importance of these healthy flora is offered by the finding that mice raised in a sterile environment show spontaneous inflammation of the gut. In addition to local effects, these bacteria may also secrete little molecules which travel via the blood stream to influence distant organs such as the brain. This has led to the appreciation that microbiome- mediated effects may be occurring locally, such as in the colon and inflammatory changes therein, but may also be inciting effects at as distance, such as in the brain. This has helped understand how changes in the microbiome in the gut may contribute to obesity, metabolic syndrome, Parkinsons, and autism, to name only a few. Intriguingly, effects on medical therapy are also being suggested, with microbiome-induced modifications in drug metabolism altering responses to therapeutic agents in Parkinsons disease and immune checkpoint inhibitor therapy for cancer also being suspected.3

In ENT, the role of the microbiome in maintenance of health is only beginning to be appreciated.4,5 It has been understood for over a decade that bacteria frolic a role in the persistence of chronic disease, with Staphylococcus Aureus implicated via roles in biofilm formation, development of inflammation via superantigen production, and most recently, impairment of epithelial repair and regeneration. However, it is only recently revealed that chronic nasal and sinus ailments such as chronic sinusitis and nasal allergies are characterised by not only the presence of selected pathogens but also by a lack of healthy bacteria. In addition, it is also suggested that lack of acquisition of healthy bacteria in early life may predispose to development of allergies. Lack of exposure to maternal bacteria during Caesarian-section as opposed to vaginal delivery increases the risk of allergy in offspring.6 Further support for this is the finding that the lesser incidence of allergies in children raised in farming environments is accompanied by a strikingly diverse microbiome to allergic, urban-dwelling children.7 In these instances, this is suspected to be a more direct effect of bacteria directly in the nasal passages and sinuses, rather than distant effects from gut bacteria.

Therapeutic manipulation of the microbiome

Taken together, these findings propose the possibility of improving health via restoration or supplementation of healthy bacteria rather than focussing on pathogenic ones. However, for the moment, technologies for modulating or supplementing the microbiome remain a work in progress and the practitioner may own difficulty selecting between them.

The first example of microbiome supplementation therapy remains the stool transplant. Yellow soup made from feces collected from a healthy donor were suggested as treatment of diarrhea as far back as the time of Hippocrates.8 Over the past decade, this has been used clinically for episodes of Clostridium difficile colitis, with often life-saving effects. However, in addition to obvious psychological obstacles, lack of a standardised method or commercially available formulation pose the risk of transmitting infections from donor to recipient. This has led the FDA in the USA to restrict stool transplants only to patients with C Difficile diarrhea.9,10

Given the difficulties with directly transferring bacteria from patient to patient, efforts own mostly concentrated on the use of Probiotics. Probiotics are defined by the World Health Organisation as live micro-organisms that confer digestive and immune health benefits to the in taker when consumed in adequate amounts. These bacteria own generally been used in food or cheese production for over a century, and generally benefit from Generally Accepted as Safe status given their endless history of safe use in industry.

Probiotics exert their beneficial effects by modulating inflammation, secreting little molecules which may act at a distance, and by restricting the growth of pathogenic bacteria via both direct bacterial inhibition and also via competition for scarce nutriments. Certain strains own beneficial effects upon epithelial regeneration and repair.11 Not every bacteria possess probiotic properties: changing even a few amino acid sequences in their DNA may alter them considerably. It is thus significant to use isolates with documented probiotic properties and explains why manufacturers frequently identify their strain of bacteria specifically with letters or a code: every bacteria are not created equal.

Physicians may also hear the terms prebiotic or postbiotic. These refer either to substances such as dietary fiber, which when ingested urge the growth of healthy gut bacteria (pre-biotic) or else the health-conferring little molecules secreted by healthy bacteria (post-biotic). This area remains in the early stages of development and it remains hard to make firm recommendations for their use.

Probiotics for the sinus?

The nasal passages and sinus cavities are excellent potential candidates for probiotic therapy.12,13 Multiple authors own now documented microbiome dysbiosis in chronic rhinosinusitis and nasal allergy, leading several authors to propose a role for microbiome manipulation in these disorders. While proponents of the SNOT transplant propose that direct transfer of material from healthy to diseased individuals may be possible,14 as in the stool transplant, practical limitations regarding risk of transmission of infection remain a limit to this approach. For the moment, attention has focussed on probiotics.

As orally istered probiotics for allergy and CRS own met with limited success at best,15 attention has mostly focussed on topical intranasal application of probiotics directly to the nasal passages via nasal spray or irrigation. In mice experiments, Lynch et al reported that application of Lactobacillus sakei prevented overgrowth of the purported pathogen Corynebacterium Tuberculostereaticum.16 However, these studies own not progressed to human trials.

The safety of this approach is supported by previous experiments. Mrtensson ()17 initially applied a nasal spray containing 40 Million () CFU (colony forming units, representing number of bacteria) lactic acid bacilli isolated from the honeybee to healthy volunteers and demonstrated the absence of ill effects with therapy. In a follow up study, they applied the same dosage to patients with CRS without nasal polyps.18 While there was no beneficial therapeutic effect noted, again no adverse effects were seen.

A beneficial effect of probiotics for nasal disease is nevertheless suggested by a clinical trial of probiotic Lactococcus lactis W in patients with chronic sinusitis with and without nasal polyposis unresponsive to treatment despite previous sinus surgery.19 In this trial, which was performed by our group, 24 patients received 1.2 billion CFU of L lactis W self-applied directly to the nasal and sinus passages via nasal and sinus irrigation. Treatment was twice-daily for fourteen days. Therapy was well tolerated and led to improvements in symptoms, measures of quality of life, and improvement in endoscopic scores. Gene expression profiling to identify implicated mechanisms suggested enhanced epithelial repair and regeneration, and modulation of inflammation. Microbiome profiling using 16s technology showed reduction in the pathogens Staphylococcus Aureus, Peptostreptococcus, and Enterobacteriacae.

Explanation of the difference in results between the two trials may be explained by differences in bacteria used and experimental design. While L lactis W is a cocci, or spherical-shaped bacteria, the Mrtensson trial used a bacillus, or rod-shaped bacteria that differs from the normal flora of the nose, which are mainly cocci. In addition, the dosage used was 30x less than that used for the L lactis W trial, and istered via a nasal spray, which has less intranasal penetration and deposition than does the nasal irrigation use in the L lactis W trial. It is thus possible that these factors limited success of the Mrtensson trial.

Microbiome therapy for the nose and sinuses: current and future perspectives

For the moment, direct applications of the implications of the nasal and sinus microbiome remain limited. Oral probiotics do not protest grand efficiency and the snot transplant remains plagued by the same safety concerns as the stool transplant. The best option for the moment remains topical application of probiotic. Only one specifically formulated intranasal therapy is currently available, unfortunately only in North America. Based on probiotic Lactococcus lactis W, Probiorinse Probiotic Nasal and Sinus Rinse is Health Canada approved as a natural product for relief of chronic sinusitis, nasal polyposis, nasal obstruction and nasal allergies, and has been on sale in the USA and Canada for fifteen months (www.probiorinse.com, www.probiorinse.ca). Post-marketing experience has shown favorable consumer acceptance and an absence of notable adverse effects.

The future of microbiome therapy is hard to predict as numerous means of manipulating the microbiome are being suggested, including a potential use in prevention and treatment of the common cold. However, these will require confirmation of efficacy with clinical trials. A glance into the crystal ball nevertheless suggests that continuous advances in sequencing technology will permit inexpensive analysis of individual patient microbiomes and genetic makeup, opening the future to personalised therapeutic recommendations for enhanced results.

FundingMartin Desrosiers:

Financial disclosures: President, Probionase Therapies Inc.

Funding: Merck, Sharpe & Dohme Corp./McGill Faculty of Medicine Grant for Translational: Immune modulatory bacteria for the treatment of chronic rhinosinusitis.

Fondation Antoine-Turmel, a private philanthropic organisation.

Fabiana Cardoso Pereira Valera:

Research support: FAPESP, Sao Paulo Research Foundation, Brazil (grant no. /.

Conflicts of interest

The authors declare no conflicts of interest.

When spring allergy season first starts, causing you to sniffle and sneeze, tree pollen is to blame.

Trees start producing pollen as early as January in the Southern U.S. Numerous trees hold producing pollen through June.

Back to Top

Emergence of microbiome — a new role for bacteria

Increased appreciation of the role of the microbiome in human health and disease is contributing to a revolution in our understanding of chronic diseases and has significant implications for physicians.

While traditional physician training concentrates on management of acute infection and its attendant complications, the significant role of bacteria and pathogens in chronic disease is increasingly appreciated, often in unexpected fashion. Over the past decade there has been an increased understanding of the importance of the bacterial communities present on every body surfaces and cavities.1 These bacterial communities, consisting of trillions of individual bacteria form diverse species, form bacterial communities of interacting bacterial species which we term the microbiome. Fuelled by the revolution in sequencing technology, researchers now use specific DNA signatures to identify bacterial organisms without having to culture them in the laboratory using conventional methods. These culture independent techniques permit identification of bacteria which grow poorly in culture conditions and own opened up a new treasure trove of knowledge on how bacteria contribute to development and persistent of chronic diseases.

It is now understood that every surface and cavity of the body contains its own specific microbiome, Early work began in the gut, with the realisation that altered bacteria balance in the microbiome (microbiome dysbiosis) contributes to persistence of disease. Surprisingly, this has been not so much about forming an abundance of pathogens and attendant toxins, but more a lack (loss) of healthy bacteria required for the maintenance of health.

Our understanding of how bacteria paradoxically contribute to health maintenance is growing exponentially. Healthy bacteria are associated with regulation of immune responses, defense against pathogenetic bacteria, and epithelial regeneration or repair of epithelial surfaces.2 Proof of the importance of these healthy flora is offered by the finding that mice raised in a sterile environment show spontaneous inflammation of the gut. In addition to local effects, these bacteria may also secrete little molecules which travel via the blood stream to influence distant organs such as the brain. This has led to the appreciation that microbiome- mediated effects may be occurring locally, such as in the colon and inflammatory changes therein, but may also be inciting effects at as distance, such as in the brain. This has helped understand how changes in the microbiome in the gut may contribute to obesity, metabolic syndrome, Parkinsons, and autism, to name only a few. Intriguingly, effects on medical therapy are also being suggested, with microbiome-induced modifications in drug metabolism altering responses to therapeutic agents in Parkinsons disease and immune checkpoint inhibitor therapy for cancer also being suspected.3

In ENT, the role of the microbiome in maintenance of health is only beginning to be appreciated.4,5 It has been understood for over a decade that bacteria frolic a role in the persistence of chronic disease, with Staphylococcus Aureus implicated via roles in biofilm formation, development of inflammation via superantigen production, and most recently, impairment of epithelial repair and regeneration. However, it is only recently revealed that chronic nasal and sinus ailments such as chronic sinusitis and nasal allergies are characterised by not only the presence of selected pathogens but also by a lack of healthy bacteria. In addition, it is also suggested that lack of acquisition of healthy bacteria in early life may predispose to development of allergies. Lack of exposure to maternal bacteria during Caesarian-section as opposed to vaginal delivery increases the risk of allergy in offspring.6 Further support for this is the finding that the lesser incidence of allergies in children raised in farming environments is accompanied by a strikingly diverse microbiome to allergic, urban-dwelling children.7 In these instances, this is suspected to be a more direct effect of bacteria directly in the nasal passages and sinuses, rather than distant effects from gut bacteria.

Therapeutic manipulation of the microbiome

Taken together, these findings propose the possibility of improving health via restoration or supplementation of healthy bacteria rather than focussing on pathogenic ones. However, for the moment, technologies for modulating or supplementing the microbiome remain a work in progress and the practitioner may own difficulty selecting between them.

The first example of microbiome supplementation therapy remains the stool transplant. Yellow soup made from feces collected from a healthy donor were suggested as treatment of diarrhea as far back as the time of Hippocrates.8 Over the past decade, this has been used clinically for episodes of Clostridium difficile colitis, with often life-saving effects. However, in addition to obvious psychological obstacles, lack of a standardised method or commercially available formulation pose the risk of transmitting infections from donor to recipient. This has led the FDA in the USA to restrict stool transplants only to patients with C Difficile diarrhea.9,10

Given the difficulties with directly transferring bacteria from patient to patient, efforts own mostly concentrated on the use of Probiotics. Probiotics are defined by the World Health Organisation as live micro-organisms that confer digestive and immune health benefits to the in taker when consumed in adequate amounts. These bacteria own generally been used in food or cheese production for over a century, and generally benefit from Generally Accepted as Safe status given their endless history of safe use in industry.

Probiotics exert their beneficial effects by modulating inflammation, secreting little molecules which may act at a distance, and by restricting the growth of pathogenic bacteria via both direct bacterial inhibition and also via competition for scarce nutriments. Certain strains own beneficial effects upon epithelial regeneration and repair.11 Not every bacteria possess probiotic properties: changing even a few amino acid sequences in their DNA may alter them considerably. It is thus significant to use isolates with documented probiotic properties and explains why manufacturers frequently identify their strain of bacteria specifically with letters or a code: every bacteria are not created equal.

Physicians may also hear the terms prebiotic or postbiotic. These refer either to substances such as dietary fiber, which when ingested urge the growth of healthy gut bacteria (pre-biotic) or else the health-conferring little molecules secreted by healthy bacteria (post-biotic). This area remains in the early stages of development and it remains hard to make firm recommendations for their use.

Probiotics for the sinus?

The nasal passages and sinus cavities are excellent potential candidates for probiotic therapy.12,13 Multiple authors own now documented microbiome dysbiosis in chronic rhinosinusitis and nasal allergy, leading several authors to propose a role for microbiome manipulation in these disorders. While proponents of the SNOT transplant propose that direct transfer of material from healthy to diseased individuals may be possible,14 as in the stool transplant, practical limitations regarding risk of transmission of infection remain a limit to this approach. For the moment, attention has focussed on probiotics.

As orally istered probiotics for allergy and CRS own met with limited success at best,15 attention has mostly focussed on topical intranasal application of probiotics directly to the nasal passages via nasal spray or irrigation. In mice experiments, Lynch et al reported that application of Lactobacillus sakei prevented overgrowth of the purported pathogen Corynebacterium Tuberculostereaticum.16 However, these studies own not progressed to human trials.

The safety of this approach is supported by previous experiments. Mrtensson ()17 initially applied a nasal spray containing 40 Million () CFU (colony forming units, representing number of bacteria) lactic acid bacilli isolated from the honeybee to healthy volunteers and demonstrated the absence of ill effects with therapy. In a follow up study, they applied the same dosage to patients with CRS without nasal polyps.18 While there was no beneficial therapeutic effect noted, again no adverse effects were seen.

A beneficial effect of probiotics for nasal disease is nevertheless suggested by a clinical trial of probiotic Lactococcus lactis W in patients with chronic sinusitis with and without nasal polyposis unresponsive to treatment despite previous sinus surgery.19 In this trial, which was performed by our group, 24 patients received 1.2 billion CFU of L lactis W self-applied directly to the nasal and sinus passages via nasal and sinus irrigation. Treatment was twice-daily for fourteen days. Therapy was well tolerated and led to improvements in symptoms, measures of quality of life, and improvement in endoscopic scores. Gene expression profiling to identify implicated mechanisms suggested enhanced epithelial repair and regeneration, and modulation of inflammation. Microbiome profiling using 16s technology showed reduction in the pathogens Staphylococcus Aureus, Peptostreptococcus, and Enterobacteriacae.

Explanation of the difference in results between the two trials may be explained by differences in bacteria used and experimental design. While L lactis W is a cocci, or spherical-shaped bacteria, the Mrtensson trial used a bacillus, or rod-shaped bacteria that differs from the normal flora of the nose, which are mainly cocci. In addition, the dosage used was 30x less than that used for the L lactis W trial, and istered via a nasal spray, which has less intranasal penetration and deposition than does the nasal irrigation use in the L lactis W trial. It is thus possible that these factors limited success of the Mrtensson trial.

Microbiome therapy for the nose and sinuses: current and future perspectives

For the moment, direct applications of the implications of the nasal and sinus microbiome remain limited. Oral probiotics do not protest grand efficiency and the snot transplant remains plagued by the same safety concerns as the stool transplant. The best option for the moment remains topical application of probiotic. Only one specifically formulated intranasal therapy is currently available, unfortunately only in North America. Based on probiotic Lactococcus lactis W, Probiorinse Probiotic Nasal and Sinus Rinse is Health Canada approved as a natural product for relief of chronic sinusitis, nasal polyposis, nasal obstruction and nasal allergies, and has been on sale in the USA and Canada for fifteen months (www.probiorinse.com, www.probiorinse.ca). Post-marketing experience has shown favorable consumer acceptance and an absence of notable adverse effects.

The future of microbiome therapy is hard to predict as numerous means of manipulating the microbiome are being suggested, including a potential use in prevention and treatment of the common cold. However, these will require confirmation of efficacy with clinical trials. A glance into the crystal ball nevertheless suggests that continuous advances in sequencing technology will permit inexpensive analysis of individual patient microbiomes and genetic makeup, opening the future to personalised therapeutic recommendations for enhanced results.

FundingMartin Desrosiers:

Financial disclosures: President, Probionase Therapies Inc.

Funding: Merck, Sharpe & Dohme Corp./McGill Faculty of Medicine Grant for Translational: Immune modulatory bacteria for the treatment of chronic rhinosinusitis.

Fondation Antoine-Turmel, a private philanthropic organisation.

Fabiana Cardoso Pereira Valera:

Research support: FAPESP, Sao Paulo Research Foundation, Brazil (grant no. /.

Conflicts of interest

The authors declare no conflicts of interest.

When spring allergy season first starts, causing you to sniffle and sneeze, tree pollen is to blame.

Trees start producing pollen as early as January in the Southern U.S. Numerous trees hold producing pollen through June.


The Best Research Resources

American Academy of Allergy, Asthma, and Immunology

This academy’s website provides valuable information to assist readers determine the difference between colds, allergies, and sinusitis. A primer guide on sinusitis also provides more specific information about the chronic version of the illness.

Additional resources include a «virtual allergist» that helps you to review your symptoms, as well as a database on pollen counts.

American College of Allergy, Asthma, and Immunology (ACAAI)

In addition to providing a comprehensive guide on sinus infections, the ACAAI website also contains a wealth of information on allergies, asthma, and immunology. The site’s useful tools include a symptom checker, a way to search for an allergist in your area, and a function that allows you to ask an allergist questions about your symptoms.

Asthma and Allergy Foundation of America (AAFA)

For allergy sufferers, the AAFA website contains an easy-to-understand primer on sinusitis.

It also provides comprehensive information on various types of allergies, including those with risk factors for sinusitis.

Centers for Disease Control and Prevention (CDC)

The CDC website provides basic information on sinus infections and other respiratory illnesses, such as common colds, bronchitis, ear infections, flu, and sore throat. It offers guidance on how to get symptom relief for those illnesses, as well as preventative tips on practicing good hand hygiene, and a recommended immunization schedule.

U.S. National Library of Medicine

The U.S.

National Library of Medicine is the world’s largest biomedical library. As part of the National Institutes of Health, their website provides the basics on sinus infection. It also contains a number of links to join you with more information on treatments, diagnostic procedures, and related issues.


What Trees Cause the Most Symptoms?

Some tree pollen causes more problems than others. Some of the trees that cause the most symptoms are:

  1. Poplar
  2. Aspen
  3. Beech
  4. Alder
  5. Oak
  6. Hickory
  7. Box elder
  8. Birch
  9. Olive
  10. Mulberry
  11. Cottonwood
  12. Mountain elder
  13. Cedar
  14. Pecan
  15. Ash
  16. Elm
  17. Willow

Being allergic to some trees could cause you to react to certain foods.

It happens because the tree pollen is similar to the protein in some fruits, vegetables and nuts.1Your immune system gets confused and can’t tell the difference between the two. Eating these foods may cause your mouth or face to itch or swell. These foods may include apples, cherries, pears and more. This is called oral allergy syndrome (OAS). Birch and alder trees cause the most OAS food reactions.

In some cases, your tree pollen allergy may cross-react with some nuts, love peanuts or almonds. If you own mouth itching or swelling while eating nuts, you could own a more serious, life-threatening reaction calledanaphylaxis, which is common with nut allergies.

If this happens to you, call your doctor correct away.



How to Stay Healthy, Breathe Easier, and Feel Energetic This Winter

Indoor allergies, freezing weather, less sunlight — winter can make it hard to stay well mentally and physically. Discover out how to protect yourself against seasonal allergies, the winter blahs, freezing winds, comfort-eating traps, and fatigue this year.

Learn More About the Ultimate Winter Wellness Guide

Sinusitis can be a confusing thing to treat for anyone. Because a sinus infection can be so easily confused with a common freezing or an allergy, figuring out the best way to alleviate your symptoms can be difficult.

Even more challenging, a sinus infection can evolve over time from a viral infection to a bacterial infection, or even from a short-term acute infection to a long-term chronic illness.

We own provided for you the best sources of information on sinus infections to assist you rapidly define your ailment and get the best and most efficient treatment possible.


What Can I Do to Relieve My Pollen Allergy Symptoms?

Thankfully, there are several options for relieving pollen allergy symptoms, available both over-the-counter and by prescription.

Talk to your doctor or a board-certified allergist about your symptoms and treatment options. Your doctor might own you take a combination of medicines to hold your symptoms controlled. These medicines include:

  1. Leukotriene (loo-kuh-trahy-een) receptors
  2. Antihistamines
  3. Decongestants
  4. Nasal corticosteroids
  5. Cromolyn sodium nose spray

If these medicines don’t completely relieve your symptoms, your doctor might also give you immunotherapy. This is a long-term treatment that can reduce the severity of your allergic reactions. It generally involves regular shots, tablets or drops you take under the tongue.

You can also take steps to reduce your exposure to tree pollen:

  1. Dry your clothes in a dryer and not exterior on a clothes line.
  2. If you haven’t had allergy testing, discover a board-certified allergist to test you for pollen allergies.

    What is the difference between allergies and sinus problems

    Work with your doctor to come up with a treatment plan.

  3. Start taking allergy medicinebefore pollen season begins.
  4. Learn about the trees in your area and when they produce the most pollen. For example, oak tree pollen is highest in the morning. If you are allergic to oak pollen, save your outdoor activities for later in the day.
  5. Avoid pets that spend a lot of time outdoors.
  6. Keep your windows closed and use a CERTIFIED asthma & allergy friendly® filter on your central air conditioner.
  7. Watch pollen counts on a website love theNational Allergy Bureau™.
  8. Change and wash clothes you wear during outdoor activities.

It may be hard to avoid tree pollen during the tardy winter and spring.

But you can reduce your symptoms with the correct treatment.

Medical ReviewFebruary

References
1. Oral allergy syndrome (OAS) | AAAAI. (n.d.). Retrieved February 26, , from

It is significant to stay up-to-date on news about asthma and allergies. By joining our community and following our blog, you will get news about research and treatments. Our community also provides an chance to join with other patients who manage these conditions for support.

What Can I Do to Relieve My Pollen Allergy Symptoms?

Thankfully, there are several options for relieving pollen allergy symptoms, available both over-the-counter and by prescription.

Talk to your doctor or a board-certified allergist about your symptoms and treatment options. Your doctor might own you take a combination of medicines to hold your symptoms controlled. These medicines include:

  1. Leukotriene (loo-kuh-trahy-een) receptors
  2. Antihistamines
  3. Decongestants
  4. Nasal corticosteroids
  5. Cromolyn sodium nose spray

If these medicines don’t completely relieve your symptoms, your doctor might also give you immunotherapy. This is a long-term treatment that can reduce the severity of your allergic reactions.

It generally involves regular shots, tablets or drops you take under the tongue.

You can also take steps to reduce your exposure to tree pollen:

  1. Dry your clothes in a dryer and not exterior on a clothes line.
  2. If you haven’t had allergy testing, discover a board-certified allergist to test you for pollen allergies. Work with your doctor to come up with a treatment plan.
  3. Start taking allergy medicinebefore pollen season begins.
  4. Learn about the trees in your area and when they produce the most pollen.

    For example, oak tree pollen is highest in the morning. If you are allergic to oak pollen, save your outdoor activities for later in the day.

  5. Avoid pets that spend a lot of time outdoors.
  6. Keep your windows closed and use a CERTIFIED asthma & allergy friendly® filter on your central air conditioner.
  7. Watch pollen counts on a website love theNational Allergy Bureau™.
  8. Change and wash clothes you wear during outdoor activities.

It may be hard to avoid tree pollen during the tardy winter and spring. But you can reduce your symptoms with the correct treatment.

Medical ReviewFebruary

References
1.

Oral allergy syndrome (OAS) | AAAAI. (n.d.). Retrieved February 26, , from

It is significant to stay up-to-date on news about asthma and allergies. By joining our community and following our blog, you will get news about research and treatments. Our community also provides an chance to join with other patients who manage these conditions for support.

JOIN NOW


What Are the Symptoms of a Tree Pollen Allergy?

Pollen allergysymptoms are commonly called “hay fever.” Pollen released by trees, as well as grasses and weeds, cause these symptoms.

They include:

  1. Red and watery eyes
  2. Runny nose and mucus production
  3. Sneezing
  4. Itchy nose, eyes, ears and mouth
  5. Stuffy nose (nasal congestion)
  6. Swelling around the eyes

If you haveallergic asthmaand are allergic to tree pollen, you might also own asthma symptoms while the trees are pollinating.

Tree pollen is finer than other pollens. Because of this, the wind can carry it for miles.

These light, dry grains easily discover their way to your sinuses, lungs and eyes, making them hard to avoid.


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