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Congestion. Pain and pressure in the sinuses and teeth. Runny nose. Coughing and sneezing. Sore throat. Let's put a hold on Spring!

Spring Means Sinusitis
Johns Hopkins University
By Howard Levy, M.D.

This time of year is a common time for sinusitis, which simply means inflammation of the sinuses. Let's take a look at the causes of these bothersome symptoms:
Pain and Pressure
The inflammation causes mucus to build up in the sinus cavities behind the cheeks and forehead, causing pain and pressure in the face and head.

Sneezing
When some of the mucus runs down the nose, it triggers sneezing.

Coughing
When mucus drips down the back of the throat into the lungs and upper airway, it causes the coughing.

Sore Throat
The sore throat is due to post-nasal drip. The mucus tends to accumulate in the back of the throat while we're sleeping overnight, so the sore throat is often worse first thing in the morning.

Patients often ask for or expect to be prescribed antibiotics for sinusitis. However, the most common cause is allergy, not infection, so antibiotics are often not the best choice.

Allergy symptoms can occur year-round (perennial) or just during the times when certain triggers are present in the environment (seasonal). The timing, frequency, duration and severity of allergic sinusitis vary from one person to the next, and can change over time.

Allergies are immune reactions to something in the environment. For allergic sinusitis, it is typically something in the air. Pollens (from grasses, trees and other plants), animal dander, and molds are some of the more common allergic triggers, but there are hundreds of possible causes.

Allergy can develop at any time in life - with the very first exposure, after thousands of exposures, or any time in between. So even if you've never been diagnosed with allergy before, it is always something to consider if you have sinusitis.

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Exams and Tests

Your doctor will diagnose a drug allergy by asking you questions about the medicines you are or have recently been taking, your past health, and your symptoms (medical history) and by doing a physical exam. To find out which medicine is causing your allergic reaction, your doctor will consider:

* Your medicine. Some medicines are more likely to cause an allergic reaction than others.
* Whether you have a drug allergy or another adverse reaction to medication. You have more treatment options if you have an adverse reaction that does not involve the immune system.
* How many medicines you are taking. If you take several medicines, the medicine you began taking most recently is often the cause.

Your doctor probably will ask you to stop taking the medicine that is most likely to be causing the reaction. If this does not help, your doctor may ask you to stop taking other medicines, until you can find which medicine is causing the allergic reaction.

If your doctor cannot find out which medicine is causing the reaction, he or she may suggest a skin test. In a skin test, your doctor will place a small amount of medicine on or under your skin to see if your body reacts to it. However, a skin test does not work for all medicines, and you risk having a severe reaction.

Skin tests can diagnose allergies to:

* Penicillin, which is the most common cause of drug allergies.
* Insulin.
* Heterologous serum (used in the prevention or treatment of botulism, diphtheria, severe gangrene, organ transplant rejection, and snake and spider bites).
* Streptokinase (used to dissolve blood clots).
* Chymopapain (used for herniated discs).

Another way to find the cause of your allergic reaction is a medicine challenge. In a medicine challenge, you start by taking small doses of a medicine and slowly increase how much you take to see whether you have an allergic reaction. This challenge is usually done where emergency medical help is available and under the supervision of a health professional.

If you have medicine fever, serum sickness, or other complications, you may need more tests. These tests include a chest X-ray and blood tests to see how well your liver and kidneys are working.

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Immunotherapy for allergies to insect stings
Treatment Overview

Immunotherapy is a series of allergy shots given to reduce your sensitivity to allergens that cause an allergic reaction. Small doses of allergens are injected under the skin. Over time, allergy shots can decrease the severity of your reaction to allergens. To treat allergies to insect stings, very small amounts of the venom of the insect or insects are used. The treatment also is sometimes called venom immunotherapy (VIT).

Immunotherapy is available to treat allergies to stings from:

* Honeybees.
* Yellow jackets.
* Hornets.
* Paper wasps.
* Fire ants.

A solution of dilute saline containing a very small amount of the insect venom is injected under the skin. At first, you get one or more shots about once a week. The amount of allergen injected is slightly increased each time, unless you have a reaction to the shot.

After about 4 to 6 months of weekly shots, you are usually getting an optimal amount of allergen in the shot—this is called the maintenance dose. After you reach maintenance level, you get the same dose in shots every 4 weeks for another 4 to 6 months.

After the first year of shots, you will have maintenance shots every 6 to 8 weeks over the next 3 to 5 years.1

Depending on your situation, your doctor may recommend rush immunotherapy. Several shots are given over a period of days to weeks. This type of treatment can provide faster protection in the short term. But you will still need to have regular shots over the long term.
What To Expect After Treatment

Allergy shots are usually given in a doctor's office. It is normal to remain in the doctor's office for a short time after getting an allergy shot to be watched for possible serious reactions to the injected insect venom.

Redness and warmth at the shot site are common but go away after a short time.
Why It Is Done

Immunotherapy can prevent life-threatening reactions and also reduce anxiety associated with insect stings.

An allergic reaction that spreads far from the sting or that affects the entire body is called a systemic reaction. Systemic reactions are not common but can be life-threatening. Allergy shots are usually recommended if an adult or child has had a severe systemic reaction, especially anaphylaxis. Immunotherapy reduces the risk of another severe systemic reaction.
How Well It Works

Immunotherapy for insect stings significantly reduces your chances of having another severe systemic allergic reaction from 60% to less than 3%.1

It is not clear exactly how effective the protection against future stings is after the treatment has ended. In about 80% to 90% of cases, you will still be protected against systemic reactions even if tests show some remaining immune sensitivity.1
Risks

Allergy shots are safe if the shots are given correctly. The most common side effects are redness and warmth at the shot site. Some people may experience large local reactions that include itching, hives, or swelling of the skin near where you had the shot. More serious but less common side effects include systemic symptoms such as hives, itching, or difficulty breathing.

In rare cases, a person may have a severe allergic reaction (anaphylaxis) to the shots. Because of this possibility, the shots are given in a doctor's office or other setting where emergency care can be provided if needed.

Allergy shots should not be used if you:

* Have certain heart conditions, especially unstable angina or a recent heart attack.
* Are not expected to live for at least 5 more years.
* Are not able to communicate about reactions to shots. Most doctors do not give allergy shots to children younger than age 5.
* Have an impaired immune system due to a chronic disease (such as AIDS). Talk to your doctor first about whether allergy shots would be safe for you.
* Are taking beta-blockers, such as propranolol (Inderal, for example) or timolol maleate (Timoptic or Blocadren, for example), which are often used to treat heart conditions, glaucoma, migraine headaches, and high blood pressure.
* Are taking ACE inhibitors, such as captopril (Capoten, for example) or lisinopril (Prinivil, Zestril, or Zestoretic, for example), which are often prescribed for high blood pressure and a variety of heart conditions. Talk to your doctor first about the potential risks of immunotherapy.

What To Think About

People with multiple insect venom allergies may still be at risk for a severe systemic reaction if they are receiving allergy shots for only one type of insect venom.

Immunotherapy is generally not needed for adults or children who have only a large local reaction to a sting. But anyone who experiences increasingly severe large local reactions with each new sting may want to consider immunotherapy.

Allergy shots take 3 to 5 years to complete and are expensive. You have protection from insect sting allergies after you have had the series of initial shots and after you start your maintenance dose. This may take about 1 to 2 months for standard immunotherapy but only 1 to 8 days with rush immunotherapy.