Allergies or a Sinus Infection?

 

Many of you have been having the sniffles over the past few weeks as Spring has made it’s presence known. Specifically, there are currently high concentrations of tree pollens in the air, including: a high amount of Cottonwood and Aspen tree pollen, a moderate amount of Cedar and Juniper tree pollen, and a low amount of Elm tree pollen.

Upper respiratory allergies can manifest in various ways and sometimes a viral or bacterial infection could be complicating matters as well. Let’s go over some of the main allergy symptoms and then also review some of the symptoms that could suggest more of an infection that would benefit from an antibiotic.

Allergic Conjunctivitis: dry or watery eyes; red, itchy, and/or burning sensation in the eyes.

Allergic Rhinitis: runny or stuffy nose, nasal and sinus pressure, sneezing, frontal headache.

Post-Nasal Drip: dry cough, worse at night or in the morning, intermittent or chronic sore throat, fullness or pressure in the ears, phlegm stuck in the back of your throat.

Asthma/Airway Hyperreactivity: cough, dry or whitish phlegm, chest congestion but “can’t bring anything up”, wheezing, chest constricted or tight.

With allergies, patients also frequently feel kind of tired or fatigued, “headachy”, and it can affect your sleep, etc.

The following symptoms make me think of an infection:

  1. The fatigue is more pronounced, no energy, you get tired really easy. Many patients will sense this change and know to come in because it “feels like more than just an allergy”.
  2. An increase in the quantity of phlegm production.
  3. A change in the color of the phlegm from white or clear to green or yellow; what we call purulent sputum. (Ok that’s a little gross).
  4. The presence of fever. Most sinus infections occur without fever, however, if there is a definite fever that would argue against this being simply an allergy.
  5. Significant pressure or pain over any of your sinus cavities (forehead, cheeks, or behind your nose/eyes). Symmetric or diffuse involvement of the sinuses is more likely allergy or a virus while one-sided symptoms are more likely bacterial requiring an antibiotic.
  6. Tooth pain.
  7. Loss of sense of smell or taste.
  8. Some patients will get a bad smell in their nose or taste in the mouth and know that their allergy turned into an infection.
  9. Any of the above symptoms for more than 10-14 days suggest more of a bacterial sinusitis.
  10. An initial common cold followed by improvement in symptoms and then a sudden worsening 1-2 weeks later.

Because sinus infections tend to wax and wane, patients will come in after having symptoms for a few weeks and sometimes a few months. It will feel like its getting better and then it gets worse again, etc.

For many, sinus infections can turn into “bronchitis” or “it always goes into my lungs”. This is what we call Reactive Airways Disease. It’s kind of a form of asthma except it eventually gets better. I will often prescribe an asthma-type inhaler to help with the chest symptoms and if it’s really bad it gets better with a steroid (cortisone).

Anyway, if you’re mainly having allergy symptoms most of you have your own strategies of how to get through the season including anti-histamines (ie- Claritin, Zyrtec, etc) and/or nasal steroids (ie- Flonase, Nasonex, etc).  A sinus irrigation system is also helpful and it may help prevent the progression towards a sinus infection. Options include: Ocean Nasal Spray, Neilmed, or a Neti Pot (yes I said Neti Pot).

Once things turn into a sinus infection, then we go with the following:

 

 

  1. Decongestants: pseudophed or afrin (max 3 days) if needed.
  2. Mucolytic agents (Mucinex).
  3. Sinus irrigation.
  4. Ibuprofen for pain/pressure.
  5. Anti-histamine in the allergic patient.
  6. Nasal steroid for more chronic symptoms or as monotherapy if symptoms are mild.
  7. Oral steroids if symptoms are severe or persistent.
  8. Antibiotics for 10-14 days usually.

Now don’t let those allergies keep you indoors; please get out and enjoy!

 

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