What Are The Best Treatments For Sinusitis Caused By Allergies?

  • Isabelle Lally Bachelor of Science with Honours in Biology, University of Nottingham

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Introduction

You don't realize the importance of something until it's taken away from you. In this case, you’ll find yourself wishing for your healthier self, longing for the time when you didn’t have a blocked nose or a severe headache. It’s frustrating and disrupts your sleep which impacts your productivity the next day. If this sounds familiar, it's likely you’re suffering from sinusitis. Now, let's talk about what sinusitis is and how you can treat it.

Sinuses are essentially four air-filled cavities or spaces in your head that are interconnected. They produce mucus, which drains into the nose and helps clear the nasal passages of any foreign particles. Normally, they act as a defence system against bacteria and viruses, fighting off infections. Sinuses also protect us from injuries by absorbing shock, such as in the case of head trauma, and they play a role in how our voice sounds.

However, sometimes these sinuses become affected, resulting in sinusitis.1 Sinusitis is the inflammation and swelling of the nasal tissues caused by a buildup of fluid, usually due to microbial infections or allergens.

Types of sinusitis 

Acute Sinusitis: This type lasts less than 4 weeks and is usually caused by a virus, though it can also result from a bacterial infection. The symptoms are generally less severe.

Recurrent Acute Sinusitis: This condition occurs when a person frequently experiences acute sinusitis, with symptoms lasting for a week or two. As a result, the patient suffers from acute sinusitis multiple times a year. 

Chronic Sinusitis: The condition is considered chronic when symptoms such as nasal congestion, headache, cough, and pressure around the facial features last for more than 12 weeks, even with medication. Chronic sinusitis must be immediately treated, and in severe cases, surgery may be necessary.

Allergic Sinusitis: This type is triggered by allergens such as pollen, dust, and pet dander. Symptoms include headache, blocked nose, pain in the cheeks, and itchy eyes.

Allergic reactions and their impact on the sinuses

Pollen and dust trigger the immune system, causing inflammation of the nasal passages. This leads to swelling and excessive mucus production, which ultimately blocks the nose and causes nasal congestion. Due to the blockage and excess mucus, pressure builds up in the sinuses, leading to symptoms such as headaches, pain around the eyes, and swelling and pressure around the nose and cheeks.

Sign and symptoms2

  • Nasal congestion,  sneezing, and runny nose
  • Blocked nose and fever
  • Itchy eyes, nose, and throat 
  • Headache, pain, and tenderness
  • Swelling and pressure in  the forehead, cheeks, nose, and eyes 
  • Reduced sense of smell and bad breath
  • Toothache
  • Yellow or green nasal discharge 

Medical treatments for sinusitis

Antihistamines3

The body releases histamine when a foreign entity enters, helping to protect the body by dilating blood vessels and alerting the immune system to act against the pathogen. However, some people are hypersensitive to even harmless substances such as pollen, pet dander, or dust. In these cases, histamine release leads to excessive mucus production, sneezing, watery eyes, a blocked nose, redness, and swelling.

This can be treated with antihistamines, which work by blocking histamine action by blocking histamine receptors and thereby stopping the allergic reaction. It is recommended to take antihistamines as a prophylactic measure if you are aware of potential exposure to allergens.

Some common antihistamines include:

  • Chlorpheniramine 
  • Diphenhydramine 
  • Loratadine
  • Cetirizine
  • Fexofenadine

It is best to consult a physician or pharmacist to determine an accurate dosage regimen according to your diagnosis and symptoms.

Decongestants4

Decongestants are available in oral solid dosage forms and nasal sprays and can be used to relieve sinus congestion. They work by binding alpha-adrenergic receptors, causing constriction of blood vessels and decreasing blood flow to the nasal mucosa. This reduces inflammation and clears the nasal passages,  providing relief from a blocked nose. 

Some common decongestants include:

  • Pseudoephedrine
  • Oxymetazoline

It is recommended to consult your doctor, as individuals may experience different side effects at various doses.

Corticosteroids

Intranasal corticosteroids are an effective treatment for relieving many symptoms associated with allergic sinusitis, reducing symptoms by 60% to 90%.5 Corticosteroids are generally considered safe for both adults and children. 

They work by reducing the release of histamines and cytokines, which are responsible for swelling and inflammation. This helps clear the nasal passages and stops symptoms such as sneezing, wheezing, and congestion. While corticosteroids are generally safe, it is important to consult a doctor before use to avoid any allergic reactions.

Some common medications include:

  • Fluticasone
  • Budesonide
  • Beclomethasone

Leukotriene inhibitors

Leukotrienes are inflammatory mediators released in response to allergen exposure. These mediators cause excessive mucus production, shortness of breath, inflammation, and swelling in the chest. Leukotriene inhibitors can be prescribed to individuals suffering from allergies, as they inhibit the synthesis of leukotrienes, thereby reducing associated signs and symptoms. 

Some common leukotriene inhibitors include:

  • Montelukast
  • Zafirlukast

Antibiotics

Antibiotics should only be prescribed when sinusitis is caused by a bacterial infection. Signs that sinusitis is likely bacterial include a high fever, thick mucus production, and worsening symptoms. 

Some common antibiotics include

  • Amoxicillin
  • Azithromycin
  • Cephalosporins

Immunotherapy6

It is a novel method designed to revolutionize the treatment of allergic sinusitis by providing long-lasting relief and reducing reliance on over-the-counter drugs. This therapy aims to improve the body's immune system by gradually exposing it to various allergens, allowing the body to recognize these potential triggers and develop immunity against them. This approach not only provides long-lasting relief but also prevents the disease from progressing. The treatment is tailored to each individual’s profile to identify specific triggers and address them. Additionally, it aims to promote tolerance to various substances, potentially improving the quality of life. The steps for immunotherapy are as follows:

  1. Allergy Test: This is usually done by drawing blood with a skin prick test to identify potential allergens.
  2. Personalized Plan: Once the results are received, the relevant doctors will create a treatment plan that includes the antigens, duration, and frequency.
  3. Build-Up Phase: A small amount of the allergens will be administered to the body to activate the immune system. The amount of allergens gradually increases to allow the body time to adjust and respond.
  4. Maintenance Dose: At this stage, the person receives the required dose of allergen under the supervision of a physician until they become accustomed to it.
  5. Immune Response: Over time, the immune system no longer considers the allergen a threat,  resulting in a diminished response and providing long-lasting relief.

Home remedies and self-care

It is always ideal to take precautionary measures, especially during specific seasons such as winter or pollen season. It is advised to follow these preventative measures, which include:

  • Monitoring areas to ensure cleanliness 
  • Balanced diet
  • Management of air quality
  • Stress management
  • Adequate sleep

Home remedies

Humidifiers and steam therapy

A humidifier can be placed on your bedside table to help you enjoy a peaceful night’s sleep. The humidifier prevents the sinuses from drying out, helps prevent nasal blockage, and keeps the airways open. This eases the breathing and also reduces the discomfort by decreasing the pressure in the sinuses. It is recommended to use steam therapy at least three times a day as an alternative to humidifiers.

Hydration

This is perhaps the easiest way to relieve symptoms. Drinking water helps thin the thick mucus, which ultimately provides relief from congestion and sinus pressure.  Setting an alarm to remind yourself to stay hydrated can aid in rapid recovery.

Warm compresses

A warm cloth or compress provides symptomatic relief from headaches caused by sinus pressure and facial pain. It is a great alternative for temporary relief until medications are administered.

Summary

Sinusitis is the inflammation of the sinuses located in the face. They play a crucial role in fighting infections and allergens, but they can sometimes become affected by bacteria, viruses, mould, or allergens. This causes inflammation, resulting in an inflamed nasal passage, thick mucus production, and nasal congestion. These symptoms cause extreme discomfort such as headache, pain behind the eyes, itchy eyes, nasal congestion, pain in the cheeks, and toothache.

Sinusitis can be treated using antihistamines, nasal decongestants, leukotriene inhibitors, corticosteroids, and antibiotics in cases of bacterial sinusitis. These medications provide quick relief from the symptoms associated with sinusitis. Additionally, various home remedies can be used for treatment or as a preventative measure. 

References

  1. ACAAI Patient [Internet]. [cited 2024 Sep 7]. Sinus infection | causes, symptoms & treatment | acaai public website. Available from: https://acaai.org/allergies/allergic-conditions/sinus-infection/
  2. Sinusitis - types, causes, symptoms, complications and treatment [Internet]. 2020 [cited 2024 Sep 7]. Available from: https://www.pacehospital.com/sinusitis-types-causes-symptoms-and-treatement
  3. nhs.uk [Internet]. 2017 [cited 2024 Sep 7]. Antihistamines. Available from: https://www.nhs.uk/conditions/antihistamines/
  4. Johnson DA, Hricik JG. The pharmacology of α‐adrenergic decongestants. Pharmacotherapy [Internet]. 1993 Nov 12 [cited 2024 Sep 7];13(6P2). Available from: https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/j.1875-9114.1993.tb02779.x
  5. Vitanza JM, Pearlman DS. Corticosteroids in the treatment of allergic rhinitis. Immunology and Allergy Clinics of North America [Internet]. 1999 Nov 1 [cited 2024 Sep 7];19(4):783–98. Available from: https://www.sciencedirect.com/science/article/pii/S0889856105701223
  6. Exploring immunotherapy for allergic rhinitis treatment - sinusdoctor [Internet]. 2023 [cited 2024 Sep 7]. Available from: https://www.sinusdoctor.com/exploring-immunotherapy-for-allergic-rhinitis-treatment/

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Doctor of Pharmacy - PharmD, Medicine, Riphah International University

I am Syeda Mahnoor Kazmi, a Doctor of Pharmacy graduated from Riphah International University, Islamabad, Pakistan. My professional experience spans both pharmaceutical industries and healthcare settings, where I have completed internships that provided a well-rounded foundation in each sector.

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