“A large nose is the mark of a witty, courteous, affable, generous and liberal man.”– Cyrano de Bergerac
For an organ normally taken for granted (unless we’re like Cyrano!), the nose is a gateway for more than its fair share of challenges to its owner. We have all experienced or heard about “sinus problems”, haven’t we?
In clinic during my ENT rotation, we saw a lot of patients coming in because of their sinus problems. Many of them ended up having allergic rhinosinusitis – “rhino” referring to your nose, “sinus” to your sinuses and “-itis” referring to an inflammatory reaction.
Your “sinuses” are air-filled spaces within the bones of your skull. The lining of the nose and sinuses are continuous, so usually both are affected in conditions like rhinosinusitis.
For some people, when they’re exposed to dust, pollen or pet dander, an allergic reaction is triggered. Allergic rhinosinusitis, asthma and eczema are called “atopic” conditions and what this means is basically, in these conditions, your body encounters a normal stimulus, but some persons overreact to it. Your immune system is there to protect your body from threats. So when something like a virus or bacteria invades our defences, there is a chain of events that happen to fight off the invading organism.
But with atopic conditions, your body doesn’t just pull out the big guns for actual threats, it does that for relatively benign things like pollen or dust. Instead of just ignoring the stimulus, your body kicks off a chain of events in response. In rhinosinusitis, special antibodies and cells release chemicals like histamine that cause your nose to become blocked up and runny.
Unlike a sinus infection, in allergic rhinosinusitis, the nasal discharge is usually clear and thin. If the sinuses are infected, the discharge is usually thick and yellow/green.
Because of the congestion and airflow obstruction in the nose, many people with allergic rhinosinusitis have a reduced or even absent sense of smell. One of the things that people with allergic rhinosinusitis tend to do is rub their nose quite frequently to relieve itching – an “allergic salute”. They might rub their nose so much so that they end up having a crease just above the tip of their nose.
Other triggers of this allergic reaction are house-dust mites which can be found on mattresses and pillows. And is a good reason why we should periodically “dust” these out.
There’s a strong association between allergic rhinosinusitis and asthma- in fact, it can even make asthma worse.
But since allergic rhinosinusitis is an allergic reaction and not an infection, antibiotics aren’t needed to manage it. You’ll only need antibiotics if you end up developing a bacterial infection. Allergic rhinosinusitis is usually managed with antihistamines and intranasal steroids. And you can see why those things will help – histamine is the main chemical causing the symptoms so antihistamines work against that and since the condition is basically an overblown immune response to a normal stimuli, the steroids help by damping down that immune response.
Nasal decongestants are also used but they should be used briefly and sparingly if at all. Nasal contestants, if they’re overused, can cause a rebound nasal congestion (rhinitis medicamentosa) which ends up worsening the problem.
Like asthma, one of the most important parts of managing allergic rhinosinusitis is to avoid triggers. Try to identify things at home, at work or in your environment that might be triggering an allergic reaction.
I realise I’ve been a bit technical this week, but I wanted you to know your runny nose a bit more so you could take care of its problems.
