Novel Treatment for Non-Allergic Rhinits

Non-allergic rhinitis is an extremely frustrating sino-nasal disorder that is characterized by all the same symptoms of sinusitis and allergies, but NOT due to sinusitis or allergies. Rather, I consider non-allergic rhinitis to be the over-sensitive nose syndrome whereby breathing in air containing particulates (whether smoke, perfume, dust, pollen, etc) PHYSICALLY irritates the nose causing symptoms.

This is in contrast to allergies where the pollen causes an immunologic reaction causing symptoms or sinusitis which is due to an infection.

Non-allergic rhinitis is diagnosed by a negative allergy test (meaning symptoms are not due to allergies) and normal CT sinus scan (meaning symptoms are not due to a sinus infection).

Usually, treatment encompasses avoiding triggers (ie, perfume, smoke, dust, etc), applying a barrier nasal emollient (ie, ponaris), anti-histamine nasal spray (ie, astelin, astepro, patanase), and nasal hygiene using saline flushes which washes away the irritants causing symptoms.

Well, a new study published this month have shown another mode of treatment is quite helpful... ICX72, a proprietary homeopathic preparation of Capsicum annum and Eucalyptol, otherwise known as Sinus Buster!

When used twice daily over two weeks, symptoms were found to be significantly improved when compared to placebo. Furthermore, sinus buster alleviates symptoms attributable to non-allergic rhinitis within 52.6 seconds on average.

Past studies have shown improvement using Sinus Buster, but this is the first controlled study demonstrating efficacy.

Of note, unlike nasal decongestant sprays like Afrin which can result in addiction over time (rhinitis medicamentosa), there does not appear to be any addictive component with this nasal spray.

Read the study abstract here.

Read more about this condition here.



Reference:
A randomized, double-blind, parallel trial comparing capsaicin nasal spray with placebo in subjects with a significant component of nonallergic rhinitis. Annals of Allergy, Asthma & Immunology. Volume 107, Issue 2, Pages 171-178 (August 2011)

Intranasal Capsicum spray in idiopathic rhinitis: a randomized prospective application regimen trial. Acta Otolaryngol. 2009 Apr;129(4):367-71.

Intranasal capsaicin reduces nasal hyperreactivity in idiopathic rhinitis: a double-blind randomized application regimen study. Allergy. 2003 Aug;58(8):754-61.

The long-term effects of capsaicin aqueous spray on the nasal mucosa. Clin Exp Allergy. 1998 Nov;28(11):1351-8.

Beneficial effects of intranasal applications of capsaicin in patients with vasomotor rhinitis. Eur Arch Otorhinolaryngol. 1991;248(4):191-4.

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Saline Nasal Flush - Mayo Clinic Video

Ever since our office produced one of the first videos on saline nasal flushes back in December 5, 2007, there have a been a number of additional videos created by medical offices and companies ever since.

The most recent is Mayo Clinic which you can watch here.



Here's our video we made back in 2007.

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Allergies Associated with Heart Disease!

First weight gain and now heart disease. Allergies is certainly getting bad rap (though it has been associated with decreased risk of cancer).

Researchers in Philadelphia have found an association between allergies and heart disease when analyzing data from more than 8,600 adults aged 20 or older who participated in the National Health and Nutrition Examination Survey conducted between 1988 and 1994.

After adjusting for other related factors, such as age and asthma, there was a 2.6-fold increased risk of heart disease with wheezing and a 40 percent increased risk with rhinoconjunctivitis, compared to no allergies.

Researchers suggested that the intermittent inflammation that comes with allergies may lead to the thickening of artery walls with subsequent development of heart disease. It could also be that some people simply carry genes that are linked to the development of both allergies and heart disease.

Clearly more research is needed to clarify this relationship.

Reference:
Relation Between Common Allergic Symptoms and Coronary Heart Disease Among NHANES III Participants Am J Cardiology Received 19 March 2010; accepted 20 May 2010. published online 13 August 2010.

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Antihistamines Associated With Weight Gain!

Yale researchers have found an association between obesity and antihistamine use based on data from the 2005–2006 National Health and Nutrition Examination Survey (NHANES). In the study, adults taking prescription H1 antihistamines were matched by age and gender with controls and compared on the basis of body measurements, plasma glucose, insulin concentrations, and lipid levels.

What does tbis mean? It means that there is an association and not necessarily a cause-and-effect between weight gain and antihistamine use. In order to truly determine whether antihistamines actually CAUSES weight gain, prospective studies need to be obtained.

It may be that antihistamines does not cause obesity, but that obesity may lead to increased risk of allergies which makes people take more antihistamines.

OR... perhaps there is a 3rd unknown factor that causes both problems?

It's not clear right now and more studies are required to clarify this finding...

Reference:
Association of Prescription H1 Antihistamine Use With Obesity: Results From the National Health and Nutrition Examination Survey Obesity (2010) doi:10.1038/oby.2010.176

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Got Allergies? Maybe It's Actually Non-Allergic Rhinitis

USA Today published a story on Aug 22, 2010 describing a condition called "Non-Allergic Rhinitis" or "Vasomotor Rhinitis" which essentially is having pretty much all the symptoms of classic nasal allergies, but caused NOT by allergies!

Such symptoms include:

- Runny nose
- Nasal congestion
- Post-nasal drainage
- Nasal obstruction
- Sinus pressure
- Sneezing
etc

These individuals also report that their nasal symptoms are triggered not only by pollen and dust, but also perfumes, strong odors, cigarette smoke, chemicals, cold air, high wind, humidity, and certain foods, especially spicy ones.

The way I try to explain this condition from those suffering from it is to consider their nasal lining to be hypersensitive... so hypersensitive that things which ordinarily shouldn't cause any problems, do.

The best way to address this condition is by avoiding known triggers and keeping the nose clean by regular saline washes. The saline washes are quite important in that they clean out the substances which are irritating the nose (much like washing your skin reduces the irritation if you get poison ivy).

Some patients may benefit from medications like anti-histamine and steroid nasal sprays, but such medications do not work as well as for those suffering from classic nasal allergies.

Barrier type of medications like ponaris may also be helpful. Such medications work by creating an oily barrier such that the irritating substances don't actually touch the lining itself when breathed in (much like chapstick on lips).

Some patients with non-allergic rhinitis and large turbinates may benefit from a surgical procedure called turbinate reduction, but rarely cure the problem. At best, there is perhaps a 50% reduction in symptoms.

One should also be aware that you can have BOTH allergic and non-allergic rhinitis.

Read the USA Today article here.

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USNews: Cold versus Allergies... How to Tell The Difference

US News and World Report came out with a story on July 27, 2010 regarding how one can tell the difference between an allergy versus a cold, especially since each has symptoms in common.

Especially with mild symptoms, it may be hard even for an ENT to distinguish the two. Add chronic sinus infections and flu to the mix, it can be downright difficult without allergy testing, CT scans, and other types of testing to come up with a correct diagnosis.

To help distinguish among these possible illnesses, at least based on history, here is a chart our office has made.

NIH also has produced a chart that can be seen here.

Click here to read the US News & World Report story.

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Kids Who Eat Fish and/or Live On a Farm At Less Risk of Allergies Later in Life!

Researchers in Germany who have followed thousands of families with children have discovered that children who eat fish before the age of 9 months had less allergies 4.5 years later than children who did not eat fish at the same age.

Furthermore, they found that school-age kids living on/near a farm were two-thirds less likely to suffer from hay fever or asthma than children with no exposure to a farm.

These studies will be published soon. Read the media report here.

Our office provides allergy testing and allergy shots / allergy drops.

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Dr. Chang Featured in TV Medical News Program on CBS 6/5/10

On May 21, 2010, a video crew came to our office to film a segment on Dr. Chang and what he does (or rather a very small part of what he does) as an otolaryngology-head and neck surgeon.

Dr. Chang along with 9 other practices were featured in a medical news television show "American Health Front" that aired on June 5, 2010 at 7PM on Channel 9 (WUSA-TV CBS).

The main focus of what Dr. Chang talked about are the different causes of nasal obstruction and their treatment including:

Allergies
Septal Deviation
Turbinate Hypertrophy
Adenoid Hypertrophy
Nasal Polyps

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Dr. Chang to be Featured in TV Medical News Program on CBS

On May 21, 2010, a video crew came to our office to film a segment on Dr. Chang and what he does (or rather a very small part of what he does) as an otolaryngology-head and neck surgeon.

Dr. Chang along with 9 other practices will be featured in a medical news television show "American Health Front" that will air on June 5, 2010 at 7PM on Channel 9 (WUSA-TV CBS).

The main focus of what Dr. Chang talked about are the different causes of nasal obstruction and their treatment including:

Allergies
Septal Deviation
Turbinate Hypertrophy
Adenoid Hypertrophy
Nasal Polyps

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Mouth Breathing Can Cause Major Health Problems

Everyone knows somebody who mouth-breathes due to nasal obstruction... What many may not realize is that chronic mouth-breathing can lead to health problems whether in an adult or child.

Especially in children, over time, whose mouth breathing goes untreated may suffer from abnormal facial and dental development, such as long, narrow faces and mouths, gummy smiles, gingivitis and crooked teeth. The poor sleeping habits that result from mouth breathing can adversely affect growth and academic performance. Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity. In addition, mouth breathing can cause poor oxygen concentration in the bloodstream, which can cause high blood pressure, heart problems, sleep apnea and other medical issues.

These issues were brought up in a recent article in the Jan/Feb 2010 issue of General Dentistry.

What can cause nasal obstruction leading to mouth-breathing?

Allergies
Turbinate Hypertrophy
Adenoid Hypertrophy
Nasal Polyps
Deviated Septum

Read more about nasal obstruction here.

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You May Have a Condition Called Local Allergic Rhinitis Even If Allergy Testing Negative!!!

Image from Wikipedia

A recent study was published describing a condition called "Local Allergic Rhinitis." This condition is when a patient appears to have sino-nasal allergies, but yet, have negative allergy test results whether on skin prick or RAST.

Up to 40% of patients with negative allergy test results may have this condition.

In order to diagnose this condition, it requires the detection of local antigen specific IgE in nasal secretions during natural exposure to aero-allergens as well as positive nasal allergen provocation test with local production of tryptase, eosinophil cationic protein and antigen specific IgE.

Read the study here.

Please note, our office is not able to perform these testing. We recommend getting evaluated at University of Virginia Allergy Department if you suspect you have Local Allergic Rhinitis.

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Nasal Irrigation Beneficial for Pregnant Women With Allergies

Italian researchers have reported in the International Archives of Allergy and Immunology in Sept 2009 that saline nasal rinsing is a safe and effective treatment option for nasal problems in pregnant women with seasonal allergic rhinitis. In their paper titled "Nasal Lavage in Pregnant Women with Seasonal Allergic Rhinitis: A Randomized Study," the researchers instructed the study group to perform hypertonic saline lavages to the nose 3X per day. Of note, HYPERTONIC saline solution was used instead of the more usual isotonic saline solution.

A statistically significant improvement in rhinitis symptoms (rhinorrea, obstruction, nasal itching and sneezing) was found during the observed weeks 2-6. Furthermore, the mean number of daily antihistamines use per patient per week was significantly reduced at weeks 2, 3 and 6. No adverse effect was reported in the active group.

Read the abstract here.

In our office, we recommend the Neilmed Sinus Rinse bottle as the cheapest and most effective way to perform nasal irrigations. Of note, the Neilmed sinus rinse bottle also comes with hypertonic saline version (along with the more common isotonic version). For convenience, irrigation devices (shown below) are also sold, but much more expensive.

Click here to watch a video of how to perform nasal rinses.

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Saline Nasal Sinus Irrigation Systems

I must admit... our office is a big fan of the Neilmed Sinus Rinse bottle for patients who suffer from chronic sinusitis and severe allergies as it is cheap, easy to clean, and it works. However, many patients who are already fans of flushing the nose with saline water end up purchasing saline irrigation systems. There's a bunch of these devices sold on Amazon.com. Check them out below, but I would suggest that you first become adept and able to tolerate saline flushes using the Neilmed sinus rinse bottle first prior to paying almost $100 for these devices.

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