Allergic Rhinitis: Is It Just Allergies or Immune Issues?

Health issues

I have a history of allergic rhinitis and have mostly consulted with an otolaryngologist.
I also have a history of acute tonsillitis, sinusitis, bronchitis, and upper respiratory infections.
I feel that these conditions are the main reasons for my frequent medical visits.
I would like to know if these issues are solely caused by nasal allergies or if they are related to poor immune function.
I have visited an immunology clinic twice, and while I learned that my allergen is dust mites, the medications prescribed are ones that can also be given by general practitioners, and I don't find the immunology clinic particularly effective.
I am unsure if my situation is due to poor immune function or allergic rhinitis.
Which specialty should I consult? Most of the time, I am prescribed medications and nasal sprays, but I still find myself frequently needing to see a doctor.
What is your opinion on this? Should I go to a medical center, and if so, which specialty should I see?

Q, 40~49 year old female. Ask Date: 2021/04/13

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Symptoms of upper respiratory tract issues, including rhinitis, can have various causes beyond allergies, such as sensitivity to temperature.
The medications used are quite similar, which may not give you a distinct feeling.
My suggestions are: 1.
For nasal symptoms, it's important to ask detailed questions, such as whether runny nose or nasal congestion is more severe, as this will influence medication choices.
2.
Even if blood tests show dust mite allergies, it is possible to have nasal mucosa that is overly sensitive to environmental temperatures, and one might overlook the possibility of concurrent sinusitis.
Therefore, I recommend follow-up with an otolaryngologist, either at a medical center or a regional hospital, and if necessary, use a nasal endoscope to examine the nasal cavity to avoid missing the diagnosis of other serious conditions.
3.
If symptoms persist for a long time, it is advisable to consult a trusted otolaryngologist for regular monitoring of the nasal cavity, which would be ideal.
4.
Rhinitis is a modern ailment; as long as dust mites cannot be eliminated and the nasal mucosa remains sensitive, symptoms will persist, and long-term medication may be necessary.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, cares about you.

Reply Date: 2021/04/13

More Info

Understanding allergic rhinitis can be quite complex, especially when considering the interplay between allergies and immune system function. Allergic rhinitis, commonly known as hay fever, is primarily an allergic reaction to airborne allergens such as pollen, dust mites, mold, and pet dander. When your immune system mistakenly identifies these harmless substances as threats, it triggers an inflammatory response, leading to symptoms like sneezing, nasal congestion, runny nose, and itchy eyes.

In your case, you have a history of allergic rhinitis along with recurrent infections such as acute tonsillitis, sinusitis, bronchitis, and upper respiratory infections. This pattern raises an important question: is your condition solely due to allergies, or is there an underlying issue with your immune system?
While allergic rhinitis itself is not an immune deficiency, it can indicate that your immune system is hyper-responsive to certain allergens. This hyperactivity can lead to chronic inflammation, which may make you more susceptible to infections. For instance, when your nasal passages are inflamed due to allergies, they can become more prone to infections, as the normal mucosal barrier is compromised. This could explain your recurrent episodes of sinusitis and bronchitis.

It’s also worth noting that individuals with allergic rhinitis often have a higher prevalence of other atopic conditions, such as asthma and eczema, which can further complicate the clinical picture. The fact that you have been treated by both ENT specialists and immunologists suggests that your condition may be multifactorial. The medications prescribed, including nasal sprays and antihistamines, are standard treatments for managing allergic symptoms, but they may not address the underlying inflammation or susceptibility to infections.

If you feel that your current treatment is not effective, it may be beneficial to seek a second opinion or consult with a specialist in a comprehensive allergy and immunology center. These centers often have a multidisciplinary approach, combining the expertise of allergists, immunologists, and ENT specialists. They can perform more detailed assessments, including allergy testing and possibly immunotherapy, which can help desensitize your immune response to specific allergens.

In terms of your immune function, if you have concerns about being immunocompromised, it would be prudent to discuss this with your healthcare provider. They may recommend specific tests to evaluate your immune system's functionality, such as measuring immunoglobulin levels or assessing specific antibody responses.

In summary, your symptoms and history suggest that allergic rhinitis is a significant factor in your recurrent infections, but it does not necessarily indicate a primary immune deficiency. A thorough evaluation by a specialized center may provide you with a clearer understanding of your condition and more effective treatment options. It’s essential to address both the allergic component and any potential underlying immune issues to improve your overall health and quality of life.

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