Sinusitis – A Pain in the Head

Sinuses are part of the upper respiratory system. They are empty cavities within your cheek bones, around your eyes and behind your nose. The sinuses contain mucus, which helps to warm, moisten and filter air in your nasal cavity. When the mucus membranes that line the sinus cavities become inflamed, this is called sinusitis or a sinus infection. Sinusitis is often called rhinosinusitis because the symptoms of sinusitis and rhinitis are very similar. Rhinitis is a swelling of the mucous membranes of the nose while sinusitis includes swelling of the sinuses in addition to the nasal passages.

Sinusitis symptoms frequently develop after a cold or during times of severe or ongoing allergic rhinitis symptoms. A stuffy nose and cough lasting longer than 10-14 days or worsens after 7-10 days, may be more than a cold. Signs of sinusitis include: painful pressure in the cheeks and forehead, thick yellow-green nasal discharge, postnasal drip, cough, congestion or toothache.

Acute sinusitis is sinusitis lasting less than four weeks. People with allergic rhinitis or asthma are more likely to suffer from chronic sinusitis which can last three months or longer. Allergic rhinitis puts you at risk for developing sinusitis because allergies can cause swelling of the sinusitis and nasal linings. When the sinus cavities are unable to drain due to swelling, this increases your chances of developing a secondary bacterial sinusitis.

Sinusitis can be caused by a fungus, deviated nasal septum or nasal polyps, as well as allergy or infection. Many patients who have recurring or chronic sinusitis have more than one factor that puts them at risk of infection. So, it is essential to have an accurate diagnosis. In many cases allergies play a significant role and an allergist can help with managing your symptoms.

Pollen Allergy

Airborne pollen grains are a major trigger of many allergic symptoms. Pollen grains are reproductive structures of seed bearing plants. Most pollens of allergic importance are wind-borne and too small to be seen by the naked eye. If the pollen is easily seen, it is usually too large as well as too heavy to be an important allergen. Most plants with windborne pollen are drab with inconspicuous flowers. Generally, the heavy pollens of showy plants with colorful, fragrant flowers require insect transport.

The first pollens appearing in the spring in the Northeast are tree pollens. They begin to appear in mid-March and are present into June. Maple, poplar, and ash are the earliest pollens beginning in April. In late April, May, and early June, birch and oak pollens are present in the air. Each tree species produces pollen differently from other species, with a variation in the intensity, duration and seasonal pattern of pollination.

In the springtime, people often notice their cars are covered with yellow pollen. This large, waxy pollen released from pine trees is not particularly problematic for tree allergy patients. Likewise, the fuzzy seed balls seen in the air in May and June do not cause allergy problems.

Grass Pollens begin to appear in late May. This season tends to peak in June and then low levels of pollen are present throughout the summer months. In the northeastern states, the majority of grass pollen comes from blue grass, orchard grass, timothy grass, and red top.

Ragweed Pollen becomes airborne from mid-August through September, which is also hay baling season. “Hay Fever” is not associated with hay but with ragweed pollination in late summer and early fall.

Throughout the pollen season, even mild winds can carry pollen for many miles and produce high concentrations in urban areas, far from their rural and suburban sources.

What can be done about pollen allergy symptoms?

Using air conditioning can cut down on the amount of pollen inside the house and the car. Over-the counter antihistamines can be helpful. There are anti-inflammatory nasal sprays, antihistamine nasal sprays, decongestant products, and eye drops that can help alleviate symptoms. Allergy shots, drops and tablets (immunotherapy) can be very helpful in reducing sensitivity to pollen.

Best Practices for Pollen Sensitivities

• During the pollen season keep all windows in your home and car closed. This is particularly useful during the night hours to prevent pollens and molds from drifting into your home. Instead, use air conditioning, which cools, cleans and dries the air. Avoid the use of fans, which will increase the amount of airborne pollen and result in increased symptoms.

• HEPA air cleaners may be helpful when air conditioning is unavailable.

• Stay indoors on high pollen days and especially on windy days. Avoid early morning activity when pollens are usually emitted (between 5am – 10am).

• When vacationing during the height of the pollen season, choose places such as the beach or seacoast, which contain less pollen.

• Remember that pollen is sticky and will adhere to your clothes and body until washed off. Showering after long exposure and rinsing your hair before going to bed to remove pollens that have accumulated during outdoor exposure is helpful. When working outdoors, wear a mask when raking leaves or mowing the lawn.

• Take the medications prescribed by your allergist regularly, in the recommended doses. Don’t take more medication than is recommended to relieve your symptoms.

• Don’t hang your clothing outside to dry. Pollens and molds will collect on them.

Penicillin Allergy – Real or Not?

According to the CDC, up to 10% of people report a penicillin allergy. Recent studies have shown that most people who were labelled “allergic” are actually able to tolerate penicillin safely because they never were truly allergic or they lost sensitivity over time. Many never had a true allergic reaction, but a rash or hives that developed after taking penicillin was thought to be caused by the medication.

Penicillin Allergy Symptoms

Penicillin allergy is serious and can be life threatening. Symptoms include rashes, inflammation, wheezing, coughing and shortness of breath. Many patients have been labelled “allergic” based on childhood symptoms which does not necessarily mean they will have a reaction as an adult. Studies have shown that 80% of adults with reactions 10 or more years ago no longer have sensitivity to penicillin.

Penicillin Allergy Treatment

Avoiding penicillin without an allergy diagnosis is not the best idea. Broad spectrum antibiotics may be less effective in treating infections and may cause antibiotic-resistant superbugs. This can result in unnecessary hospital stays and be more expensive.

Testing for penicillin allergy is safe and reliable but should only be conducted by an allergist who can recognize and treat a potential allergic reaction. Fewer than 1% of the population is truly allergic to penicillin. Don’t wait until you are in a medical crisis. Talk to an allergist if you think you are penicillin allergic.

Mold Allergy

Studies indicate that mold allergy is an important cause of allergic symptoms. Molds are a form of living plant life, which are widely distributed.
Hundreds of varieties exist and some of these are common causes of allergic reactions. In temperate climates, molds are the most abundant natural particles in outdoor air. Relative humidity over 40% enhance mold growth. “Showers” of mold particles may occur on warm, windy, rain-free days. High mold concentrations in air can also occur during and after rainfall. In general, molds cannot be completely avoided, but reductions in exposure can be made.

Mold Allergy Symptoms

• Sneezing

• Runny Nose

• Nasal Congestion

• Cough and Post Nasal Drip

• Itchy Mouth, Nose and Throat

• Itchy, Watery Eyes

• Wheezing, Shortness of Breath or Chest Tightness

Mold Allergy Treatment

• Avoid excess exposure to dust from farms, overgrown fields and pastures.

• Use a dust mask when cutting grass, clearing brush, spreading mulch or raking leaves.

• Avoid excessive houseplants and keep them out of the bedroom.

• Do not store firewood indoors.

• Use dehumidifiers in damp basements and crawl spaces. Check drainage in basements and lower levels of homes on cement slabs to make sure surfaces are kept as dry as possible.

• Shower stalls, bathrooms and windowsills may require special attention using fungicides.

• Avoid using appliances that contain stagnant fluids, including cool mist vaporizers unless they are cleaned daily. If using a humidifier during winter months, keep humidity less than 40%, change water frequently and clean the reservoir daily.

• Fungicides can be used by direct application.

• Direct application Lysol (phenolated disinfectant) can be used as a spray or solution for application on surfaces where mold can grow.

• Clorox (sodium hypochlorite 5.25%) diluted 1 to 10 in water may be used as a surface disinfectant.
• Zephiran concentrate (benzalkonium chloride 12.5%) diluted 1 to 10 in water may also be used for surface application or as a spray for mold control.

• Allergy injections or drops (immunotherapy) can benefit patients with mold allergies.

Hives and Angioedema

Hives and Angioedema

Hives can be a very distressing form of allergic reaction. A hive is an area of swollen skin (wheal) surrounded by red skin (flare). They often are itchy. A single hive can last just a few minutes or for days. Hives can occur as a single episode or recur for years.

The same kind of reaction can occur deeper in the skin causing swelling. This is angioedema. Angioedema of the face and hands is usually more dramatic than other parts of the body because a little swelling here is easily noticed.

With hives and angioedema, very active materials (mediators) are released by cells of the immune system and cause certain blood vessels to leak fluid. This fluid leaking into the tissue causes swelling. Reflexes from nerves cause surface blood vessels to enlarge and carry more blood, making the characteristic redness. These “mediators” also stimulate nerve endings, causing itching or burning.

What Causes Hives?

There can be many causes of hives. Common causes include foods, insect stings, antibiotics, animal contact, pressure, cold and viral infections. In rare cases, endocrine problems, water, heat, cosmetics, light, bacterial infections and tumors can be the cause. Emotional factors and anxiety can make hives worse. It is important to note any new medications, exposures or medical conditions that may have occurred when the hives started. Your doctor can help, but you are the best detective. The longer hives are persistent, the less likely it is that you’ll be able to remember the possible cause.

Rarely, swelling can occur in the throat, blocking breathing. A drop in blood pressure can result from a severe allergic reaction. Use of adrenaline may be necessary in this situation. An Epi Pen should be used in such a severe condition before or while heading to the nearest emergency facility. Those who suffer hives with cold exposure should avoid swimming in cold water and should never swim alone.

Treatment for Hives

Fortunately, the treatment of hives has improved over the past few years. Antihistamines have usually been the most effective medications for this problem. In severe cases, injectable medications may be used in treatment.

Treatment for hives begins with identifying the cause of the allergic reaction, so pay attention to how and when hives develop.

Exercise Induced Asthma

Do you cough, have shortness of breath, chest tightness, or wheeze during or after exercise? Does exercising in cold air make your symptoms worse? If so, you could have exercise induced asthma. Asthma as a chronic condition is seen in about 16% of the population in the United States. Exercise induced asthma may even be a more common condition.

Exercise Induced Asthma Symptoms

Many people with asthma will often suffer increased chest congestion with exercise. Usually, this is worse in cold dry weather. Some individuals will have symptoms of asthma only with exercise. Usually, wheezing, chest tightness or coughing worsens one to ten minutes after exercising. Some people will note a “late phase” worsening of symptoms several hours after exercise.

Exercise Induced Asthma Treatment

How do you avoid having wheezing with exercise? Stopping exercise altogether is usually not an acceptable answer. First, keeping general asthma symptoms under good control is essential. Use of inhaled steroids or use of other prescribed medications may be needed. If asthma is not well controlled when a patient isn’t exercising, exercise induced asthma will persist. If you need to use a “rescue” medication more than twice a week for asthma symptoms other than those caused by exercise, additional preventative treatment is needed. Wearing a mask or scarf in cold air to help warm and moisten the air can help many individuals. Warm up exercises performed for 30 minutes before vigorous exercise have been found to diminish the severity of exercise induced symptoms. Other recommendations include pre-treatment with medication before exercise, avoiding heavy exercise when air pollution is high, and if you have pollen allergies when the pollen counts are high. A “common cold” can make asthma markedly worse, so exercise should be limited with a cold.

Although exercise induced asthma is a common condition it can usually be controlled with medications and simple precautions.

Dust Mite Allergy

Dust mites live by the thousands in your bedding, carpet and mattress. They feed on flaked off human skin in bedding, carpet and stuffed toys and furniture. Their droppings are the size of a pollen grain. For those who are not allergic, these microscopic relatives of spiders cause no harm. For the allergy sufferer, they are frequently the main cause of “dust” allergy. Each mite may leave as many as 20 pollen size droppings each day. Each female may lay as many as 50 eggs. New generations are produced every 3 weeks. Their droppings are often a cause of allergy misery, even months after they have died. The inhalation of waste products and fragmented mite body parts cause allergy symptoms. Dust mites multiply and thrive in warm humid weather. Their numbers dwindle with the onset of the cooler weather and lower humidity, but the legacy of their products remains. Usually, during the warmer weather, windows are open and fresh air circulates through the house and dilutes the mite allergens. With cooler weather, windows are closed, and the heat comes on, re-circulating air in the house. This is when mite sufferers usually notice worsening of their symptoms.

Dust Mite Symptoms


Runny Nose

Itchy, Red or Watery Eyes

Nasal Congestion

Itchy Nose, Roof of Mouth or Throat

Postnasal Drip


Facial Pressure and Pain

Dust Mites Allergy Treatment

For a dust mite sensitive patient, their surroundings should be as free from dust of all kinds as much as possible. Most people cannot control exposure to dust during their working or daylight hours, but dust can, to a large extent, be minimized in the bedroom. In the course of 24 hours people spend most of their time in the bedroom. While the directions below may seem a little challenging at first, forming simple habits around cleaning and avoidance can make a big difference. For many, the results will be well worth the effort.

In the Bedroom

Encase your mattress, box spring, and pillows in zippered allergen impermeable encasings. This will prevent inhalation of dust mite by-products.

Wash all linens on a weekly basis.

Remove the bedroom carpet, if possible. Millions of mites live in the carpet and become airborne. Replace the carpet with a wipeable surface, (i.e. hardwood, vinyl or tile).

Remove all dust mite-gathering items from the bedroom, (i.e. stuffed toys, stuffed furniture, throw pillows).

Use readily cleanable window treatments that may be washed frequently.

Throughout the Home

If hot air heating is used, adequate filters which are changed regularly as well as an electronic air filter may be helpful to minimize dust throughout the house. Check with your furnace company for further details.

Keep the relative humidity less than 40% in your home to help prevent replication of dust mites. Use air conditioning in the summer.

Use a quality vacuum cleaner with high quality filtration bags (HEPA filter preferred).

Care must be taken to keep down dust throughout the entire house. Go over floors and furniture with a vacuum cleaner at frequent intervals. Use a damp or oiled cloth to avoid raising dust.

Be careful not to handle objects covered with dust, such as books, boxes or clothing that have been stored over a long period of time. Avoid attics, basements and closets and, if exposure is unavoidable, wear a dust mask.

Cat Allergy

Allergy to cats is extremely common, occurring in up to 25% of people with allergies.

Studies have shown that the material that is responsible for causing the allergic reaction (allergen) is concentrated in cat dander and saliva. All cats produce allergens; it is identical in different breeds of cats.

Cat allergen particle size allows it to remain airborne for several hours. Cat allergy symptoms result when dander is inhaled into the nose or lungs of sensitive individuals. Cat allergen is extremely difficult to remove from an area once present. Studies have demonstrated the presence of cat dander in public places and cat-free private homes, so cat allergen is everywhere. It’s easily transported on clothing. Indirect contact with cat allergen in schools and workplaces can cause significant symptoms.

Symptoms of cat allergy range from mild to severe and depend on sensitivity and level of exposure to cat allergen. Symptoms may include the following:

  • Sneezing
  • Runny, Stuffy Nose
  • Cough, Chest Congestion, Shortness of Breath, Wheezing
  • Watery, Red or Itchy Eyes
  • Rash or Hives

Cat Allergy Treatment

  • Avoidance is best; cat sensitive individuals with severe allergies or asthma should remove cats from their homes.
  • After a cat has been removed from a home, it takes 6 months or longer for cat allergen to dissipate. A trial of cat avoidance for its effect on symptom relief must be a minimum of 6 months in length or one may get the false impression that they are not allergic to cats. Cat allergen has been found to accumulate in carpeting and mattresses where it has been detected as long as 5 years after a cat has been removed from a home!
  • Limit cats to a single area of the home and keep strictly out of the bedroom.
  • Remove carpeting, rugs and upholstered furniture which can trap pet dander, especially in the bedroom.
  • Allergy encasings should be used on the pillows, box spring and mattress.
  • Wash bedding weekly.
  • Wash hands and change clothing after contact with a cat.
  • Use of a high efficiency vacuum cleaner with HEPA filter can decrease allergen levels.
  • A room HEPA filter that runs continuously can decrease airborne cat allergen concentration by 50% (in rooms without carpeting and cat not allowed in that room).
  • Bathing the cat at least weekly can decrease airborne cat allergen.

Medications such as antihistamines, nasal sprays and bronchodilators can help relieve symptoms.

Allergy shots or drops (immunotherapy) are a very effective treatment option for cat sensitive individuals.

Bee Sting Allergy

In upstate New York, bees are the most common stinging insects to produce an allergic reaction. In other parts of the U.S., fire ants are also a common stinging insect.

Honeybees, wasps, yellow jacket and hornets inject venom into their victims at the site of the sting. Most people develop a mild reaction to the venom with symptoms such as local pain, itching, redness or swelling. Usually such symptoms last a few hours, but on occasion may last longer.

Some people experience bee sting allergy symptoms, which in some cases are severe and even life threatening. Severe allergic reactions may develop rapidly and can involve more than one organ system. Symptoms of a severe allergic reaction include: itching and hives over different
parts of the body, difficulty breathing or swallowing, swelling in the throat or tongue, dizziness, drop in blood pressure, stomach cramping, nausea, diarrhea, and loss of consciousness. These symptoms require immediate emergency medical treatment.

Avoiding Insect Stings

To decrease the chance of exposure to stinging insects:

• Wear shoes outdoors at all times.

• Avoid bright colored clothing which attracts insects.

• Wear garments that fit close to the body. Insects can become trapped in loose
fitting clothing.

• Avoid using scented soaps, cosmetics and perfumes.

• Stay away from insect feeding grounds (flower beds, fields of clover, garbage cans/bin
and orchards with ripe fruit).

• Keep automobile windows closed to keep bees out.

• If it is necessary to dispose of garbage, spray the area first with an effective
rapid-acting insecticide.

• Wasp or hornet nests or beehives noted in the vicinity of the home should be destroyed
by a professional exterminator.

• When eating outdoors be aware that some bees are attracted to food and beverages. Bees often go inside beverage containers left unattended.

Bee Sting Allergy Treatment


If you have experienced a severe reaction to a bee sting, it’s best to be tested to determine the species that caused the reaction.  Future stings can be life threatening.  Allergy shots (immunotherapy) is available to help prevent severe reactions to future stings.

Asthma In Pregnancy

Asthma is a common medical condition that occurs in approximately 25 million Americans, and many people with asthma suffer from allergies as well. Women of child bearing age, who are pregnant or may become pregnant, need special consideration in treating asthma and allergies. The treatment plan needs to consider the medical condition of the patient, while reducing the risks to the unborn child.

For many years, it was suggested that a woman with asthma may risk complications during pregnancy. Most complications from asthma result from patients who poorly control their symptoms, who experience daily symptoms, and have frequent emergency room visits or hospitalizations because of their asthma. Poor asthma control can result from a fear of using medication during pregnancy, leading to under-treatment and unstable asthma. The risks to the child include premature birth, low birth weight and other complications.

Recent information suggests risks to the unborn child can be minimized, if a mother’s asthma is under good control. In general, asthma medications in use today are safe for use during pregnancy. Although pregnant women rarely participate in studies of medication side effects, there is extensive data available from long-term use of these medications and from laboratory studies on animals.

For patients with allergies, it is important to know that many allergy medications are also safe for use during pregnancy. Some over-the-counter medications should be avoided however, so it’s important for your physician to know what medicines you use. Allergy shots are not started on pregnant patients, but can be continued during pregnancy for patients currently receiving them. The dose will not be increased however, to avoid the risk of a significant reaction to the shots.

In treating allergies or asthma during pregnancy, it is important to emphasize environmental controls, which help avoid exposure to allergic triggers such as dust, pet dander, or pollen. Understanding allergic triggers is an important part of a treatment plan. Allergic triggers are the cause of asthma attacks for some patients, so avoidance is essential and can help reduce the need for medication. Also, patients with asthma should monitor their asthma with a peak flow meter. This can help track asthma control and identify a potential attack before symptoms even develop.

If possible, before becoming pregnant, a patient should discuss the status of her asthma and allergies with her physician. If it’s not possible, patients should contact their physician as soon as they know they are pregnant. By doing so, adjustments can be made to the treatment plan so control of asthma symptoms can be improved or maintained. When asthma is under good control, the mother and baby can avoid the risks of complications. When using medications, patients should understand their safety for use during pregnancy. It is important to remember that the risks of poorly controlled asthma generally outweigh the risks of today’s medications. Finally, it is important to remember that asthma and allergy control should be monitored throughout pregnancy.