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`The Differences Between Allergic Rhinitis and Sinusitis
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`The Differences Between Allergic Rhinitis and Sinusitis
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`Dec 2, 2015
`When you start sneezing and your nose starts running, is it allergies or a sinus infection? It can be difficult to
`distinguish the two , especially during the colder months. Dr. Tom Miller talks to otolaryngologist, Dr. Jeremiah
`Alt, about the differences between allergic rhinitis versus the common cold. Though the symptoms for both may
`overlap, it might surprise you that the treatments are not the same.
`
`Transcript
`
`Dr. Miller: Allergies, colds or something else? How do you tell and how do you treat them? That's next on
`Scope Radio.
`
`Announcer: Access to our experts with in-depth information about the biggest health issues facing you today.
`The Specialists with Dr. Tom Miller is on The Scope.
`
`Dr. Miller: Hi. I'm here with Dr. Jeremiah Alt. He is an ENT surgeon. That's an ear, nose and throat surgeon.
`He's a member of the Department of Surgery here at the University of Utah. Jeremiah, how does one tell the
`difference between an allergic symptoms of nasal discharge versus a common cold or sinusitis? Is there a way
`to sort of know if you have one or the other?
`
`Dr. Alt: Yeah. That's very difficult. Even very difficult for the physician to figure that out in many cases and
`requires a thorough history with the patient to figure some of these things out. In general, allergic rhinitis if it's
`seasonal will occur during the season, where if you have hay fever, you'll get itchy eyes and a runny nose.
`
`Dr. Miller: I always think of hay fever as being itchy.
`
`Dr. Alt: Right.
`
`Dr. Miller: Right? So people are scratching the corners of their eyes and they're blowing and sneezing.
`
`Dr. Alt: Right.
`
`Dr. Miller: The back of the throat is kind of scratchy. Sometimes when I think of the common cold or sinusitis
`that doesn't feel very itchy. That's [inaudible 00:01: 15].
`
`Dr. Alt: Right. So the common cold will have some of the similar symptoms, as there's definitely overlap where
`you can have increased congestion and nasal blockage. You'd probably be more likely, though , to have some
`facial pain and pressure. We commonly talk about the loss of smell occurring with sinusitis. But this can also
`occur with allergies as the inner lining inside your nose is swollen and angry, and inflamed and it can block off
`some of the ability to smell.
`One of the big differences though, is we commonly think of discharge. So if the discharge is yellow or green,
`this is more signs that this is more severe than just an allergic reaction.
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`Dr. Miller: More inflammation, more at that issue of infection in the sinus.
`
`Dr. Alt: Correct.
`
`Dr. Miller: So one goes to the store to self-remedy what they would consider to be a fairly short course of this
`problem . If they have rhinitis, that is the itchy symptoms, what should they be using to treat that problem with? I
`think most of the medications now are purchased or can be purchased over the counter.
`
`Dr. Alt: Correct. The oral antihistamines are a great option, and they've been used for many years. The second
`generation are non-sedating, like the Benadryls were that can make people very tired . Although, the second
`generations can make some people tired.
`
`Dr. Miller: I've taken Benadryl and it works as an antihistamine. But man, does it knock me out. I think it does
`the same with some people and some people, they don't seem to have that fatigue that I get or that a number
`of people will get.
`
`Dr. Alt: Correct.
`
`Dr. Miller: Now, I've heard with Claritin, which is an example that comes generic as loratadine, that it's not
`sedating. But do you think it works as well as something like Benadryl or diphenhydramine?
`
`Dr. Alt: Well, partly it's also what we're targeting. The itchiness, I think, works great. Another great antihistamine
`is Zyrtec. So if the patient has the itchiness with the runny, drippy nose, what we call clear rhinorrhea, or clear,
`drippy nose, the Zyrtec is actually quite more drying than let's say the Claritin. So we would push the patient
`more towards the Zyrtec, which is a more drying medication.
`
`Dr. Miller: This is also listed as a non-sedating antihistamine.
`
`Dr. Alt: Correct. One thing to consider is even if the second generations make you drowsy or feel a little
`fatigued, you can also take them at night which is an option.
`
`Dr. Miller: So sleep a little better and maybe get a little bit better coverage for the allergic symptoms.
`
`Dr. Alt: Yeah. A third option that's more recent is a topical spray antihistamine. This is not taken by the mouth
`and you can spray it in the nose. This type of antihistamine, I've never seen it cause drowsiness or fatigue in
`patients, and you can use it on contact. So if you know you're going outside you can quick spray it in your nose
`to reduce the antihistamine response that you have for your allergies.
`
`Dr. Miller: So Jeremiah , does that require a prescription or is that available over the counter?
`
`Dr. Alt: That one is still a prescription medication. So you really need to get that from you allergist or your ENT,
`or your primary care doctor.
`
`Dr. Miller: Now, there's another class of medication used to treat allergic rhinitis as well, and that would be the
`nasal steroids.
`
`Dr. Alt: Yeah. So the nasal steroids actually have great evidence to be used both for allergic rhinitis and for
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`many of the diseases that we talked about in some of the other pod casts, including chronic rhinosinusitis or
`reoccurring acute rhinosinusitis, where there's just an overall inflammation inside the sinonasal cavity. This just
`calms the inside of the nose down. It's a topical steroid. It's sprayed within the nose, usually dosed once or
`twice a day. What I like to think of it, it addresses the root of the problem.
`
`Dr. Miller: The inflammation.
`
`Dr. Alt: The inflammation , correct. So it really reduces the overall amount of goblet cells in the nose, the
`inflammatory, or those mediators in the nose and the immune system that are really creating the immune
`system to start with to create this inflammation.
`
`Dr. Miller: Now, do you think that a patient with allergic rhinitis could also take the antihistamine orally,
`antihistamine nasal spray, and a topical steroid nasal spray, or should they use them separately? What's your
`thought on that?
`
`Dr. Alt: It really depends on the patient's response and the overall diagnosis that you've come up with your
`doctor and your treatment plan. However, commonly we like to use both and we feel like patients get a good
`response by both blocking with an antihistamine and using a topical nasal steroid like Flonase or Nasonex.
`
`Dr. Miller: Both of which they could get over the counter.
`
`Dr. Alt: Correct.
`
`Dr. Miller: It's possible that they could start their own treatment and then if things weren't going well they could
`end up seeing their physician.
`
`Dr. Alt: There is a new medication, Dymista, that has actually combined the two together. So you can get it in a
`single spray, which patients are noting that they've really enjoyed using just one medication instead of two
`separate.
`
`Dr. Miller: Now, let's say they have the common cold or sinusitis. Do the same medications work?
`
`Dr. Alt: Yes. In general, though, we don't typically use antihistamines for chronic sinusitis unless they have a
`comorbidity or that's one other disease process that they also have on top of the chronic sinusitis that we want
`to help control symptomology. So if they have allergies and we want to help control some of that drippy nose,
`postnasal drip symptoms, we can add on an antihistamine. But, yeah, the steroids are great, as we talked
`about. It's really disease of inflammation, so that topical nasal steroid is ideal for helping.
`
`Dr. Miller: Would you recommend using an oral, what we call, sympathomimetic, like pseudoephedrine or
`Sudafed for someone who has the common cold or sinusitis?
`
`Dr. Alt: Those are really two different diseases and two different applications for that. For an acute onset cold or
`viral rhinosinusitis or bacterial, this can help make the patient feel better. I don't think it really helps get you over
`the illness quicker. But it can help improve your overall well-being. Now, in sinusitis it can also improve your
`overall feel of increasing your ability to breathe through your nose.
`But this doesn't get at the root of the cause of the disease itself, and we commonly don't like to think of using
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`these long-term in a disease like chronic rhinosinusitis, which is a chronic condition. You'd have to use this over
`potentially months and years, which we're concerned about the possibility of hypertension.
`
`Dr. Miller: Now, you could also use the same medication as the nasal spray for a few days, I understand.
`
`Dr. Alt: Afrin or over-the-counter oxymetazoline is a great sympathomimetic, which really reduces the overall
`swelling inside the nose. We commonly like to really counsel the patient that these are great short-term . So
`these are two to three-day treatment options, and then they really need to consider trying to come off of them .
`
`Dr. Miller: So to wrap up, it sounds like if one has allergic rhinitis the bottom line there would be to use
`antihistamines orally and perhaps nasally, and also to use nasal steroids to reduce the inflammation. But when
`you have the common cold or sinusitis you could use an oral agent that is a medicine like pseudoephedrine or
`Sudafed. Or you could also use a similar compound as a nasal spray that would come as oxymetolazone [SP]
`or a similar compound. Then, you could also use the nasal steroids to reduce the inflammation for a short
`course.
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`Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be
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