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Beyond nasal congestion

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You’ve probably seen “The Odd Couple” reruns in which Felix Unger whines about his sinus condition — he, like most people, equates the stuffed up feeling of nasal congestion with the disorder known as sinusitis. In fact, sinusitis is a much more complex disorder, experts say, and one that often strikes during spring allergy season.

While most people know that spring is prime time for allergies, few realize that hay fever makes conditions ripe for sinusitis, the fancy term for swelling of the hollow cavities within the fine bones around the eyes and behind the nose.

“Sinus disease typically begins when the small openings to the nose get clogged up for any number of reasons and inflammation develops,” says Dr. Larry Borish, an allergist at the University of Virginia in Charlottesville.

The result for some 37 million Americans: coughing, sneezing and congestion coupled with headache, fatigue, muscle pain and a feeling that your head is so full it is going to burst. Some suffer acute disease, which can be thought of as a sinus attack lasting a few days to weeks, while others develop chronic sinusitis, which persists for months or years.

The allergic connection

The common cold is the most common cause of acute sinusitis, according to the National Institute of Allergy and Infectious Diseases. But hay fever is at the root of many sinus attacks, experts say.

As plants and trees begin to bloom, they release tiny particles known as pollen into the air that can set off allergies. And allergies, in turn, can trigger swelling of the sinuses and nasal mucous linings, Borish explains.

This inflammation causes the sinus openings to close up, preventing the sinus cavities from doing their job of clearing out the bacteria that most healthy people harbor in their upper respiratory tracts. Microbes that may have been living harmlessly in your nose or throat flourish, multiply and attack your sinuses, causing an acute sinus infection.

If you suffer from spring allergies, taking medication to control your symptoms may help prevent you from ever getting sinusitis in the first place. But once you do develop the sinus condition, other measures are necessary or you’ll develop chronic disease, says Dr. Howard Druce, an allergist at New Jersey Medical School in Newark.

Antibiotics to kill off the flourishing bacteria can help some people, but they are also overused, Borish says. “It might work, but numerous recent studies show that antibiotics have very little to contribute,” he says.

“You need to let the sinus cavities drain or it won’t go away.”

Decongestants such as Sudafed have been shown to open up the tubes, thereby facilitating drainage, Druce says. And new research suggests that intranasal steroid sprays decrease inflammation at the site where the sinuses drain into the nose, though that work is still preliminary.

But how do you know if you even have sinusitis when so many of the symptoms mimic those of hay fever or a cold? Think of it as a cold that won’t go away, Druce advises. If symptoms last more than a week or aren’t relieved by cold and allergy medications, see your doctor for a thorough exam and sinus X-rays.

New understanding of sinusitis

Druce and Borish addressed misconceptions about sinusitis at a recent meeting of the American Academy of Allergy, Asthma and Immunology in New York.

According to Borish, research shows that chronic sinusitis is not just a complication of acute disease, but can actually develop by a whole different mechanism — one that leads him to dub the condition asthma of the upper airways.

In an experiment in which researchers put pollen grains in the nostrils of volunteers, the same cascade of events that occurs in allergic asthma was observed, he explains.

First, antibodies in the immune system whose purpose is to capture unwanted invaders — in this case, pollen — are produced. These antibodies, dubbed IgE, journey through the bloodstream and lock onto the surface of so-called mast cells, plentiful in the nose, eyes, lungs and gastrointestinal tract.

Then they lie silently in wait — until the allergen strikes again. The IgE antibodies, now poised, jump on and gobble up the allergens, triggering the release of inflammatory chemicals such as histamine and prostaglandin.

In asthma, the airways become inflamed, boggy and red — very much like the skin of an eczema patient. This, in turn, causes the airways to narrow, or bronchospasm. The victim begins to wheeze, cough, even lose his breath.

But in sinusitis, it is, of course, the sinuses that are victimized. The result: the plugged-up nose, facial swelling, nasal drip and aches of chronic sinusitis.

“Virtually everyone with asthma has sinusitis,” Borish says. “And it makes sense since the cells and tissues of the sinuses are identical to those of the lung. A disease that attacks lung tissue wouldn’t be able to distinguish sinus tissue.”

Treating chronic disease

If you think you suffer from chronic sinusitis, you should see a specialist who can get at the root of the problem, Druce says. “Is it allergic or non-allergic? Is there inflammation or not? Is there a structural component — i.e., does the plumbing need fixing?”

Then, based on the findings, the doctor may prescribe any of a number of medications, including simple decongestants. For allergic sinusitis, antibiotics will rarely do the trick, though allergy shots or steroid nasal sprays to reduce inflammation may help.

“There’s no cure for allergic sinusitis, but we certainly can modify the course of the disease,” Druce says. “And a new understanding of the inflammatory cascade means better medications in the pipeline.”