I have had ongoing sinus problems for years, and in November 1996 was tested for allergies and started on allergy shots. I also got an air purifier at that time. Since then, my sinuses have been bleeding and since mid-February I've developed a terrible sinus infection that didn't clear with 3 weeks of Ceftin and now I am on the second day of Biaxin. Also, I've been dizzy, as if my balance is off, my chest has been hurting when I breathe and I feel incredibly terrible. The allergist's nurse says that allergy shots cannot make you worse, but I feel like the symptoms have slowly escalated each time I get a shot. Have you heard of people getting worse on allergy shots? If the Biaxin doesn't clear my infection (they ordered it for 10 days-.,then what?P{lease help. THanks
Reply: -------------------
It is possible that you have chronic sinusitis. Allergy treatment, whether it be avoidance, medication, or shot therapy, is not a primary treatment for chronic sinusitis. It is true that chronic sinusitis may result from untreated allergies, and therefore allergy evaluation and management may certainly be an appropriate adjunct in the evaluation and management of chronic sinusitis.
Chronic sinusitis however, must be dealt with and treated directly, separately from allergy treatment. In fact, the medications most commonly prescribed for allergies known as antihistamines, actually can be detrimental to management of chronic sinusitis. This is because antihistamines dry secretions up and this impairs sinus drainage. When chronic sinusitis is present, it is necessary to enhance sinus drainage in order to speed up the resolution of the infection. Thus, until chronic sinusitis is resolved, antihistamines should be avoided.
Chronic sinusitis usually will require multiple treatment approaches including antibiotic therapy, mucous-thinning medication, topical nasal steroids, etc. Antibiotic therapy is usually required for an extended period of time (weeks) because there are usually multiple organisms involved and because it is more difficult to get good tissue concentrations of antibiotics in the lining of sinuses as opposed to other tissues in the body. Mucous thinning medication, known as expectorants, are recommended to assist in the mobilization of tenacious mucous. Guaifenesin is commonly used. Topical nasal steroids are highly recommended in this condition since they do not appear to inhibit sinus drainage and they are very helpful in reducing swelling and inflammation of the sinus and nasal lining which is necessary to improve ventilation. Improved ventilation helps to eradicate infection since many of the organisms found to be involved in chronic sinusitis thrive in environments low in oxygen. I also highly recommend pulsed nasal irrigation with a "Water-pik" device using a warm dilute salt water solution. This greatly helps mobilize thick secretions and helps to stimulate normal sinus drainage.
When sustained multiple modality treatment for chronic sinusitis fails to result in symptomatic improvement after 1-2 months, CT scan imaging of the sinuses would be recommended. If significant obstruction to the normal drainage pathways was seen at this point on CT scan despite aggressive medical treatment, then surgical intervention may be the most appropriate course.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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