[Allergy & Asthma Corner]

Tasty Treat? Beware if you are allergic to shellfish.

Cicadas Hanging Out

Are you surviving the Cicadas? They are everywhere, around my house, yet many of my patients have only seen them on the news and in the newspaper.

Are you grossed out by all the talk and special  TV programming directed towards cicada recipes? I know I've seen enough.

Did you know that there may be a risk of having an allergic reaction to cicadas if you eat them, particularly if you are allergic to shellfish? I recently read about this issue and googled it. I have a site which describes a case report posted below.

Bottom line: The cicadas are here. They are not everywhere though. Avoid eating them if you are allergic to shellfish.

Case Report on a person who had an allergic reaction after eating 30 cicadas:  www.aafp.org/afp/20050601/letters.html

My posting on "Asthma and Tobacco Smoke" is almost ready (Stay Tuned!).

Enclosure

Effective but may be habit forming

Rhinitis Medicamentosa (RM) is a disease brought on by extended use of topical nasal decongestants. “Rhinitis” means nasal (rhino= nose) inflammation (“-itis” = inflammation). Medicamentosa means medication; hence nasal inflammation from medication.

There are several brands of nasal sprays for stuffy nose available over-the counter (OTC). These are most often chosen to relieve symptoms associated with common cold, allergies or sinus infection. Recommendations (package insert) usually include avoiding use beyond 5-7 days. When used for more than 5 days the nose becomes progressively less responsive to each dose. The duration of the decongestant effect becomes shorter as more doses are taken. The result is that you get hooked on the medicine and suffer from rebound congestion after laying off of it for a while. The rebound is a sudden feeling of rapidly worsening nasal congestion which leads to using more nasal spray.

It is not uncommon for people with RM to buy 2-3 nasal sprays at a time and overuse the sprays to the level of taking 12 to 20 doses a day (usually recommended between 2 and 4 times daily depending on the formulation). People with RM develop dependency because of the rebound effect. The inside of the nose often sustains damage because of the constant vasoconstriction (narrowing of small arterial blood vessels which decreases blood flow to the surrounding nasal tissue).

I see between 10 to 25 new patients a year with RM. Some reports have estimated about 1% of the population having this problem.

How do you know if you have RM?

If you have been using an OTC nasal spray for nasal congestion for more than a week (daily) and are unable or unwilling to go a day without taking a dose, you most likely have RM.

What can be done about it?

Most importantly, just realizing that you have a problem related to the medicine overuse, and the associated dependency may be helpful in curing the problem. Just stopping the nasal spray leads to resolution, but this is often difficult. Your doctor can assist you by prescribing a topical nasal steroid and oral decongestant (usually pseudophedrine or phenylephrine tablets). There are potential side effects associated with oral decongestants which should be considered, so a doctor’s guidance is important. Occasionally an oral steroid may be prescribed for a period of 5-10 days (tapering dose).

What if one continues to use the OTC nasal decongestants for months to years?

Severe damage to the inside of the nose may follow prolonged RM. Nasal irritation, bleeding and perforation of the septum (the midline wall) may occur. Scarring of the inner lining of the nose may lead to chronic dysfunction of the nose.

Remember, RM can be avoided by not over using OTC nasal spray decongestants. I rarely recommend them at all to my patients. I warn those that choose to use them to limit use to only 3 days, less than 3 times a year. I think children should be kept completely away from OTC nasal spray decongestant. Allergy sufferers should stick to prescribed antihistamines, oral decongestants and nasal steroids which are much more safe and effective in the long run.

Want more detailed information?

Try: www.answers.com/topic/rhinitis-medicamentosa

Next Topic: Tobacco Smoke and Asthma Control (a smoke free home and body is essential)

The nose has several functions which contribute to maintaining good health. Besides being a place to hang our eyeglasses, the nose conditions the air for our lungs, filters out particles and germs, allows us to detect odors and fumes through the sense of smell (as a warning system), represents the preferred route for getting air to the lung (the mouth is the alternate path), and may enhance (or decrease) one’s appeal. Does your nose make you more attractive?

The nose is capable of adding liters of water to air breathed into the nasal passages (when the air is dry). The nose is the first line of defense against germs suspended in the air. A number of events may disturb the normal function of the nose.

The common cold (viral nasal infection), allergic rhinitis (hayfever) and sinusitis (bacterial infection of the nose and sinuses)  most commonly disrupt nasal function. Many medications have become available for treatment of these disorders but a number of people have failed to adequately respond. Some rhinitis sufferers experience excessive drying of the nasal passages when on antihistamines (for example Benadryl, Allegra, Zyrtec and many others). Nasal steroid sprays are frequently prescribed for allergic nasal problems but have potential drawbacks which include nasal irritation and bleeding. Most people take prescribed antihistamines and nasal steroids without adverse effects but a small percentage have problematic side effects.

Imagine how your sinuses feel after a nice hot bath or shower.

Ever notice how your sinuses clear out after a swim in the pool or a lake?

Most over-the-counter (OTC) nasal saline sprays are formulated for moisturizing the inside of the nose. Even when properly used these sprays do not reach the deeper recesses of the internal nasal passages.

Nasal irrigation or rinsing has increasingly been recommended by Ear Nose and Throat specialists and Allergists, for patients with chronic nasal sinus problems, colds and sinusitis.

A number of nasal rinse systems are commercially available (no prescription needed). I have provided links to two popular systems: SinuCleanse which offers the Neti Pot and other alternative units, and NeilMed nasal rinse system.

The Neti Pot dates back thousands of years and has been taught by Yoga instructors in a comprehensive program addressing many different ailments (chronic nasal and sinus problems, visual problems, ear problems and lung problems, as well as stress relief and overall respiratory function). The nasal rinsing is quite thorough when done correctly. Over a cup of saline (salt water) runs through the nasal passages under the force of gravity. People that attempt to use the Neti Pot without good instruction may be frustrated by the lack of effectiveness. I recommend watching the video provided on the SinuCleanse site, and completely reviewing the written instructions if you choose to use it. I think nasal rinsing may be too difficult for young children but there are exceptions.

NeilMed has two different size bottles for nasal rinsing. Saline is used in a plastic bottle which you squeeze, in order to force a stream of water through the nasal passages. Proper technique is again, important for good results. Squeezing too hard may result in nasal irritation, headache and ear plugging. Be careful to keep your head flexed downward and try not to use suction (pull the bottle away from the nose to allow air back in, then reposition for squeezing).

With both NeilMed and Neti Pot systems, having the mouth open and continuing to breathe through the mouth is important. The head should be flexed downward, over a sink or basin and slightly tilted away from the hand-held unit. When done properly (with both systems) water streams in through one side of the nose and out the other.

Poor technique is not the only reason the nasal irrigation may not work. Deviated septum, extremely plugged nasal passages, a very sensitive gag reflex and unusually large Eustachian tube openings (opening in the back of the nose-throat area that leads to the middle ear compartment) may cause difficulty with nasal rinsing. Some people may struggle with this process no matter what. These systems are not for everyone but a lot of people get very good results.

I think it’s important to note that nasal rinsing is a potentially good way to enhance your upper respiratory health when struggling with recurrent colds, sinus infections, allergic rhinitis or asthma. The rinsing process is no substitute for prescribed allergy medications, allergy shots or antibiotics (when indicated).

Furthermore, fewer people experience irritation when attempting to irrigate the nose when they have carefully prepared the saline and warmed it a bit. Cold or hot water may irritate the lining of the nose. Wrong amounts of salt or iodized salt may also be less well tolerated. Non-iodized salt and a small amount of bicarbonate (baking soda) help to make a more soothing solution. Both systems come with readymade, preservative-free , salt packets which make it much easier to make the saline. The packets are simply dumped into a measured amount of distilled or boiled (and then cooled ) water, in the case of NeilMed. SinuCleanse recommended running warm water from the faucet then adding the packet.

For more information about SinuCleanse (Neti Pot) go to: www.sinucleanse.com

The NeilMed site is : www.unimedprod.com/

Interested in more historical facts about Neti Pot (Jala Neti- Sanskrit term for “water cleansing”)?

 Check out:   (you may have to copy and paste this link)   en.wikipedia.org/wiki/Jala_neti  

For my patients tuning in:

I think nasal rinsing may assist you in good nasal inflammatory control. I have probably instructed you to take your prescribed nasal spray medication after a bath or shower. If you do nasal rinses, you may take your nasal spray after clearing out the residual moisture (saline). The after shower routine would not be necessary (your choice).

Let me know that you saw this posting at your next appointment. I will spot you an extra sample of something (if available).

Next Stop: Rhinitis Medicamentosa (over-use of OTC (over-the-counter) nasal spray decongestants)