Thread by @AllergyKidsDoc

Environmental allergies are extremely common - affect ~40% of people.
Many upper/lower respiratory symptoms due to allergies but undiagnosed or treated incorrectly.
Likewise, many symptoms NOT due to allergies, also treated incorrectly.
This #MondayMorning thread will discuss⬇️

4 main nasal symptoms due to allergies:
-Sneezing
-Itching
-Congestion
-Runny nose (clear mucous)

No itching + mainly congestion = likely nonallergic causes.

Important to note that #asthma & allergies often go hand in hand. Poor control of rhinitis = cough, wheeze

Physical exam very important in helping diagnose environmental allergies:
- Nasal crease from rubbing
- Dark circles under eyes (although very common and can be from ANY cause of congestion)

Inside nose:
- Allergic mucosa is pale, almost bluish
- Dark red = nonallergic/infection

Common causes of environmental allergies:
Indoor = cat, dog, mouse, dust mite, cockroach, mold
Outdoor = trees, grasses, weeds, ragweed, mold

Nonallergic irritants for anyone:
Smoke, scented candles, essential oil diffusers, perfumes, cleaning sprays, any aerosolized product

Allergy testing very helpful to establish a diagnosis of environmental allergies AND determine best treatment options.

Skin prick testing takes 15 minutes - need to stop antihistamines for ~5 days
Blood testing - don't need to stop any medications

Poorly controlled or severe environmental allergies absolutely causes major problems:
- Poor sleep
- Missed work/school
- Presenteeism (physically present but unable to focus)

Important to recognize various impacts and address when not well controlled

Treatment differs by cause:
- Nasal steroid sprays single most effective treatment for ALL nasal symptoms; must use daily & consistently for best effect
- Antihistamines do NOT treat congestion or nonallergic rhinitis; may help itching/sneezing

Why proper diagnosis matters⬆️

Great evidence based approaches to answer common questions for treatment:
- European ARIA guidelines euforea.eu/aria
- US rhinitis parameters aaaai.org/Aaaai/media/Me…

Immunotherapy, either allergy shots or sublingual options can be very helpful for people w severe or poorly controlled allergic rhinitis.

Both a big commitment to long term schedule = at least 3-5 years of therapy

Neither a 1st line treatment but can really help severe patients

Allergen avoidance big part of successful treatment for those with environmental allergies, another reason why accurate diagnosis matters. worldallergy.org/education-and-…

I've seen many docs recommend broad avoidance measures for people who don't even have allergies = $$$, wasted effort

Hopefully this thread addresses some common questions surrounding environmental allergies.

As with any condition, lots of over and under-diagnosis.

Board certified allergists can help anyone with poorly controlled rhinitis or asthma. No need to suffer!