Evaluating and Treating Ear, Nose, and Throat Allergies

Evaluating and Treating Ear,
Nose, and Throat Allergies





Division of Allergy and Environmental Disease
Virginia Commonwealth University Health Systems
Department of Otolaryngology / Head and Neck Surgery
804-628-4ENT





Andrew J. Heller, MD
Evan R. Reiter, MD
VCUHS - Department of Otolaryngology / Head and Neck Surgery
Stony Point Surgery Center
MCV Hospitals / A.D. Williams Building
8700 Stony Point Parkway, Suite 220

1201 East Marshall Street, Suite 401
Richmond, Virginia 23235 Richmond, Virginia 23298
804-323-0830
804-628-4ENT

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Division of Allergy and Environmental Disease
Virginia Commonwealth University Health Systems
Department of Otolaryngology / Head and Neck Surgery

Evaluating and Treating Ear, Nose, and Throat Allergies

What is allergy?


Allergy is a condition, often inherited, in which the immune system of the
affected person reacts to something that is inhaled, eaten, or touched that doesn’t affect
most people. The patient’s immune system reacts to this substance as if it were an
“enemy invader” (like a virus). This reaction leads to symptoms that often adversely
affect the patient’s work, play, rest, and overall quality of life.

Allergens cause allergies

Any substance that triggers an allergic reaction is called an allergen. Allergens
“invade” the body by being inhaled, swallowed, or injected, or they may be absorbed
through the skin. Common allergens include pollen, molds, dust, and animal dander.

How common are allergies?



Allergies are among the nation’s most common and costly health problems. They
affect as many as one in four people. More than 50 million Americans have allergic
rhinitis. The yearly sales of antihistamines, decongestants, nasal cromolyn, and nasal
steroids now exceed five billion dollars.

What happens during an allergic reaction?


The immune system reacts to an allergen that has entered the body as if it were an
“enemy invader” (like a virus). It produces special antibodies capable of recognizing this
same allergen when it enters the body at another time. When the allergen again enters the
body, the immune system rapidly recognizes it, causing a series of reactions. These
reactions often involve cellular destruction, blood vessel dilation, and production of many
inflammatory chemicals including histamine. Histamine produces some of the more
common allergy symptoms such as sneezing, scratchy throat, hives, and shortness of
breath.

What are the symptoms of Ear, Nose, and Throat Allergies?


People often think of allergies as only “hayfever,” with sneezing, runny nose,
nasal stuffiness, and itchy, watery eyes. However, allergies can also cause symptoms
such as chronic sinus problems, excess nasal and throat drainage (post-nasal drip), head
congestion, frequent “colds,” hoarse voice, eczema (skin allergies), recurring ear
infections, hearing loss, dizziness, chronic cough, and asthma. Even stomach and
intestinal problems, as well as excessive fatigue, can be symptoms of allergy.
VCUHS - Department of Otolaryngology / Head and Neck Surgery
Stony Point Surgery Center
MCV Hospitals / A.D. Williams Building
8700 Stony Point Parkway, Suite 220

1201 East Marshall Street, Suite 401
Richmond, Virginia 23235 Richmond, Virginia 23298
804-323-0830
804-628-4ENT

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Can an allergy be outgrown?


No, but it is common for people to change the way their allergic symptoms affect
them. For example, a baby may develop colic, recurrent ear infections, or have eczema,
but as the baby grows older, he or she may develop different allergic symptoms, such as
hay fever, fluid behind the eardrum, or asthma.

How do we make the diagnosis?


The initial or presumptive diagnosis of allergy is made through a patient’s history
and physical examination. To be certain of the diagnosis and prescribe effective
treatment, findings may be confirmed by tests that identify the specific offending
antigens.

Testing for Allergies


Like all biological systems, the immune system is very complex. Many issues
relating to accurate diagnosis and effective treatment of allergies remain unsolved. The
immune reactions caused by airborne (inhalant) allergens such as ragweed and grass
pollens, molds, and dust are well understood and comparatively easy to diagnose and
treat. However, the immune reactions caused by other allergens such as industrial
chemicals, pollution, and foods frequently are more complex and difficult to accurately
diagnose and treat with standard techniques.

The following discussion of testing techniques is confined only to the better
understood and easier-to-diagnose inhalant allergies caused by dust, mold, and pollen
allergens. Although a number of methods are in use today to identify specific inhalant
allergens, they all fall into one of two basic types:
Skin Testing or
Blood Tests

Both methods attempt to determine if the patient’s immune system has
manufactured abnormally large amounts of antibody to specific allergens.

Skin Testing by Endpoint Titration


There are several ways to skin test for allergies. No one test is perfect in every
case. However, the experience of thousands of physicians, in both ear, nose, and throat,
and many other specialties, indicates that of all skin test types, one form gives superior
results in the majority of patients. This test procedure is called Intradermal Dilutional
Testing, often referred to as IDT.

There is very little discomfort from the titration technique. A series of small
injections, using very fine needles, is made in rows on the patient’s arms. Only a small
amount of the test substance (called the antigen) is injected. The result is a series of
bumps which look like small mosquito bites. If the bumps enlarge significantly in a short
period of time, it indicates the patient is likely allergic. If one receives allergy
immunotherapy (shots), the proper dosing will be based on these test results.


VCUHS - Department of Otolaryngology / Head and Neck Surgery
Stony Point Surgery Center
MCV Hospitals / A.D. Williams Building
8700 Stony Point Parkway, Suite 220

1201 East Marshall Street, Suite 401
Richmond, Virginia 23235 Richmond, Virginia 23298
804-323-0830
804-628-4ENT

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In Vitro Tests on Blood Samples (RAST)


Using a tiny amount of blood serum, this test is used to accurately measure
increased levels of allergen antibodies. Although the results of In Vitro tests are not
available immediately (need to be sent to a lab) as are skin tests, they offer the
convenience of requiring only one sample of blood to obtain the results for several
different allergens. In Vitro testing is especially advantageous for the testing of children,
as their discomfort is minimized. Skin tests are generally preferred over RAST testing
due to the more accurate and immediate results.

What is the Current Treatment for Allergies?


Despite the advances in allergy care during the past several decades, there are still
only three basic, accepted approaches to allergy care:
–
Avoidance of the offending allergens
–
Pharmacotherapy (medications used to influence the allergic reaction)
–
Immunotherapy (allergy shots or desensitization)

Avoidance


The first, most basic treatment step, once an allergen has been identified, is to
eliminate or avoid it if possible. Unfortunately, avoiding some allergens (such as dust,
molds, and animals) is often difficult and thus allergen avoidance alone may not be
effective

Pharmacotherapy


Medications can frequently control allergy symptoms. These may include
antihistamines, decongestants, prescription nasal sprays, and other products. These
medications can often control allergy symptoms, but they can also produce side effects in
some people. Many patients do very well with a combination of avoidance and
pharmacotherapy.

Immunotherapy


When allergen avoidance and medications do not successfully control allergy
symptoms, the Otolaryngic (Ear, Nose, and Throat) Allergist can alter the body’s
overactive response. This is done by carefully challenging the patient’s immune system
through regular injections of the actual allergens to which the patient is sensitive. This
treatment can be administered after allergy testing has determined what has triggered the
allergic response.

Over time, it may be possible to actually alter a person’s excessive response to
these environmental allergens, both improving symptoms and decreasing the need for
medications and allergen avoidance for many years. Thus immunotherapy is unique in
the sense that it alters the patient’s reactivity to specific allergens.

VCUHS - Department of Otolaryngology / Head and Neck Surgery
Stony Point Surgery Center
MCV Hospitals / A.D. Williams Building
8700 Stony Point Parkway, Suite 220

1201 East Marshall Street, Suite 401
Richmond, Virginia 23235 Richmond, Virginia 23298
804-323-0830
804-628-4ENT

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