Allergic Rhinitis and Sinusitis: Overview and Risk Factors

Allergic rhinitis, or hay fever, is very common, affecting at least 60 million people in the United States. Allergens cause release of chemicals in the nose that result in the typical symptoms: runny nose, sinus congestion and pressure (especially when leaning forward), sneezing, coughing, and itching of the eyes, palate, and nose. Also, sleep disturbance may occur, leading to fatigue.

Allergic rhinitis can be intermittent (seasonal) or persistent (perennial) and may be described as mild, moderate, or severe, to the extent that it interferes with sleep or daily activities.

Sinusitis, also known as rhinosinusitis, is an inflammatory disorder of the nasal sinuses. The most common causes are viral upper airway infections and allergies. Bacterial sinusitis can also occur once a viral infection has taken hold and weakened the immune system.

Along with possible symptoms of rhinitis, sinusitis may include nasal discharge, postnasal drip, cough, headache, and teeth or facial pain at sinus sites. It may also affect the sense of smell, cause bad breath, and exacerbate asthma.

Risk Factors

Allergic Rhinitis

History of allergies in the patient or family
Male gender
First-born child
Birth during a pollen season
Early introduction of infant formula and food
Early antibiotic use
Maternal smoking in first year of life
Exposure to indoor allergens (dust mites, animal dander, mold)

Sinusitis

Allergic rhinitis
Medical procedures in the nose
Dental infection
Cystic fibrosis or other lung abnormalities
Chemical irritation
Obstruction due to tumors, infection, or foreign bodies

Allergic Rhinitis and Sinusitis: Diagnosis and Treatment

Diagnosis

History and physical examination are the most important steps.
The diagnosis may be confirmed by skin or blood allergy testing.
The inner nose and sinuses can be visualized by use of a fiber optic rhinoscope.
In cases of severe or recurrent sinusitis, a sinus CT scan may be recommended.

Treatment

Allergic Rhinitis

Avoidance of inciting factors (e.g., pollen, mold, or dust mites) is the most helpful treatment.
Avoidance of tobacco is beneficial.
Nasal saline inhalers may improve symptoms.
Among pharmaceutical treatments, nasal steroids are first-line agents. Other options include antihistamines (e.g., loratadine), ibuprofen, or oral decongestants (e.g., pseudoephedrine).
Immunotherapy injections ("allergy shots") may significantly improve symptoms and quality of life. However, these cannot be used in people who are taking beta-blockers.

Sinusitis

Avoiding tobacco is beneficial.
Nasal saline inhalers or nasal steroids may improve symptoms.
Symptomatic treatment with antihistamines, decongestants, and nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) may help to alleviate cough, congestion, and fatigue.

In presumed cases of bacterial sinusitis, antibiotics (e.g., amoxicillin) may be recommended. However, antibiotics are not useful for viral sinusitis. When antibiotics are used, a prolonged course (three to six weeks) may be necessary.

Allergic Rhinitis and Sinusitis: Nutritional Considerations

Dietary adjustments may play a role in prevention and, to some extent, in treatment of allergic rhinitis and sinusitis- and they have no problematic side effects. In research studies, the following factors have shown promise in reducing the risk of allergic rhinitis and sinusitis:

Breast-feeding and avoidance of early introduction of potentially allergenic foods in a child's diet: In an Italian study, new mothers were advised to breast-feed their infants and to avoid introducing commonly allergic foods (including whole cow's milk, eggs, fish, nuts, and cocoa) during the first year of life. Mothers who did breast-feed were also asked to limit dairy products and avoid eggs in their own diets, as well as to avoid exposure to other sources of allergens (e.g., smoking) as much as possible. These interventions greatly reduced allergic symptoms, including allergic rhinitis, in their children.
Dietary fatty acids and antioxidants: These can influence the production of allergic chemicals, including histamine and leukotrienes, and may thereby play a role in the treatment (and possibly the prevention) of allergic rhinitis and sinusitis. The use of an omega-3 fatty acid supplement, paired with a multiple vitamin-mineral formula containing selenium, was shown to decrease the number of episodes of sinusitis in children.
Reducing dietary saturated fat and cholesterol: Some evidence suggests that children who eat less saturated fat and cholesterol have less risk of developing rhinitis. For example, consumption of butter and cholesterol, both high sources of saturated fat and cholesterol, has been associated with greater frequency of allergic rhinitis in children.
Vitamin supplementation: Limited evidence also suggests that blood levels of vitamins C and E are lower in children with chronic sinusitis. The intake of citrus fruit or kiwi fruit, both high in vitamin C, has been associated with a lower frequency of rhinitis in children.

Vitamin E has immune effects that might improve rhinitis symptoms, and vitamin E intake from foods was shown to be protective against hay fever in adults. People with hay fever taking vitamin E supplements during pollen season experienced fewer symptoms than those of placebo takers. Additional studies are needed to determine if food or supplemental sources of vitamins C and E benefit sufferers of allergic rhinitis.
Butterbur: A botanical treatment called butterbur (Petasites hybridus) significantly reduces the production of allergic chemicals (histamine and leukotrienes) in sufferers of allergic rhinitis. Benefits have been shown to be similar to those of a prescription antihistamine medication, without causing side effects, such as sleepiness.