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Allergic Hypersensitivity Reactions of the Upper Airways
Robert Sataloff, M.D., is Professor of otolaryngology, head and neck Surgery – Thomas Jefferson University, Philadelphia, PA; adjunct professor of otolaryngology, Head and Neck Surgery – University of Pennsylvania School of Medicine, Philadelphia, PA. John R. Cohn, M.D. is clinical professor of medicine and clinical assistant professor of pediatrics at Thomas Jefferson Medicine College, Philadelphia, PA. The authors discuss the incidence and types of allergic disease, focusing on how to diagnose and treat inhalant allergies affecting the upper respiratory tract (URT). Noting that the commonly-used term hay fever is a misnomer in URT since non-flowering plants such as ragweed cause most allergic reactions, the authors describe and illustrate the common and mainly but not exclusively seasonal symptoms – nasal congestion, sneezing, watery eyes, headache, and fatigue. While most allergic rhinitis is seen on routine anterior rhinoscopy, nasal endoscopy provides a more detailed examination. Radiologic testing is seldom required. Allergy testing begins with a detailed history of the patient's exposures and symptoms. Controlling the environment through dust control or air conditioning is an easily initiated form of both testing and treatment. The benefits, limitations and contraindications to skin testing (the quickest and least expensive testing methodology) are detailed. Skin testing is contraindicated in patients on beta blockers because of the increased risk of anaphylaxis if there's an adverse reaction. For patients in whom skin testing is contraindicated, Radioallergosorbent (RAST) testing is useful. The authors emphasize that any type of testing should be conducted only by experienced practitioners who know how to deal with adverse reactions. While topical nasal steroid sprays control most nasal symptoms the authors don't control ocular symptoms for which a variety of ophthalmic medications are available. These, however, are unsuitable for users of soft contact lenses. Alternatives to topical preparations include decongestants and oral antihistamines, whose types, dosages and sedative effects the authors illustrate. Both can cause mucosal drying that can be mitigated with Guaifenesin. Immunotherapy may be the best therapy for allergen-directed control. Finally, the authors note that mild allergies particularly affect such "voice users" as singers, actors, and politicians ... and people who travel frequently. Such patients require more extensive evaluation and follow-up. Read More from Dr. Sataloff and the Journal of Voice. |
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