For too many of us, springtime is synonymous with congestion. The combination of lingering winter colds and air suddenly full of pollen conspires to make it the season of stuffy noses, runny eyes, aching heads—and frustrating attempts to rein them all in.
Effective treatment starts with knowing whether your symptoms stem from allergies, such as hay fever, or sinusitis, an infection of the air cavities surrounding the nasal passages that frequently develops as a complication of the common cold.
But knowing the difference can be hard since some symptoms can overlap. And even when you know the cause, there are so many treatments to choose from that it's easy to end up with something that doesn't help much or even causes more problems than it solves.
For example, millions of Americans are prescribed antibiotics for sinusitis even though the drugs usually aren't necessary. The problem is so widespread that such organizations as the American Academy of Family Physicians and the American Academy of Allergy, Asthma, and Immunology recently started a campaign to discourage doctors from prescribing those drugs unnecessarily.
Allergy sufferers are often unsure of which drugstore products they should turn to or which lifestyle changes are most effective. That's unfortunate not only because it prolongs their misery but also because growing research suggests that inadequately controlled nasal allergies can worsen other health problems, notably asthma.
Sinusitis and allergies share certain symptoms, particularly nasal discharge and, in some cases, headaches. But there are several important differences (read Comparing the symptoms, below).
Usually, symptoms and medical history are sufficient for doctors to diagnose the problem. But certain tests can sometimes help confirm whether the congestion stems from allergies or a bacterial or viral infection. For example, a nasal smear that contains many white blood cells, called neutrophils, can suggest a bacterial infection, while few or no neutrophils can indicate a viral infection instead. And a nasal smear with many eosinophils, another type of white blood cell, can suggest an allergy.
Some doctors recommend CT scans of the nasal passages when they suspect sinusitis, but the allergy, asthma, and immunology group and the American College of Radiology now recommend against that, saying that scans are necessary only if you have frequent or chronic sinusitis or are considering sinus surgery.
Figuring out that allergies are the cause of your misery is an important step toward getting relief. But your work isn't done yet. You still have to choose the right treatment.
That's important, since allergic reactions in the nose may make the whole airway sensitive to future allergen exposure and vulnerable to infections and possibly asthma.
Here are some proven steps for controlling respiratory allergies:
People with sinusitis due to the common cold or other causes are often prescribed antibiotics. In fact, sinusitis accounts for 15 to 21 percent of all antibiotic prescriptions written for adults in outpatient care.
But most of them probably don't need the drugs. Here's why:
Self-help measures and, if needed, over-the-counter drugs can help ease symptoms until sinusitis clears up, typically within a week or so. They include:
For a stuffy nose, drops or sprays containing oxymetazoline (Afrin, Neosynephrine Nighttime, and generic) work faster and cause fewer side effects than oral decongestants. But they can cause rebound congestion if used for longer than three days. If the stuffiness hasn't eased by then, ask your pharmacist for pseudoephedrine pills (Sudafed and generic), which are nonprescription but kept "behind the counter" to prevent their use in making illegal drugs. Check with your doctor before taking any oral decongestant if you suffer from anxiety or have diabetes, heart disease, hypertension, or hyperthyroidism.
In general, don't bother with antihistamines. Older ones such as chlorpheniramine and diphenhydramine might help a little but can cause drowsiness, dry eyes and mouth, and urinary retention, and can worsen narrow-angle glaucoma. Newer antihistamines, such as loratadine (Alavert, Claritin, and generic), work well for allergies but usually don't help sinus symptoms.
Classic symptoms are congestion, sneezing, itchy and watery eyes, clear nasal discharge, and a scratchy or ticklish throat. They typically start or worsen with the onset of spring or fall, triggered by.exposure to specific allergens, such as mold or pollen from grass or ragweed. Pollen counts in many parts of the U.S. are expected to be extra high this year due to an unusually warm winter.
Other possible symptoms:
• Cough, headache, fatigue.
• Dark circles under the eyes, sometimes called an "allergic shiner."
Sinusitis can occur anytime, but cases are more likely during cold and flu season. Classic symptoms are congestion plus nasal discharge that has turned yellow, green, or gray, and pain or tenderness in the cheeks, upper jaw, or under or above the eyes. It often worsens when you bend over or turn your head from side to side.
Other possible symptoms:
• Fever (often greater than 101.5˚ F).
• Fatigue or muscle aches linked to the underlying infection.
This article first appeared in the Consumer Reports on Health newsletter.
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