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As an sinus doctor, I treat a lot of patients who have allergic rhinitis. It is a very common problem. It is also the most common "default" diagnosis that is given. When a patient, their family, their friend, or even their doctor doesn't really know what the cause of the nasal symptoms are, they will say, "you're allergies are flaring up, aren't they?".

When people suddenly get a stuffy nose and sneezing, people tell them they have allergies. When children have a constant runny nose, they are told that they have allergies. When patients always have sinus headaches, they believe that it is from allergies.

Guess what. Allergies are not the most common cause of congestion. Allergies are not the most common cause of acute nasal drainage. Allergies are not the most common cause of sinus pain.

Surprised?

Now this isn't to say that allergies aren't a common problem, but they are not the only diagnosis to consider. Also, just because someone tests positive to allergens or has some very obvious allergic history, that doesn't mean that all of their nasal symptoms are from the allergic reaction.

Here are some general thoughts about allergic rhinitis
  • Most (80%) of patients who have nasal allergies will have developed them before their twenties. That means that when older adults develop new nasal problems and didn't have such problems when they were younger, allergic rhinitis is less likely.

  • When symptoms are not controlled fairly well with antihistamines and or nasal steroid sprays, the diagnosis of allergic rhinitis is less likely. Except for severe cases, and especially those patients with asthma, allergic rhinits is usually pretty easy to treat with modern medicines.

  • The most common misdiagnosis that I see is when people diagnose viral infections as allergy flare ups. When someone suddenly gets a stuffy nose and drainage, viral infections are the more common culprit. People often don't feel particularly ill or have fever, but thats the way the rhinovirus is. There are hundreds of strains of rhinovirus and other upper respiratory viruses, and the character of the illness can be different with different strains.

  • Sinus pain is not usually from allergic rhinitis alone.

  • One sided symptoms can not be explained by allergic rhinitis alone.

  • People will often have multiple problems. For example, a deviated septum and allergic rhinitis or chronic sinusitis and allergic rhinitis. Children often have repeated viral infections and allergic rhinitis or adenoid hypertrophy and allergic rhinitis. In many cases, the other problem is more "fixable" and once the patient is left with just the allergic rhinitis, they don't have many symptoms, or the symptoms are easy to treat with allergy medicines.

    Turbinate hypertrophy and allergic rhinitis is an obvious example. Once the turbinates have been reduced, patients often are free of their allergy symptoms.

  • Allergic rhinitis causes symptoms in about 20% of adults. There is one or more positive responses to skin testing in about 50% of the general population. Positive allergy testing doesn't always equate with nasal symptoms.

In my practice I see a select group of patients, so my experience is naturally skewed. For example, I don't often end up seeing patients with pure allergy, because they have usually found successful ways to treat their symptoms; either through OTC medicines or from primary care physicians.

The "take home" message is: if you are having nasal allergy problems that aren't easy to treat with standard allergy medicines, you need to see a specialist who can consider other sources of your problem. It just may not be allergic rhinitis after all.



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