Allergic rhinitis seems to be the buzz word now in Hong Kong, and in
most urban cities in China nowadays. With the ever increasing Air Pollution
index (API) being daily monitored, most Hong Kongers are not only aware of
allergic rhinitis but are probably most likely sufferers of this condition.
Rhinitis is the medical term for inflammation of the nose
(rhino-itis) and when the cause is an allergen that causes an allergic response,
we call it allergic rhinitis. What is the related impact of this condition?
Looking at this condition globally, it is estimated that 20% of everyone on Planet Earth is affected
by rhinitis; that is to say one in every five persons. In the United States, an
estimated 58 million Americans suffer from allergic rhinitis due to some
allergens, whilst another 19 million have non-allergic rhinitis. This accounts
for almost 30% of clinic attendances seen by the average Ear, Nose and Throat
Specialist.
Most allergic rhinitis sufferers are usually allergic to things like
house dust mite extracts (not house dust), pollen, cockroach extracts, molds
and fungi. The fur or dander of pets like cats and dogs can also stimulate an
allergy. So what happens when this occur?
Our nose is a very fine and
sensitive organ. It regulates the temperature and humidity of the air entry in
order to protect our lung, as well as to cleanse the entering air of
particulate matter that would otherwise damage our lungs.
In the presence of house dust mite extract or molds, the blood flow
to the nose will increase and cause the tissues in our nose (the turbinates) to
swell. This blocks air entry in to the
nose; so we suffer from blocked nose. The nose starts to secrete copious
amounts of mucus to irrigate away these allergens; we then suffer with a
running nose, usually with a postnasal drip. And finally the chemical mediators
released in an allergic reaction in the nose causes us to sneeze; this removes
the allergens from our nose with a violent blow.
Allergic rhinitis, although considered as a disease, is best viewed
as our body’s natural and protective response to contaminated air entering our
body. There is no fever as there are no viruses or bacterial infection. It can
occur everyday unlike e.g. viral infections that runs a course 2-3 times a
year. And as the nasal passages get swollen, the sufferer often encounters
other associated conditions like:
- Sinusitis and sinus headaches becomes more likely as the sinus openings are blocked
- Mouth breathing to compensate for the blocked nose often ensues. This results in dry mouth, bad breath, recurrent sore throats and tonsillitis, recurrent mouth ulcers and poor sleep quality
- Recurrent tonsillitis will result in enlarged tonsils. This is a cause of snoring and obstructive sleep apnea, with a poorer sleep quality.
- A poorer sleep quality over time can affect one’s ability to function well cognitively with memory loss, irritability and frustration as well as maintaining a normal blood pressure for one’s age.
- Bronchial hyperactivity with dry cough and exacerbation of asthma is a common sequelae of poorly controlled allergic rhinitis. The simple reason for this is that the nose, mouth and lung airway share the same mucosal lining. So when the nose is no longer able to prevent soiling of the lung by the poor air e.g. because of mouth breathing, dry cough with asthmatic episodes increase.
- As the eyes have a similar lining that is equally reactive and similarly innervated by the nose, allergic rhinitis causes the eyes to stream tears, be itchy and cause blur vision and difficulty with wearing contact lenses comfortably.
So how can we
treat allergic rhinitis? Whatever we do, we need to do regularly as most
individuals are allergic to the ubiquitous house dust, which is everywhere. We
need to remove the allergens. Simply avoiding would help but it is not always
practical. Keeping our home and work environment dust free will help by wiping
with a moist cloth, cleaning air-conditioning filters regularly, washing bed linen
in water >63 degree Celsius to kill the house dust mites, avoid carpets if
possible or at least keep them clean regularly.
The simplest
way is to use a low pressure, high volume nasal saline douching system for the
nose. These are available from the local chemists. They irrigate the nose,
keeping the allergen load at a minimum and should be a part of one’s daily
hygiene regime to maximize the benefit.
Whilst the
above would work for the mild sufferers, often medication is required. The
commonest prescribed medication is a topical nasal steroid, which are
anti-inflammatory.
They are very
effective in reducing inflammation of the nasal lining topically at the target
site of the condition, improving the nasal airway and reducing the secretions
and itchiness. Unlike the dreaded injected or orally taken steroids, topical
nasal steroids have been shown to be very safe to use in children as young as 3
years. Antihistamines oral medications are also used and they are especially
effective in reducing the sneezing and runny nose.
So what about
surgery for allergic rhinitis? In patients whose main problem with their
rhinitis is a blocked nose with sinus related headaches and mouth breathing;
surgery helps to unblock the nose. Enlarged turbinates can be reduced, deviated
septum can be realigned and sinuses can be re-ventilated as necessary. As
surgery does not remove the nasal lining completely, there may be residual
allergic symptoms of sneezing and runny nose. However with a more patent nose,
saline douching and/or topical nasal steroids will be more effective in
reaching their target, and to minimize inflammation of this lining.
Allergic
rhinitis is a condition that can affect the quality of life of the sufferer.
With the sinusitis, poor sleep, reduced cognition, recurrent throat infections,
obstructive sleep apnea and asthma that can be associated with it, it adds to
the “unseen” economic loss for employers and the Hong Kong community as a
whole. Simple measures and medication do help, but just sometimes surgery is
required to better control the condition.
Case study
A 39 year old
executive presented with a blocked nose, dry mouth, snoring, with poor sleep
and morning headaches. His turbinates were swollen and they blocked the nose.
When the turbinates were decongested for a full nasal examination, a deviated
bony septum was seen and an enlarged postnasal adenoid was seen. With the
blocked nose and daily mouth breathing, the tonsils and pharynx were inflamed
and enlarged. The tonsils added to the snoring, which when he reached the
deeper stages of sleep, together with a relaxed tongue, caused an airway
obstruction during sleep. Hence good deep sleep was not always possibly
attained. In spite of medication, the condition did not improve, and surgery
was offered.
Surgery, to
straighten the nasal septum, reduce the inferior turbinates, remove the tonsils
and trim the elongated uvula, was performed. The improvement in the airway was
significant and resulted in a better sleep, minimal snoring and an overall
improved quality of life and work. Regular nasal saline douching daily was
still required to maintain good nasal hygiene.
The Chinese version of this article was published in Hong Kong Economic Journal on February 14 & 28, 2013.
