Allergies or colds: let's look at the signs
This is the first question that almost every patient asks himself, and it’s easy to make a mistake here: both here and there the nose is running. But the differences are enough to figure it out on your own even before visiting a doctor.
- Onset: with a cold, gradual, over a day or two, with a sore throat and general malaise; in case of allergies, sudden, sometimes within minutes after entering a dusty room or contact with an animal
- Itching: with allergies it is severe - the nose, palate, eyes, and sometimes ears itch; With a cold there is practically no itching
- Discharge: with allergies, transparent and watery all the time; If you have a cold, it thickens and changes color after a few days.
- Temperature: with allergies it is never present; when you have a cold, you often eat, at least a little
- Sneezing: with allergies, attacks 5-10 times in a row; for a cold, single
- Duration: a cold goes away in 7–10 days; allergic rhinitis lasts for weeks, months, or returns seasonally
- Eyes: Red, itchy, watery eyes are almost always a sign of an allergy.
- Connection with the situation: allergies intensify at home, when cleaning, with relatives with a cat, at the dacha - and subside when changing places
There is a third option that is forgotten: vasomotor rhinitis. With it, the nose is also constantly stuffy and running, but there is no itching or eye symptoms, and the attack is provoked not by allergens, but by cold air, strong odors, spicy food, alcohol, and temperature changes when entering from the street. The samples are negative. His treatment is different, and it makes no sense to prescribe immunotherapy in such a situation - therefore, examination is necessary even when the picture seems obvious.
Who's to blame: allergens in your own home
If the symptoms last all year round, and not seasonally, you need to look for the cause in the room where the person spends most of the time. As a rule, this is the bedroom.
- House dust mites are the most common cause of year-round rhinitis. They live in mattresses, pillows, blankets, carpets, upholstered furniture and soft toys; love warmth and humidity. A characteristic sign is that symptoms worsen at night and in the morning, as well as when cleaning and making the bed
- Epithelium and saliva of animals. The main cat allergen is extremely volatile and persistent: it remains in the apartment for months after the animal has stopped living there, and is found even in houses where there have never been cats - it is brought on clothes
- Mold fungi. They search in the bathroom, in the kitchen under the sink, behind the refrigerator, on window slopes with condensation, in the air conditioner, in flower pots, in basements and on damp walls.
- Cockroaches are an underestimated allergen in apartment buildings, especially significant for the development of asthma in children
- Plant pollen, if rhinitis is seasonal or seasonally aggravated
- Occupational factors: flour for bakers, latex for health workers, wood dust, varnishes and paints
Measures to eliminate the allergen work, but only if they are targeted and carried out consistently. If you are allergic to mites, it makes sense to use a special protective covering for the mattress and pillows, wash bed linen in hot water once every one to two weeks, avoid carpets and soft toys in the bedroom, and maintain moderate humidity. Only “general cleaning” without this effect does not give, and the cleaning itself temporarily worsens the condition, raising dust into the air - therefore, it is better not for the sick person to vacuum, but if necessary, then in a mask and with a fine filter.
Single airways: the connection between rhinitis and asthma
The upper and lower respiratory tracts are lined with similar mucous membranes and work as one unit, so inflammation is rarely limited to the nose. The practical implication is that most people with asthma have allergic rhinitis, and conversely, having rhinitis markedly increases the likelihood of developing asthma in the future. A doctor who asks a patient with a runny nose about a night cough and shortness of breath does not do this for formality.
- Cough at night and in the morning, especially dry and paroxysmal
- Wheezing or a feeling of tightness in the chest when exerting yourself, laughing, or going out into the cold
- Shortness of breath on exertion that never happened before
- Long cough after each cold, lasting for weeks
- Worsening of the condition upon contact with the same allergen that causes a runny nose
This relationship also works in the opposite direction: adequate treatment of rhinitis improves asthma control and reduces the need for inhalers. Therefore, in a patient with asthma, the nose must be treated, and not according to the “residual principle.” In addition to asthma, untreated rhinitis is associated with other problems: recurrent sinusitis, inflammation of the middle ear and hearing loss in children, nasal polyps, snoring and sleep apnea, and persistent impairment of the sense of smell. A separate point is sleep: a constantly stuffy nose worsens its quality, and then attention and performance decrease.
Examination: what is really needed
- Подробный расспрос: когда появляются симптомы, где, что усиливает и что облегчает, есть ли животные дома, какая обстановка в спальне, что принимает пациент постоянно.
- Осмотр ЛОР-врача с риноскопией. Для аллергического ринита типична бледная, отёчная, с синеватым оттенком слизистая. Заодно исключают искривление перегородки и полипы — при них лечение будет другим.
- Кожные прик-тесты с основными бытовыми и пыльцевыми аллергенами — быстрый и информативный метод; результат готов через 15–20 минут.
- Специфические IgE в крови — когда пробы невозможны: при обострении, при приёме антигистаминных, при кожных болезнях.
- Спирометрия при кашле, одышке и свистящем дыхании, при необходимости с пробой на обратимость обструкции.
- Компьютерная томография околоносовых пазух — только по показаниям: при подозрении на хронический синусит или полипоз, а не для рутинной диагностики ринита.
What you shouldn’t do: order wide panels “for everything” without clinical reference. A positive result for an allergen that a person has no contact with or for which he has no symptoms leads to meaningless restrictions - foods are removed from the diet, things are taken out of the house, and the cause remains undetected. Tests are prescribed based on medical history, and not vice versa.
Treatment and the truth about hormonal sprays
The regimen is selected according to the severity and duration of symptoms. For rare and mild manifestations, an antihistamine as needed is sufficient; if they are persistent and interfere with life, regular basic therapy is needed. The key point that determines success is regularity: drugs in this group work cumulatively, and taking them “when it’s especially bad” does not give results.
- Intranasal glucocorticosteroids are the first choice drug for moderate to severe rhinitis; they best relieve congestion. Used in long courses as prescribed by a doctor
- Second generation antihistamines in tablets or nasal spray - effective against itching, sneezing and discharge
- Rinsing the nose with saline solution is an auxiliary but useful method, especially before using the spray: the drug adheres better to the cleaned mucous membrane
- Antileukotriene drugs - when combined with asthma
- Allergen-specific immunotherapy is the only method that changes the course of the disease, and not just masks symptoms
- Surgical treatment - not for allergies, but for related problems: deviated septum, hypertrophy of the nasal turbinates, polyps
It’s worth speaking directly about the safety of nasal hormones, because fear of them is the most common reason for ineffective treatment. These are local drugs, and a very small part of them reaches the systemic bloodstream, so weight gain, “addiction” and hormonal disturbances do not occur from them - it is wrong to compare them with hormones in tablets or injections. The real side effects are limited to dry nose and minor nosebleeds, and they are often associated with technique: the stream should be directed to the outer wall of the nose, and not into the septum, and not to inhale the drug sharply. The second thing that is important to know: the effect develops in a few days, and is fully revealed in two weeks, so the decision “does not help” after one use is premature. In children, the doctor selects the drug and monitors growth during long-term use, which is also a matter of observation and not refusal of treatment.