Rhinitis & Allergy

The ear, nose, and throat are the most common target organs for food allergens. Congestion or inflammation of the nose (rhinitis), sinuses (sinusitis), and throat (pharyngitis) may be due to airborne irritants and allergens; however, food allergy may be the undiagnosed cause of these common problems. Food allergy is suggested by these respiratory symptoms: nasal stuffiness, snoring, increased mucus flow in nose and throat and recurrent sore throats. Recurrent middle ear "infections" are very common in the first five years of life and may be eliminated by proper diet revision. Milk, wheat, and egg white allergy are the most common cause of respiratory symptoms, but many foods do this.

Otitis Media

Allergic Eye Symptoms

Hay Fever & Airborne Allergy 

Asthma

Antihistamines

Indoor Air Pollution

More on Food Allergy

Allergic rhinitis must be one of the most obvious environmental diseases. Hay fever is the prototype of type I allergy and the mechanism was thought to be a straight forward histamine-mediated response to inhaled antigen. The early immediate responses is characterized by sneezing and anterior nasal discharge, often profuse.

Antigen triggers mast cells to degranulate and preformed mediators such as histamine, bradykinin, tryptase, heparin, and cytokines are released, and at the same time the lipid mediators, leukotrienes, are generated from arachidonic acid. The post-capillary venule endothelial cells contract and plasma extravasates into the interstitial space. This fluid accumulates as local edema or crosses the epithelium and appears as rhinorrhea. Sensory nerve endings are stimulated by the released mediators, send afferent messages to the brainstem and release neurotransmitters (substance P, neurokinin A, and others). In the nose and lung, neurogenic responses to immune triggers play an important role in the regulation of organ responses to antigen challenge. Parasympathetic efferents are the tonic stimulus for continued mucous secretion and bronchoconstriction in the lung. A late phase of inflammatory changes in the mucosa develops as other immune cells accumulate in the mucosa and secrete a variety of other mediators.

While there are patients who just have hay fever attacks as discrete events and asymptomatic between pollen or dust exposures there is larger group of patients who develop more chronic symptoms. With continued antigenic exposure a chronic cell-mediated inflammation takes over. The chronic state is more difficult to characterize and understand. Airborne antigens must be absorbed into the mucosa and processed. If the antigens are derived from large structures such pollens, then obviously antigens must be extracted from the pollen as proteins or peptides which are then ingested and presented by macrophages.

Food Allergy & Chronic Rhinitis

Food allergy causes chronic rhinitis with middle ear involvement in children. In infants and young children, nose congestion may present as mouth-breathing, sniffing, snuffling, snorting or snoring, and nose rubbing (sometimes known as the "allergic salute" - pushing the nose up with the palm of the hand until a crease develops across the skin of the nose). Increased mucus flow in nose and throat, ear-plugging with muffled hearing and ringing in the ears, recurrent middle ear "infection", recurrent sore throat, swelling of the neck lymph nodes (glands), chronic or recurrent cough, episodes of chest pain, "tightness", and/or wheezing with shortness of breath.

Food antigens arrive in the mucosa via the circulation and must also be ingested and processed by macrophages in the responding tissue. Antigen presenting cells continue to activate helper T-lymphocytes that continue to secrete lymphokines which may stimulate in turn the proliferation of IgE producing plasma cells, bone marrow production and local infiltration of mast cells and eosinophils.

In the nose and lung, eosinophils tend to accumulate and secrete major basic protein and free radicals that are toxic to the epithelium. This chronic activity may also prime the IgE-mediated, mast-cell response and the tissue activity combines immediate and delayed immune responses. Similar tissue events occur in the lungs. While antihistamines may be successful in blocking discrete acute phase responses, only steroids will inhibit the delayed reactions of chronic rhinitis and asthma.

Food allergy is suggested by: nasal stuffiness, increased mucus flow in nose and throat and sore throats.

• Hay fever (pollen allergy)  tends to produce watery discharge from the nose and comes in seasonal attacks with long symptom-free periods.
• Food allergy congestion tends to be year-long and involves persisting nasal stuffiness and mucus in the throat more than watery discharges.

Food allergy causes thick mucus secretion in the throat and upper airway and many patients are bothered by the need to frequently clear their throats - this leads to unpleasant sounds, interrupted speech, and can seriously hamper the careers of singers, actors and people who must speak fluently and clearly in their work assignments. The extra mucus can hamper breathing at night and is associated with snoring.

Patients often say they have recurring colds or sinus infections and often take antibiotics with the hope of stopping the symptoms. Chronic or recurrent cough, episodes of chest pain, "tightness", and wheezing with shortness of breath are symptoms of lower respiratory tract involvement.

Sore throats can be caused by food allergy and may be acute- coming on with contact with a food or chronic- soreness which persists for weeks of months. Swelling of the neck lymph nodes ("glands") may be associated.

Pelikan reviewed the role of food allergy and noted that skin tests and IgE RAST tests had a low correlation with oral provocation of symptoms, suggesting that food allergy produced rhinitis via a non-IgE mechanism. Rhinitis responses to foods occur in a triphasic pattern - immediate within 20 minutes; late, 4-6 hours, and delayed 24-48 hours. Rhinitis was often associated with other symptoms, typical of systemic food allergy; general malaise, headache, middle-ear response, sinus pressure and urticaria were common. The patients with delayed onset rhinitis had more headaches and general malaise than the immediate reacting group.