Should You Consult an Immunologist for Chronic Allergies and Symptoms?

Allergy medications

Hello, doctor.
I have a history of severe nasal allergies, but now my symptoms have shifted to being sensitive to cold and easily catching colds (such as being uncomfortable with direct air conditioning).
I have poor temperature regulation and am prone to heat exhaustion.
I haven't taken allergy medication for over 20 years.
However, I only experience significant nasal allergy symptoms when I have a cold.
At night, I alternate between nasal congestion on both sides, and when exposed to cold or dust, I feel dizzy, fatigued, and sleepy.
I am currently seeing an ENT specialist, but the steroid nasal spray prescribed has been used for almost four weeks with little effect on my nasal congestion (my turbinates are already hypertrophied).
I wonder if this is due to potential drug resistance from long-term treatment.
As for oral medications, I rarely experience runny or sneezing symptoms, but the side effects make me more drowsy and dizzy, so taking them feels the same as not taking them.
I have heard that allergic rhinitis falls under the scope of immunology treatment, and I also had a history of X measles in my youth, with my skin becoming easily dry and itchy in winter, sometimes leading to constant scratching.
Should I consider consulting an immunologist for comprehensive treatment?

AD, 40~49 year old female. Ask Date: 2015/03/08

Dr. Gao Jiankai reply Internal Medicine

Hello, the medications for nasal congestion and runny nose/sneezing can differ, and commonly used medications, such as antihistamines, are categorized into traditional and newer generations.
Therefore, it may be beneficial to consult an allergist or immunologist for tailored medication and advice.
Additionally, nasal congestion and runny nose are not solely symptoms of allergies; they can also result from the nasal mucosa being sensitive to temperature or cold air, leading to reflexive congestion of the mucosa.
Thus, further immunological testing is also a reasonable option.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, cares about your well-being.

Reply Date: 2015/03/08

More Info

Consulting an immunologist for chronic allergies and related symptoms can be a prudent decision, especially given your history of severe allergic rhinitis and the evolution of your symptoms over the years. Allergies are a manifestation of the immune system's response to perceived threats, and when these responses become chronic or problematic, a specialist in immunology can provide valuable insights and treatment options.

Your symptoms, which include a heightened sensitivity to cold, frequent colds, and nasal congestion, suggest that your immune system may be reacting inappropriately to environmental triggers. Chronic nasal congestion, particularly if it has not responded to steroid nasal sprays, could indicate an underlying issue that requires further investigation. An immunologist can perform specific tests to identify potential allergens and assess your immune system's functionality.

One of the key roles of an immunologist is to differentiate between various types of allergic reactions and to determine whether your symptoms are due to allergies, an autoimmune condition, or another immunological disorder. For instance, your history of severe allergic rhinitis and the development of symptoms like dizziness and fatigue could be linked to an overactive immune response or even an autoimmune condition, which can sometimes mimic allergic symptoms.

In addition to allergies, your mention of experiencing skin issues like dryness and itching during winter months could also be related to immune system dysfunction. Conditions such as eczema or chronic urticaria (hives) can be exacerbated by environmental factors and may require a comprehensive treatment plan that includes both dermatological and immunological perspectives.

Moreover, the fact that you have not taken allergy medications for over 20 years suggests that your symptoms may have evolved, and your body may have developed a different response to allergens over time. This could lead to a phenomenon known as "sensitization," where the immune system becomes more reactive to certain allergens, potentially leading to more severe symptoms.

An immunologist can also provide guidance on the appropriate use of medications. If you are experiencing side effects from oral antihistamines, it may be beneficial to explore alternative treatments or adjust dosages. Additionally, they can discuss the potential for immunotherapy, which can help desensitize your immune system to specific allergens over time.

In summary, given your complex history of allergies and the persistence of your symptoms, consulting an immunologist is advisable. They can conduct a thorough evaluation, including allergy testing and possibly immune function tests, to develop a tailored treatment plan that addresses both your allergic symptoms and any underlying immune system issues. This comprehensive approach can lead to better management of your symptoms and an improved quality of life.

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