Adults
are moody and work less efficiently
Hayfever results in poor quality sleep,
fatigue and daytime sleepiness. Adults find it harder to think
and function at work, suffer from greater absenteeism and more
work-related injury. They are more irritable and moody than their
healthier friends and find it harder to make important decisions.
They
are also more prone to injury
Treatment with sedating older antihistamines makes the situation worse. Even when sleepiness is not recognised, use of these medications slows down their reflexes and ability to drive a car safely. In one study of work-related injuries by Gilmour (1996), antihistamines increased the risk of injury by 50 %. Even taking a sedating antihistamine at bedtime can make people sleepy the next day.
Allergic children do less well
at school
Hayfever and its treatment can cause daytime sleepiness and
interfere with learning. A number of studies in children have
demonstrated poor memory, examination performance, and impaired
ability to recall information taught during class. Hearing loss
due to eustacian tube dysfunction or middle ear infection can
also interfere with academic performance.
Sinus infections are more common
An association between allergy and sinusitis is supported
by the fact that the lining of sinuses is thickened in allergic
subjects and the high incidence of allergy in patients suffering
from chronic (ongoing) sinusitis (~40-80%) or acute (short-lived)
sinusitis (75% in one paediatric study, Lombardi 1996).
Nasal
polyps grow faster too
Even though the majority of patients with nasal polyps are
not allergic, those who are allergic have polyps that grow back
at a faster rate and have an increased rate of relapse after surgery.
For example, the recurrence rate in one study of 140 patients
was 36% in allergic patients but only 18% in non-allergic subjects
(Farrell 1993).
Hayfever patients have a poor sense of smell and taste
Major causes include allergic rhinitis, sinusitis and nasal
polyps. Approximately 20 % of patients with allergic rhinitis
((hay fever) have a reduced sense of smell and taste.
Impact of allergic rhinitis on the eustacian tube and middle
ear infection
Otitis media with effusion (OME) is a non-infectious inflammatory
condition of the middle ear resulting in a serous effusion ("fluid
in the ears"), eustacian tube dysfunction and hearing loss.
It may also predispose to acute middle ear infection. Around 20%
of allergic children have OME, and 35-50% of patients with OME
are allergic.
Impact of allergic rhinitis
on sleep apnoea
Obstructive sleep apnoea results from collapse of the upper
airways during sleep. This results in reduced airflow, a drop
in oxygen levels and disturbed sleep. Factors predisposing to
this condition include being over weight and having a blocked
nose. Nasal blockage is associated with more severe obstructive
sleep apnoea, arousals during sleep and daytime sleepiness. These
abnormalities had been found to be reversible with surgical correction
of anatomical abnormalities, topical nasal steroid sprays in patients
with allergic rhinitis and reduced allergen exposure in patients
with seasonal allergic rhinitis.
Impact of allergic rhinitis on facial structure
Observational studies have linked chronic mouth breathing
to structural changes of the face. Nasal obstruction due to allergic
rhinitis or adenoid hypertrophy (the so-called "adenoid facies")
have been associated with a long and narrow face, a long narrow
tongue, high arched palate, small lower jaw, over bite and cross
bite and dental crowding and malocclusion.
While there was initial uncertainty whether these changes were
caused by nasal congestion or contributed to it,
animal studies have demonstrated the development of similar abnormalities
in experimental models. Furthermore, some have been shown to be
reversible when the obstruction has been relieved. These observations
have cosmetic and functional implications to patients with severe
dental abnormalities. What is uncertain, however, is whether these
changes are reversible in humans (there are only a few small studies),
and if so, when treatment must be commenced to achieve this aim.
Allergic rhinitis and gum inflammation
(gingivitis)
The incidence of gum inflammation (gingivitis) and severity
of dental plaque is increased in patients who mouth breath, perhaps
secondary to reduced protection of the mouth by open lips.
Allergic rhinitis and asthma
Asthma and allergic rhinitis frequently
co-exist. For example, approximately 25 per cent of patients with
allergic rhinitis have asthma, and approximately 75 per cent of
asthmatic patients have allergic rhinitis. The presence of allergic
rhinitis also substantially increases the cost of treatment of
asthma, by approximately 50 per cent in recent studies (Yawn 1999).
Pathogenic mechanisms are similar, and both disorders can respond
to similar treatment strategies including allergen avoidance,
use of medication and immunotherapy. Sub-clinical bronchial inflammation
and hyperactivity can also be found in patients with allergic
rhinitis, even in the absence of lower respiratory tract symptoms.
Allergic rhinitis often precedes the onset of asthma. For example,
a follow-up study of children aged three to 17 years demonstrated
the development of asthma or allergic rhinitis in 19 per cent
of cases over a 10-year period. (Linna 1992). A 23-year followup
study of American College students demonstrated that in those
with a history of both disorders, 45 % developed hayfever first,
34 % developed asthma first, and 21 % developed both disorders
at the same time. Of those with allergic rhinitis, 21 % developed
asthma over a 23-year period (Greisner 1998).
There is much anecdotal evidence, and some published evidence,
that the severity of allergic rhinitis influences that of asthma
(Corren 1997). Proposed mechanisms include the inhalation of cool
dry air due to mouth breathing, aspiration of inflammatory nasal
contents, the nasobronchial reflex and subjective symptoms of
chest tightness in patients with severe nasal congestion. Since
allergy is a systemic disorder, it is also conceivable that local
nasal inflammation might have an effect on inflammation in distal
organs such as the bone marrow and lower airways via humoral mechanisms
(O'Byrne 1999, Denburg 1999, Inman 1999).
Not only made these disorders co-exist, but treatment of rhinitis
may actually improve asthma control. For example, antihistamines
(cetirizine, loratadine and terfenadine) have been shown to improve
asthma symptoms when administered at higher than routine recommended
doses. Whether this relates to control of rhinitis, asthma or
both is uncertain. Nasal steroid sprays have been shown to reduce
bronchial hyperactivity on provocation testing and to improve
asthma symptom scores. In some cases, this has been achieved more
effectively by administering medication to the nose then when
the same drug is inhaled into the lung (Aubier 1992). Similar
changes have been observed in patients with both seasonal and
perennial allergic rhinitis. Indeed in some cases, treatment can
be shifted from the lower to the upper airways with greater overall
disease control.
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