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Allergen: A substance that triggers an allergic reaction.

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Allergic Rhinitis: An allergy affecting the mucus membrane of the nose. Seasonal allergic rhinitis is often called "hay fever."

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Allergist: A doctor that diagnoses, treats, and manages allergy-related conditions.

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Ana-Kit: A device used to inject epinephrine during an anaphylaxis attack.

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Anaphylaxis: A life-threatening allergic reaction that involves the entire body. Anaphylaxis may result in shock or death, and thus requires immediate medical attention

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Animal dander: The small scales or pieces of skin, often containing proteins secreted by oil glands, which are shed by an animal. These proteins are the major causes of allergies to pets.

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Antibiotics: A class of medications used to treat bacterial infections. Certain antibiotics, such as penicillin, may cause an allergic reaction in some people.

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Antibody: A protein in the immune system that recognizes and attacks foreign substances in the body.

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Anticonvulsant: A medication used to prevent or treat seizures. Certain anticonvulsants may cause an allergic reaction in some people.

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Antihistamines: A class of medications used to block the action of histamines in the body and prevent the symptoms of an allergic reaction.

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Asthma: An inflammatory disorder of the airways, causing periodic attacks of wheezing, coughing, chest tightness, and shortness of breath.

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Atopic dermatitis: A chronic skin rash, also known as "eczema," that often appears in the first few years of life.

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Basophil: An immune system cell that attaches to antibodies and circulates through out the blood.

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Beta-blockers: A class of blood pressure medications that ease the heart's pumping action and widen the blood vessels. Beta-blockers counteract the effects of epinephrine used for emergency treatment of anaphylactic shock and should not be used during immunotherapy.

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Bronchial tubes: The lower sections of the airway that lead into the lungs.

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Challenge test: A test used to confirm an allergy to specific substance. A doctor will administer small but increasing amounts of a suspected allergen until an allergic response is noticed. Due to the risk of anaphylaxis, this should only be performed under a controlled setting.

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Conjunctivitis: Inflammation of the conjunctiva, or the mucous membrane surrounding the eye. Also known as pinkeye.

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Contact dermatitis: An allergic reaction resulting from skin contact to an allergen.

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Corticosteroid: An anti-inflammatory medication used to treat the itching and swelling associated with some allergic reactions.

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Cromolym sodium: An anti-inflammatory nasal spray used to treat and sometimes prevent allergic rhinitis.

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Decongestants: A class of medications used for nasal congestion. Decongestants are available in oral doses, nasal sprays, or eye drops (for conjunctivitis).

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Dust mites: A microscopic organism that lives in dust.

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Eczema: See Atopic dermatitis.

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Eosinophil: A specific type of immune cell that can cause tissue damage in the late phase of an allergic reaction.

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Epinepherine: A medication used for immediate treatment of anaphylaxis by raising blood pressure and heart rate back to normal levels. Epinepherine is also known as adrenaline.

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EpiPen: A device used to inject epinephrine during an anaphylaxis attack.

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Heparin: A chemical released by basophils and mast cells that causes nearby tissues to become swollen and inflamed.

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Histamine: A chemical released by basophils and mast cells that causes nearby tissues to become swollen and inflamed.

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Hives: See urticaria.

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Hypertension: High blood pressure. When blood pushes against artery walls harder than normal.

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Immunoglobulin E: A type of antibody responsible for most allergic reactions.

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Immunotherapy: A series of shots that help build up the immune system's tolerance to an allergen.

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Insulin: A hormone that regulates blood sugar levels. Diabetics who take insulin derived from animals may have allergic reactions.

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Intradermal test: A test where an allergen is injected just underneath the skin. Intradermal tests are generally used when results from a skin prick test are unclear.

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Late Phase: The period 4 - 24 hours after exposure to an allergen where tissue damage may occur.

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Leukotrienes: Inflammatory substances that are released by mast cells during an allergic response or asthma attack.

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Lymphocyte: A specific type of immune cell that can cause tissue damage in the late phase of an allergic reaction.

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Mast cell: An immune system cell which attaches to antibodies and is located in the tissue that lines the nose, bronchial tubes, gastrointestinal tract, and the skin

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Neocromil sodium: An inhaled medication used to treat inflammation involved with asthma.

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Neutrophil: A specific type of immune cell that can cause tissue damage in the late phase of an allergic reaction.

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Otitis media: A middle ear infection. Otitis media with effusion occurs when fluid builds up within the ear.

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Radioallergosorbant Test (RAST): A blood test that measures the amount of IgE antibody produced when the sample is mixed with a specific allergen.

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Rhinitis: An inflammation of the nasal passageways, particularly with discharge.

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Sinusitis: An inflammation or infection of one or more sinuses. The sinuses are hollow air spaces located around the nose and eyes.

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Skin prick test: A test where a needle is used to scratch the skin with a small amount of allergen. A response can usually be seen within 15 - 20 minutes.

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Urticaria: Raised areas of the skin that are often red, warm, and itchy. Urticaria is also known as hives.

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Urushiol: An oil found on poison ivy, oak, and sumac.

"Sinusitis" refers to inflammation of the nasal sinus cavities, which are moist, hollow spaces in the bones of the skull. There are four pairs of sinuses: frontal, maxillary, ethmoid, and sphenoid. The sinuses are located behind the eyebrows, cheekbones, and nose. The sinuses help moisten and warm air that is filtered by the nose, serving to protect the lungs. The sinuses also play a role in voice resonation.

The sinus cavities, nose, and lungs are lined with mucous membranes, which protect the airways by trapping irritants that are inhaled. Tiny hair-like filaments called cilia are in constant movement and sweep mucus and the trapped irritants out of the airways and nasal passages. In the sinuses, the mucus drains out of a tiny opening called the ostium.

The ostium of any sinus cavity can get plugged. When this blockage prevents the flow of mucus, the pressure builds up, leading to sinusitis (inflammation and pain). If the blocked sinus becomes infected with bacteria, the sinus becomes even more inflamed and painful.

There are four different pairs of sinuses -- the frontal, ethmoid, maxillary, and sphenoid sinuses. In this illustration, the sinuses on the right side are shown as inflamed and infected, although any sinus can be affected. The sphenoid sinuses are not shown because they are further back in the head.

Symptoms

Sinusitis often affects people who have a stuffy or runny nose due to allergies (allergic rhinitis). Nasal discharge may be either a symptom or a cause of sinusitis. Other symptoms of sinusitis can include:

  • Facial pain or pressure
  • Thick, discolored mucus (yellow or green)
  • Diminished sense of smell
  • Cough (worse when laying down)
  • Headache
  • Bad breath
  • Fever
  • Toothache
  • Pressure in the ears
  • Fatigue

Acute vs. chronic sinusitis

Sinusitis can be acute or chronic. Acute sinusitis usually lasts for 3 weeks but can persist for as long as 3 months. Acute sinusitis is often accompanied by high fever in young children.

Chronic sinusitis lasts longer than three months and does not respond to conventional antibiotic treatment. Symptoms of chronic sinusitis are less severe than those of acute, but can last for years.

A distinguishing symptom of chronic sinusitis is a persistent cough -- with sinusitis in children, cough may be the only symptom.

Causes

Acute sinusitis is usually caused by a viral respiratory infection. Chronic sinusitis can also be caused by infection, but is more often caused by inflammation and blockage due to allergies or a physical obstruction (deviated septum, misformed bone or cartilage structures, nasal polyps, tumors, or foreign objects).

This view shows the bones and cartilage that surround the sinuses, including the septum and the turbinates. The septum and turbinates can block the sinuses, leading to pain and inflammation.

The septum separates the two sides of the nasal cavity. A "deviated septum" is one that is crooked or misformed; in some cases a deviated septum may actually block the opening to one of the sinuses.

The turbinates are bones that usually help protect the openings to the sinuses. The ostium is a tiny canal between the turbinates that drains a sinus cavity. If any of turbinates had a structural problem (by birth or from an accident), it could block the canal.

A cyst or polyp is a harmless structure that can block the ostium, depending on how big it gets and where it is located in the sinus.

Some people have structural problems that partially block the sinuses, and their allergies just make the problem even worse.

Other factors that may contribute or cause sinusitis (both acute and chronic) include a weakened immune system due to existing illness, cocaine abuse, overuse of decongestant nasal sprays, and activities like swimming and diving.

Diagnosing sinusitis

If you suspect you have sinusitis, ask your primary care physician for a referral to an Ear, Nose, and Throat (ENT) doctor (also called an otorhinolaryngologist). If you have bad allergies and think they may be causing sinusitis, ask for a referral to an allergist.

To make a diagnosis, your doctor will need to consider all of your symptoms. Your doctor will examine your nasal and sinus passages with an endoscope to see whether your sinuses are clear or inflamed with excess, cloudy mucus.

A computerized tomography (CT) scan of the sinuses (shown above) can be considered the "gold standard" in diagnosing sinusitis. The CT scan allows the doctor to clearly see where there are healthy pockets of air versus mucus build-up, structural obstruction, and inflammation in your sinuses.

Treatment and management

Acute sinusitis may require aggressive treatment with antibiotics. If you don't respond to the medication within 3 -5 days, your doctor may change your prescription for a stronger antibiotic. Chronic sinusitis may require as many as 6 weeks of treatment with antibiotics.

Decongestant medications may relieve symptoms of stuffy, runny nose that accompany sinusitis. Corticosteroid nasal sprays may help with inflammation.

If you don't respond to antibiotics and continue experiencing symptoms, surgery may be recommended. If you have nasal polyps, a deviated septum, or other obstructive growths, surgery may be the only answer to relieve your symptoms.

Nasal irrigation with saline is often recommended for people with sinusitis, particularly those having undergone surgery. It helps to clean out the sinuses and nasal passageways after surgery.

If you suspect that you have allergies, determine what you may be allergic to with allergy testing, so you can avoid them. If you can control your allergies, you may find that your sinusitis symptoms clear up too.

References

American Academy of Allergy, Asthma & Immunology. Consultation and referral guidelines citing the evidence: how the allergist-immunologist can help. J Allergy Clin Immunol. 2006 Feb;117(Suppl 2):S495-523.

Institute for Clinical Systems Improvement (ICSI). Acute sinusitis in adults. Bloomington, MN: Institute for Clinical Systems Improvement. 2004 May:29.

Cincinnati Children's Hospital Medical Center. Evidence-based care guideline for management of acute bacterial sinusitis in children 1-18 years of age. Cincinnati, OH: Cincinnati Children's Hospital Medical Center. 2006 Jul:17.

 

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Review Date: 4/4/2007

Reviewed By: Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc.


The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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