Allergies and Sinuses Q&A with Dr. Mary Kendall Rago.

Dr. Rago treats patients of all ages for allergy and sinus conditions. For more information, or to schedule an appointment, call 412-787-3400

Dr. Mary Kendall Rago

What causes allergies, sinusitis and infections?

Allergic symptoms occur when your body's immune system reacts to something with which you have come into contact such as poison ivy, cat dander, an insect bite or even a certain food.  The substance causing the reaction, an allergen, can enter your body through the skin, nose, lungs or the GI tract.  The allergen stimulates the immune system to release different chemicals such as histamine that then cause symptoms ranging from rash, itchy nose and eyes, runny nose, hives, wheezing to life threatening anaphylaxis.

Sinusitis occurs when you have an inflammation and swelling of the lining of your sinus cavities.  This often starts with either an allergic reaction or a viral upper respiratory infection (URI) causing the swelling of the nasal and sinus lining and increased mucous production, and can then progress to a painful bacterial infection in 10 days or so if the inflammation does not subside.  Bacterial sinusitis usually needs antibiotics to clear.

Allergies - A person has had every treatment, taken every drug, and nothing works; now what do they do?

First line treatment for allergies is an antihistamine such as loratadine, cetirizine, or diphenhydramine.  If that is not enough to control symptoms the next step is to add on an intranasal steroid, and if the combination is not sufficient, add on a third drug, montelukast.  If these drug therapies do not control the symptoms, the next step is to test for inhalant and possibly food allergies and start allergy desensitization with weekly allergy shots.  This usually takes up to six months to see marked improvement in symptoms, but, if patiently pursued, is very effective for most people, including children.

Additional treatments that help control allergies are daily 8 oz saline rinses, topical intranasal antihistamine spray, and even procedures to shrink the tissue inside of the nose to make less mucous and decrease nasal congestion.  Making a concerted effort to avoid allergen exposure such as air filters and mattress covers for dust mite allergies really does work, and even taking timely vacations to go to another climate curing a certain pollen season can help.

 What techniques can a person use for allergy prevention?

Allergy prevention techniques range from staying away from animals to which you are allergic to covering mattresses, using hypoallergenic pillows, removing carpeting and draperies, installing solid flooring in your house, and cleaning air ducts.  It is helpful to have undergone allergy testing to determine what specific allergens are causing the problems before embarking on such measures.

What is Pediatric Sinusitis?

Pediatric sinusitis is inflammation and swelling of the lining of the sinuses, just like adult sinusitis.  However, there are some key differences in pediatric patients with sinusitis.  Children are not born with fully developed sinuses, but rather are still developing their sinus cavities into their teenage years.  Children have many more viral URIs per year than adults, often 10-12 per year, probably because of their greater exposure to viruses in daycare, etc. as well as their less mature immune system. 

Most cases of pediatric sinusitis will clear without surgical intervention, but investigations need to be made into possible allergies or immunodeficiencies in children with persistent symptoms of face pain, nasal purulence and fatigue.  Because of concerns about radiation exposure, CT scans for evaluation should used with care.

 Are Headaches Common with Sinusitis?

Face pain can be one of the presenting symptoms of a sinusitis but, without the other symptoms such as nasal obstruction, nasal purulence, fever, or cough, a sinusitis is unlikely.  A CT scan may need to be done to see if there is an inflammation of one of the paranasal sinuses.  However, it is estimated that 85% of patients who complain of "sinus headaches" are really having some form of migraine headache.