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I see hundreds of people every year who ask for help controlling their allergy symptoms. Allergies can be serious and even life-threatening in some cases. But at least half of the patients I see for ear, nose and throat allergy symptoms don’t have allergies at all.
It’s a common mistake to make. Symptoms like nasal obstruction, “post-nasal drip,” runny nose and cough also may be caused or contributed to by other conditions having nothing to do with allergies.
Good treatment sometimes requires that we determine exactly what’s causing a person’s symptoms. That way, we can prescribe the right treatment for the right problem. Let’s examine the top three problems patients commonly mistake for allergy symptoms or sinus infections and see the impacts they can have on sufferers.
Symptom 1: Nasal obstruction
Nasal obstruction, or a blockage of the nasal airway, is a common symptom of allergies and sinus infections. But the anatomy of the nose, or the way the nose is shaped, can have a major effect on a person’s ability to breathe easily.
The nasal septum is the thin, wall-like structure that separates the right and left nostrils in the nose. Ideally, the septum is straight to divide the nostrils evenly. But birth defects, injuries to the nose or even rapid growth during puberty can cause the septum to become crooked, or deviated.
Most of us have septums that are less than perfectly straight, but it’s usually not noticeable. For some people, though, a deviated septum, depending on its shape, may lead to an obstruction of one or both nostrils.
A nasal steroid may be prescribed, or, in more severe cases, we can correct a deviated septum through a surgical procedure called a septoplasty.
The turbinates are another structure of the nose. They’re located on either side of the septum inside the nostrils. The turbinates filter, warm and humidify air and keep it from being too dry as you breathe in.
If the turbinates are too large (a condition called turbinate hypertrophy) or misshaped, they can block the airway in the nose. This can lead to a similar type of nasal obstruction as one caused by a deviated septum, and the conditions can also occur together. Someone who has turbinate hypertrophy can feel like they have a stuffy nose or trouble breathing all the time.
A nasal steroid may decrease inflammation (and therefore, the swelling) of the turbinates, or surgery can be performed to decrease their size.
Symptom 2: Chronic cough and sore throat
Allergies or sinus infections can be associated with other inflammatory symptoms, such as:
- Chronic coughing
- Hoarseness, or a harsh, strained or raspy voice
- Sore throat
But these also can be symptoms of other problems, such as chronic acid reflux. Acid reflux occurs when stomach acid backs up, or refluxes, out of the stomach and into the esophagus. The chronic type of acid reflux is called gastroesophageal reflux disease, or GERD. In some cases of GERD, referred to as laryngopharyngeal reflux (LPR), stomach contents can back up and cause symptoms all the way up into the throat, which can damage the soft tissues in that area. LPR can lead to coughing, hoarseness or sore throat, which could be mistaken for allergy symptoms or signs of a sinus infection.
Symptom 3: Headache and facial pain
I frequently see people who come in complaining of “sinus headaches.” They have “congestion” all the time. They have debilitating pain on one or both sides of their head and face and are sensitive to bright lights.
Some of these people actually do have sinus infections or other sinus conditions, but others don’t. Many people who think they have sinus conditions actually are undiagnosed migraine sufferers.
When I bring this up to patients, some don’t believe me at first. They’ve never considered that their symptoms might be caused by migraine. They say things like, “I’m not seeing sparkly lights or an aura. I didn’t throw up. Aren’t you supposed to throw up if you have a migraine?” That’s not always the case.
I start thinking of migraine whenever I see a patient who complains of sinus headaches but who doesn’t have any other symptoms relating to the sinuses or nasal cavity, such as abnormal nasal drainage or obstruction. If you think you have frequent sinus headaches or infections, but you don’t have nasal symptoms like obstruction, abnormal drainage or other upper respiratory symptoms, ask your doctor if you might actually have migraine.
Smoking: A major contributor to mistaken allergy symptoms
Symptoms of upper-respiratory conditions are a common thread among people with allergies: runny noses, coughing, sore throats, hoarseness, etc. But those are also symptoms we associate with irritation from first- or second-hand smoke. Smoking contributes to many upper-respiratory conditions patients often think of as allergy symptoms.
One of the things we ask during a routine allergy examination is whether the patient smokes or lives with a smoker. It’s surprising how many people don’t know or haven’t accepted that their smoking is the cause of their problems.
When I see a patient for allergy symptoms, and I learn that the patient smokes, I always begin by recommending that the patient stop smoking. It often can resolve the respiratory problems that brought them to see me in the first place. And even if smoking isn’t the root cause of the problem, it’s often very difficult for us to deal with the issue while the body is under constant respiratory distress from the person’s smoking.
Find the root cause of symptoms to get lasting relief
Allergies are a common condition, and they’re easy to misdiagnose. Most patients don’t need full skin or lab testing for allergies, so doctors often make a diagnosis based on patients’ symptoms, which can be similar to those of other conditions.
People often assume they have allergies based on a Google search of their symptoms without checking with a doctor. Or they dismiss allergies or sinus problems as something not worth caring about; they just want relief from the symptoms that are interfering with their lives. Talk to your doctor about chronic symptoms, even if you think you know what’s causing them.
My job as a doctor is to get to the root of what’s harming my patients. If that’s an allergy or a sinus condition, we have treatments available to address those problems. But these symptoms could be signs of more serious issues. If allergy or sinus treatments aren’t giving you relief, talk with your doctor about other potential causes of your symptoms to make sure you’re getting to the root cause—and treating it appropriately.