Recurrent sinus infections

– Non-allergic rhinitis (vasomotor rhinitis)

Non-allergic rhinitis (NAR) is a condition whose mechanism is not as well defined as allergic rhinitis. It is believed to be due to a nerve reflex mechanism which results in changes in the nasal blood flow leading to chronic nasal congestion, post-nasal drainage, runny nose, and sneezing. NAR is triggered by chemical and physical factors such as fumes, tobacco smoke, chemical, and other strong odors, changes in temperature, barometric pressure or changes in body position or eating. Symptoms are usually year round but can improve or worsen depending on an individuals surrounding environment.

NAR, like allergic rhinitis, can lead to complications such as sinusitis and ear infections. Distinguishing between these nasal disorders is, therefore, very important in order to ensure that correct treatment is recommended. Whereas allergic rhinitis is treated with a combination of avoidance measures, medications, and allergy injections, NAR is primarily treated with medications.

Allergy injections are not indicated for the treatment of NAR. NAR can be severely troublesome for the patient but if treated properly is usually well controlled thereby allowing for an improved quality of life.

– Nasal polyps

Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They result from chronic inflammation and are associated with asthma, recurring infection, allergies, drug sensitivity or certain immune disorders. Small nasal polyps may not cause symptoms but larger growths or groups of nasal polyps can block your nasal passages or lead to breathing problems, a lost sense of smell and frequent infections. Nasal polyps can affect anyone, but they’re more common in adults. Medications can often shrink or eliminate nasal polyps, but surgery is sometimes needed to remove them. Even after successful treatment, nasal polyps often return therefore it is necessary to have close follow-up with an Allergist to monitor your condition.

– Aspirin Exacerbated Respiratory Disease (AERD): aspirin desensitization

AERD describes patients with asthma and chronic rhinosinusitis (CRS) with nasal polyposis, who experience acute upper and lower respiratory tract symptoms following the ingestion of aspirin or other NSAIDs. AERD affects 5-20% of all patients with asthma. Reactions to NSAIDs typically begin 30 minutes to three hours after ingestion and present as a sudden worsening of asthma and nasal congestion. Aspirin desensitization followed by daily aspirin therapy may be beneficial in carefully selected patients with AERD and one of the following disorders:

  1. Nasal polyposis that is worsening or recurring despite intranasal glucocorticoids and other appropriate therapies.
  2. Inflammatory conditions requiring daily NSAID therapy that cannot be treated with selective COX-2 inhibitors.
  3. Atherosclerotic heart/vascular disease requiring the antiplatelet effects of aspirin.
  4. Recurrent headaches or other conditions requiring intermittent use of NSAIDs.

Aspirin desensitization is performed in the office with close observation. Following desensitization, patients must ingest aspirin or an NSAID daily to maintain the desensitized state. The choice and dose of aspirin or NSAID for ongoing therapy depends on the indication for desensitization. As long as the desensitized state is maintained, the patients can tolerate different COX-1-inhibiting NSAIDs interchangeably.

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