Nasal allergies and hay fever

It is not always obvious. Many people with nasal allergy never itch, sneeze or run — their only symptom is congestion. The clues are elsewhere in the body: itchy or watery eyes, reactive skin such as eczema or atopic dermatitis, and asthma, particularly asthma that began in childhood. These are allergic conditions, and when they are present, allergy is usually affecting the nose as well.

The most reliable test is skin prick (epicutaneous) testing: a drop of each allergen is placed on the forearm and the skin is pricked through it; a small itchy bump within 15–20 minutes shows a reaction. It is quick and not painful, and it is done in our suite at Kogarah. Blood tests for allergen-specific IgE are the alternative when skin testing is not possible. One important limitation: a positive test is reliable, but a negative skin or blood test does not exclude allergy in the nose — the false-negative rate is high. That is why examination of the nose with an endoscope is so important: it shows whether the lining looks allergic, whatever the tests say.

Immunotherapy works by identifying which airborne allergen — dust mite, grass pollen, animal dander, mould — your immune system is reacting to most, and then exposing the immune system to a controlled dose of that allergen regularly until it stops over-reacting. It is most often given as a tablet dissolved under the tongue every day, sometimes as drops; it can also be given as injections by a doctor, weekly at first and then every four weeks as a maintenance dose. Benefit is expected within the first six months of treatment, and most people continue for one to three years. It is one of the most established and well-researched treatments for long-term control of allergy, treats the allergy itself rather than suppressing symptoms, and benefits the eyes, skin and lungs as well as the nose. Dr Jessica Tattersall provides immunotherapy at Kogarah — see allergy testing and immunotherapy.

Yes, in three ways. First, by answering whether it really is allergy — examining the nose with an endoscope and testing — and excluding the other conditions that mimic it. Second, by deciding whether immunotherapy is appropriate, so the allergy is treated rather than suppressed. Third, when there is a structural problem causing a true restriction of airflow — not just a sense of congestion — septal and turbinate surgery can help. At Kogarah the ENT surgeons and our allergist work in the same suite, so this is done together.

Yes, at any age, although testing is generally done from about five years onwards: by then it has usually become clear whether a child is atopic — has an allergy-skewed immune system — and the results are more useful. Skin prick testing is quick and safe in children and is done in our suite at the time of the appointment by the scientists of our nasal airway laboratory, with assessment by our allergist for children with hay fever, asthma or eczema.