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Q. My daughter, who suffers from nasal allergies, has large dark circles under both eyes and my mother-in-law is saying she looks like someone has given her black eyes or shiners. Why does she have these, and what causes them?

A. Nasal allergy symptoms (allergic rhinitis) can really beat up some patients. Dark circles under the eyes are due to swelling and discoloration from congestion of small blood vessels beneath the skin in this area. This can give the appearance of having "gone a few rounds" on the playground.The symptoms of allergic rhinitis often produce a combination of gestures and facial features, particularly in children and teens. The following are telltale characteristics that allergists look for to help diagnose nasal allergies:

Q. My toddler son has had numerous ear infections that started around 6 months of age. Why does my son get so many ear infections, and what can be done to evaluate and treat them?

A. Nasal inflammation and congestion spread easily to the middle ear, especially in babies, causing fluid to accumulate behind the eardrum. If this fluid becomes infected, we treat it with antibiotics. But this only patches the problem. It's important to look for the underlying cause. Repeated ear infections can be a sign of allergies. So if a child is congested for long periods of time, or has three or more ear infections per year, it's time for an evaluation by an allergist, who is trained to detect symptoms and put together a strategic treatment plan. The evaluation starts with a history to understand the intensity of the symptoms, then a physical exam, looking in the nose and the ears and a test to detect the fluid in the ear. If the symptoms suggest allergy, then allergy skin testing or blood testing can be done. Contrary to what some believe, young children can be tested for allergies. However, skin test results may be falsely negative at a younger age, and blood testing may be indicated. Once we know what the child is allergic to and how severe the allergy is, we can put together a management plan. Recurrent fluid buildup and infections can cause hearing loss, so if symptoms continue despite appropriate treatment, the toddler may benefit from surgery. Unfortunately, some doctors wait too long to intervene and stop the cause of the congestion, this results in the overuse of antibiotics as well as potentially unnecessary surgery and hearing loss.

Q. I am a 40-year-old stay-at-home mom who works as a freelance writer and have noticed that I might be starting to develop allergies for the second time in my life. As a child, I had eczema and nasal allergies to ragweed. I outgrew these problems as a teen and had been relatively well until now. Since the beginning of August, I have developed chronic watery, itchy, red eyes with a runny nose and a cough. My husband also mentioned that my breath has started to change. Could I be redeveloping allergies at this point in my life?

A. Yes, this could certainly be occurring. Typically "redeveloping" allergies later in life is caused by a combination of allergic and "non-allergic" triggers. If symptoms are increased while being outdoors during a typical pollen season - such as ragweed at this time of year - this suggests an allergic basis. Ragweed pollinates from mid-August through "Indian Summer" until the first frost in the Northeastern U.S., but this varies depending on location, with pollination somewhat earlier the further south one lives. Tears drain naturally into the nose, and can cause a postnasal drip. In addition, allergenic pollen irritates the nasal lining causing sneezing, congestion and even at times blocks the sinus openings leading to sinus pressure or "sinus headaches". One should also consider non-allergic triggers, as your work likely has you staring at a computer for several hours day which can increase non-allergic dry eye issues, or potentially nasal congestion if exposed to cold air blowing from a nearby AC vent. Windy conditions additionally can increase eye dryness and irritation, as well as nasal symptoms. These are just some of the potential non-allergic triggers. Oral antihistamines may block the itch of allergies, but they also decrease tear formation causing eyes to feel dry and "gritty". The use of medications topically applied to the eyes and nose would be ideal, and an allergist can best assess your triggers and get you relief from these symptoms.

Q. My almost 4-year-old grandson often suffers from a runny nose and sneezing. When these symptoms start, he is given an antihistamine such as loratadine or cetirizine. While these do seem to help, he often later develops a cough and fever. I wonder if he is suffering from nasal allergies/allergic rhinitis. My first question is whether regular use of antihistamines would help prevent these symptoms, and if these can be used long term. Also, would saline or steroid nasal sprays be helpful? Any advice would be appreciated, as he is missing many days of preschool as a result of his symptoms.

A. "Rhinitis" is the general term we use to describe symptoms of runny or stuffy nose, sneezing, and itching of the eyes and nose. This is the nose's natural response to inflammation and irritation. Rhinitis can result from multiple sources such as nasal allergies (called allergic rhinitis), infections (called infectious rhinitis/ common cold or flu ), or irritants (called non-allergic rhinitis). Allergic rhinitis is also commonly known as hay fever, although it does not directly cause fever unless there are associated complications such as sinusitis (bacterial sinus infection). The term "hay fever" is very misleading and has historical origins. Sinusitis is an infection or inflammation of any of the 4 pair of sinus cavities (8 sinuses in total), which can worsen symptoms of nasal allergies and may be the source of the fever. Also, uncontrolled nasal allergies can lead to other complications including fatigue, ear infections, recurrent sore throats, cough, altered sleep patterns, irritability, and poor school performance. Allergic rhinitis can be broken down into two different types based on symptoms and testing: seasonal, when symptoms occur in spring, summer and/or early fall; or perennial, when symptoms occur year-round. Seasonal symptoms are caused by allergic sensitivity to pollens from trees, grasses or weeds, or to airborne mold spores. Perennial symptoms are generally caused by allergic sensitivity to house dust mites, animal dander, cockroaches, and/or mold spores.The best way to find out what kind of rhinitis your grandson may be suffering from is to see an allergist. An allergist is a doctor who is an expert in the diagnosis and treatment of rhinitis along with other diseases and conditions caused by allergies (encompassing the specialty of allergy/immunology). Sometimes several causes of rhinitis can exist together in the same person such as allergic rhinitis along with non-allergic rhinitis, or anatomical abnormalities. An allergist can perform allergy testing to see if allergic sensitivity is playing a role in his symptoms. Once the type of rhinitis is diagnosed, the best treatment options can be discussed, including avoidance measures, medicines, and possibly allergy shots. One class of medications is antihistamines (such as loratadine and cetirizine that you mentioned). Just like the name implies, antihistamines reduce the body s response to histamine, which is a chemical that the body uses to produce inflammation. Some antihistamines can cause people to be sleepy or have symptoms from the drying effect of the medicine. Nonetheless, they are well tolerated and are safe to use long term. This type of medicine often helps to improve symptoms in patients with nasal allergies, but may not be enough to control symptoms alone. Other medicines such as steroid nose sprays can be helpful if antihistamines are not working. Saline rinses are also helpful in people with irritant/non-allergic rhinitis. In summary, there are many ways of treating rhinitis, and each person s treatment should be tailored based on their symptoms, and whether or not allergic sensitivity is present.You also mentioned that your grandson often has a cough along with his nasal symptoms. Cough can be caused by a number of things including rhinitis, reflux of acid from the stomach, or inflamed airways (as in asthma). Often cough at night or after exercise can be a sign of airway inflammation or asthma, which an allergist can also help diagnose and treat. If asthma is recognized early, appropriate treatment can keep symptoms from becoming worse and allow a person to lead a normal life, without limitation!

Q. Several people have recommended I eat local honey as a remedy for my seasonal allergies. Does it really help?

A. There is a widespread belief that eating local, unprocessed or "raw" honey can help allergy symptoms by regularly exposing you to pollen - not unlike the concept of how allergy shots work. Allergy injections help desensitize pollen-allergic people by exposing them to a specific pollen or pollen mixture injected at regular intervals. An important difference here is that the pollen amounts in allergy injections are known, and progressively increasing to a certain level, for best results. Studies have shown allergy shots are very effective for decreasing seasonal allergy symptoms. Local, unprocessed honey does contain small amounts of pollen from the environment. The pollen in honey is mostly from the flowers where bees are found (with flowering plant pollen less likely to cause allergy symptoms) and allergenic, airborne pollen from trees, grasses and weeds (not pollinated by bees!) in lesser amounts. Thus, the amount of allergenic pollen in the honey is typically very small, as bees don't intentionally incorporate this pollen into the honey. This is considered a contaminant, like the bee parts, mold spores, bacteria and other environmental particles that can be found in honey. (Commercial processing seems to remove most pollen and contaminants.) There is no scientific proof that eating local honey will improve seasonal allergies. One study, published in 2002 in the Annals of Allergy, Asthma & Immunology, showed no difference among allergy sufferers who ate local honey, commercially processed honey, or a honey-flavored placebo. And in rare cases there might actually be a risk. In extremely sensitive individuals, the ingestion of unprocessed honey can result in an immediate allergic reaction involving the mouth, throat, or skin - such as itching, hives or swelling - or even anaphylaxis. Such reactions may be related to either pollen or bee part contaminants.

Q. My son gets frequent nosebleeds during the late spring. When he wakes up in the morning, there is blood on his pillow. We have tried putting Vasoline, in his nose but it doesn't help. What can we do to prevent his nose from bleeding?

A. Nosebleeds are a common problem for children who have allergies. The bleeding happens because there are many blood vessels just inside of the nasal opening on the middle part of the nose (called the nasal septum). You can damage it through vigorous rubbing, picking the nose, or even incorrect use of nasal sprays. Nosebleeds often happen at night, because you may pick and rub at your nose in your sleep.

Though it can be scary when your nose bleeds a lot, it is not usually dangerous. The most effective way to stop a nosebleed is to apply pressure by pinching your nose closed and holding it firmly for 5 minutes. That will cause the broken blood vessel to clot and the bleeding to stop. It is not a good idea to apply Vasoline or other substances to the nose to stop the bleeding once it has started. This won't help, and it can irritate your nose even more. If the nosebleeds persist, or don't improve after a reasonable amount of pressure, consult your doctor.

The best way to prevent nosebleeds that are worsened by allergies is to treat the underlying problem that is causing discomfort that leads to rubbing and picking. Treatment often involves use of medicines for allergies taken orally (such as antihistamines) or nasally (such nose sprays).

Nasal sprays must be used correctly or they can increase the risk of nosebleeds. Proper technique involves spraying away from the middle of the nose, up and out towards the ear.

Saltwater (saline) nasal rinses can be very effective for removing nasal secretions and dried up mucus. As long as you're using it correctly, you don't need to wait a long period after a nosebleed to make use of a nasal rinse. The rinse should not be too vigorous. To avoid trauma to the blood vessels, don't insert the bulb syringe or Netipot very far into the nose. Residual or dried blood may come out with these rinses.


Q. I am an 18 year-old female, and I currently suffer from allergies. They really only flare up in the morning, and the rest of the day they are fine, with a few sneezes here and there. I have also suffered from second-hand smoke since I was born. Is this a specific type of allergy?

A. It is common for allergies to flare up in the morning for a variety of reasons. The first is that people can be exposed to common allergens at night while they are sleeping, and morning symptoms may be a reflection of nighttime exposure. Pollen counts are often at their highest in the early mornings. In people who are allergic to pollens, this can be a time when symptoms occur most strongly, especially if you are outdoors or around open windows. Your allergist can perform testing to help determine if allergies are playing a role in your symptoms.

Second hand smoke exposure is a common trigger for nasal congestion and runny nose; but second hand smoke is actually not an allergic trigger, but rather an irritant trigger. Other common irritants include fireplace smoke, fragrances, and cleaning agents. Symptoms resulting from exposure to irritants are often the same as those triggered by allergies. An evaluation with your allergist and allergy testing can help determine if allergies are the cause of your symptoms. 

Q. When I drink water or other liquids I often get a very runny nose. Why? Is there something to stop that?

A. Based on your description of runny nose in association with drinking a variety of beverages, you may have gustatory rhinitis. You should see your physician, who may wish to observe you drinking for a physical examination at the time of symptoms. Evaluation with your physician will help to establish a diagnosis.

Gustatory rhinitis is associated with watery nasal discharge within a few minutes of ingestion of solid or liquid foods. Hot or spicy foods frequently cause symptoms. Gustatory rhinitis typically does not have associated itching, sneezing, congestion or discomfort. Gustatory rhinitis is thought to be related to nerve stimulation, and is frequently treated with anticholinergic nasal sprays such as Ipratropium bromide (Atrovent, Apovent, Ipraxa, Aerovent and Rinatec.)