When Trouble Hits Those Holes in Your Head. (Part 1)

You've had a cold for five to seven days and thought you were getting better. Then it grew worse. More congestion, increasing fatigue and now headache or facial pain around your nose or eyes or upper teeth. You guessed it was a sinus infection.

Allergies are extremely common and underdiagnosed. They are a setup for sinusitis. Sneezing, a runny or itchy nose and watery or itchy eyes are all signs of allergy. Allergy testing can help identify those items to which you are most allergic. Remember, the most effective way of addressing allergies is prevention. For example, curtains, carpets and decorative pillows may harbor dust mites that can cause allergy attacks. Also, an air purifier that contains a HEPA filter can be beneficial for lowering airborne allergens, especially when placed in the bedroom.

Depending on the severity of the symptoms, the doctor's examination and inclinations about treatment, you may be prescribed an antibiotic.

But is this what you need to get better?

Chances are, it is not. Most cases of acute sinusitis are caused by viruses, not bacteria, and taking an antibiotic does nothing more than enrich the pharmaceutical companies and increase the chances of being infected with drug-resistant bacteria.

Colds run amok can turn into sinus infections, so don't be nice to your cold. The key is to try to prevent your sinus drainage passageways from getting blocked. One helpful technique is to irrigate your nose and sinuses with a squeeze bottle filled with salt water. You can buy a sinus irrigation kit (also called sinus rinse) at your local pharmacy without a prescription. Most products come with pre-measured salt packets.

The average adult catches two or three colds a year, and 0.5 to 2 percent of them are complicated by bacterial infections. In other words, if antibiotics are prescribed for most sinusitis cases, they are most likely being way overprescribed.

In the course of a year, an estimated 37 million Americans experience sinusitis, the fifth most common diagnosis for which antibiotics are prescribed in outpatient settings.

Also, don't fly with a cold if possible: The change in pressure can stress your sinuses, causing a sinus infection, not to mention a very painful descent!

But how is the doctor to know whether an antibiotic is what is needed? Unless a sample of the pus in the nasal cavities is examined under a microscope - a rare act in most physicians' offices - there is no certain way to tell.

You may have recurrent sinusitis. After one infection clears, another one pops up weeks--or even months--down the line. There's good news for those prone to this stubborn illness prevention is sometimes as easy as using daily salt-water nasal irrigation. The same salt water solution that's used to treat sinus infections can also be used to prevent them.

Doctors are advised to use antibiotics to treat sinusitis when at least three of four signs are present: purulent (yellowish or greenish) nasal discharge predominantly on one side, local facial pain mainly on one side, purulent nasal discharge on both sides or pus in the nasal cavity.

Many physicians as well as patients take purulent nasal discharge lasting seven or more days as the primary indication of a bacterial sinus infection. Yet, study after careful study has shown no reliable benefit of antibiotics when doctors try to apply this or any of the other criteria in deciding on drug treatment.

In general, chronic sinusitis lasts for 12 weeks or longer and is often associated with allergies. Acute sinusitis, however, is usually due to bacterial infections. For those with persistent symptoms who have tried everything, ask your doctor about other treatment options.

In the latest study, published last month in The Journal of Family Practice, no significant benefit over a placebo was found from using the antibiotic amoxicillin among 135 patients with typical indications of a sinus infection. All the patients complained of sinusitis, with pus in the nasal cavity, facial pressure or nasal discharge lasting longer than seven days.

A few natural options that are effective include the following remedies and dietary changes:

Sinupret: This proprietary herbal formula (with sorrel, elderberry, and other herbs) is popular in Europe and helps promote upper respiratory and nasal passage health. Follow label directions for dosage. Several products featuring Sinupret are on the market, including a formula by Bionorica.

A small subgroup of patients receiving the antibiotic became better faster than the others. But the researchers were unable to discern anything about those patients in advance of treatment that indicated a bacterial infection, as opposed to a viral one.

That does not mean that antibiotics are useless in treating sinusitis. But it does mean more research is needed to help doctors determine who is most likely to benefit from the costly and potentially harmful drugs.

Bromelain: Found naturally in the stem of pineapple, bromelain is an excellent anti-inflammatory for acute and chronic sinusitis. Scientific studies show that bromelain can significantly reduce inflammation of the nasal lining, as well as help minimize nasal discomfort and breathing difficulties. Bromelain is widely available in supplement form. Follow manufacturer's directions for dosage guidelines.

Many people who do not seek medical care for an apparent sinus infections try to treat the problem on their own, typically buying one or more over-the-counter "sinus remedies."

Many millions of dollars are spent on such "remedies," none of them getting at the cause of the problem.

So What Is Sinusitis?

Diet: A healthy diet is always important to support your immune system and help fight off sinusitis. Ironically, eliminating some foods may also help. For example, cow's milk products, along with other foods, such as eggs, peanuts, wheat, soy, fish, shellfish and tree nuts, are the most common food allergens. Sensitivities to foods can worsen sinusitis and should be ruled out by an elimination-challenge diet or allergy testing.

Sinusitis is simply an inflammation of the lining of the sinus cavities. There are four pairs of sinuses, which are spaces normally filled with air in the front of the skull: over the eyes in the brow area; inside each cheekbone; just behind the bridge of the nose and between the eyes; and in the upper region of the nose and behind the eyes. The membranes that line the sinus cavities are moistened by thin mucus.

Sinus inflammation has many causes, including infection by viruses, bacteria or fungi;

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an allergic reaction to a food or environmental substance; or the response to an inhaled irritant like tobacco smoke or outdoor or indoor air pollution.

Alternatives for Allergies and Asthma: Proceed with Caution.

Allergy Treatment Begins At Home - Living A Healthy Lifestyle.

It is spring time, which is good news to many, but not to all. Yes, the sun is out, it is warming up, and the birds are all around us, singing happily to pass the day away, but all is not well for those who suffer from allergic reactions.

Today, people are almost as familiar with the herbal supplement echinacea as they are with aspirin. So it's no surprise that many Americans are turning to complementary and alternative (CAM) therapies to treat their allergy and asthma symptoms. When it comes to conditions for which people seek out nontraditional treatments, studies suggest that asthma and allergies are second only to lower back pain.

It's estimated that allergies affect 40 to 50 million Americans, and about 20 million have asthma.

f you are an allergy sufferer, spring can be a miserable time of wheezing, sneezing, coughing, and constant discomfort, unless you have the proper allergy treatment. The type of allergy treatment that is right for you depends on a number of factors that your doctor should discuss with you, but many of them take several weeks, to months to work, so you shouldn't delay. You've got to start treating your allergic reactions today.

While herbal supplements and other complementary and alternative therapies, such as hypnosis and acupuncture, may ease some symptoms, experts say people have to be careful about which CAM treatment they choose. Not only are some people with allergies particularly susceptible to adverse drug reactions, but there is also a chance that some alternative remedies may interact with other medications.

Why Go Alternative?

The most common allergy treatment is the antihistamine. Recently, claritin which is one of the most common antihistamines and used to be available only by prescription, has become available over the counter to treat allergies.

You may wonder why people are turning to alternatives when there are many medications, both prescription and over-the-counter, that successfully treat asthma and allergies. Like many people with chronic medical conditions, those who suffer from asthma and allergies are often particularly interested in trying new, “natural” treatments. However, natural doesn't necessarily mean without side effects, and just like medications made by pharmaceutical companies, “natural” products can be powerful and toxic.

For many people, this proves to be such an effective allergy treatment that it proves to be all that they need to treat their conditions, but for many more, this is not the case. There are a variety of nasal allergy treatments which can relieve swelling and discomfort in the nose and sinuses, but many of these have side effects. If you suffer from bad allergic reactions, you should consider a more complete allergy treatment.

Another driving force behind the move toward alternative remedies may be the high cost of allergy and asthma medicines, says Dr. Gailen Marshall, a professor of medicine and director of the clinical immunology, asthma and allergy division at the University of Mississippi in Jackson. For example, some patients who have both allergies and asthma may choose to only treat their asthma to cut costs. But they may run into trouble quickly, because flaring allergies can worsen asthma symptoms. When this happens, Marshall says, people are more inclined to turn to CAM therapies, which are typically less expensive than prescriptions.

What I recommend is to take several steps, instead of looking for the cure-all allergy treatment. The first thing to do is to make sure that your house is clean. Clean out the refrigerator and check it for mold. Same goes for the bathroom, and any other room which may harbor dirt, dust, or fungus. Remember that the most effective allergy treatment is to prevent the inhalation of allergens in the first place, and that means dusting, washing, vacuuming and sweeping every single day of the week.

Safety Concerns.

Unlike drug makers, manufacturers of herbal products and other dietary supplements do not have to demonstrate the safety and effectiveness of their products to the Food and Drug Administration (FDA). So little may be known about the true effects of a particular CAM product.

In a study published in a supplement devoted to CAM therapies in the Annals of Allergy, Asthma and Immunology, Dr. Leonard Bielory of the UMDNJ-New Jersey Medical School in Newark reviewed the medical literature to uncover the possible benefits as well as consequences of popular CAM therapies for asthma, allergies and immune system conditions.

Of course, this isn't the whole allergy treatment. In addition to cleaning up, you should get a nice HEPA air filter to clean up the air in your rooms, particularly the one you sleep in. This will remove all of the dirt and allergens from the air. Your allergy treatment will probably also include the use of an antihistamine, as well as a decongestant. Finally, you might have to get more severe medication as an allergy treatment. Shots can do wonders to minimize allergic reactions.

"Many of my patients were taking complementary and alternative therapies," Bielory explains. "I wanted to learn more about what's real and not real. Physicians shouldn't downplay CAM if people feel better, even if it's a placebo effect. However, there are some herbal supplements that have adverse effects."

Bielory found that the most common side effects were various forms of allergic reaction like hives or contact dermatitis, which usually appears as an itchy rash.

Specific CAM Side Effects.

But is the possibility of more serious side effects. Specifically, Bielory found that echinacea, used for the common cold and for upper respiratory tract allergies, carries some risk of liver toxicity. There have also been some reports linking echinacea to asthma attacks, life-threatening anaphylactic reactions, and worsening of asthma and allergies symptoms. People with pollen allergies or sensitivity to sunflower seeds or melons may be more likely to have an adverse reaction to echinacea.

Likewise, bee pollen, a CAM therapy sometimes used for asthma and allergies, has been shown to trigger sore throat and breathing problems. It should never be used by people who are allergic to bee pollen since it could lead to anaphylactic shock.

Ginkgo biloba, which has been shown to expand the air passages in the lungs, is sometimes recommended to people with asthma. But Bielory points out that ginkgo biloba interacts with warfarin (Coumadin), a blood-thinning medication, and can make it less effective. Physicians also caution people about using ginkgo biloba in combination with aspirin, or other non-steroid anti-inflammatories, since it can intensify the potency of these drugs and lead to serious complications.

Asthma sufferers specifically should be wary of St. John's wort, a supplement often recommended for anxiety and depression. It may interact with oral asthma medications such as theophylline.

Stress reduction techniques, such as biofeedback and hypnosis, are relatively safe and free of side effects. Some studies, including one conducted by Marshall, have demonstrated that chronic anxiety and depression play a role in asthma. So stress management, Marshall says, from counseling to CAM approaches, may help certain patients control their asthma and perhaps their allergy symptoms.

What Now?

According to Bielory, the next step for many of these herbal supplements is clinical trials. But that may never happen since companies don’t have to submit trial data to the FDA; costly studies just aren’t a good investment for them. In the meantime, allergists can familiarize themselves with CAM treatments, and patients need to be open with their doctors about which therapies they are taking.

"Patients with asthma and allergies should insist on an open-mindedness in their practitioners about discussing complementary and alternative therapies," Marshall says. "If their healthcare practitioner is not open-minded, the patient should find someone who is."