Medical Edge Newspaper Column

When Allergy Symptoms Aren't Relieved By Allergy Treatment

May 23, 2008
Dear Mayo Clinic:
I have a constant nasal drip that causes my throat to feel itchy. I have a feeling of mucus in my throat. And I can't control or stop the cough. I have had a chest X-ray, blood tests, allergy pills and nasal sprays. Is there something else my doctor should be looking for?

Answer:
Your itchy throat, nasal drip and cough are among the hallmark symptoms of an allergy. But, the fact they aren't relieved with the allergy medications you mention seems to indicate that the underlying problem isn't as simple as an allergic reaction. You'll probably need further evaluation with a specialist to find the root cause.

The symptoms people often think of regarding allergies — a stuffy or runny nose, sneezing and itchiness — are caused by an inflammatory chemical called histamine. Your body's immune system releases histamine during an allergic reaction. The more severe the allergy, the more histamine that is released and, consequently, the more symptoms you experience.

The good news for those who have allergies is that the medications now available usually work quite well to combat the body's reaction to histamine. People may have to try various allergy medications or combinations of medications to find what works best for them, but most can find relief from their symptoms.

Persistent symptoms such as yours, however, call for a more in-depth investigation. You say you've had blood tests and a chest X-ray. These tests can reveal some underlying conditions, such as a low-grade infection or a lung disorder. Because they didn't uncover anything, though, I'd recommend you see an ear, nose and throat specialist (otorhinolaryngologist) for a more comprehensive evaluation.

This specialist will likely perform nasal endoscopy, a procedure that involves inserting a tiny video camera attached to the end of a flexible tube (endoscope) into your nose. Using images from the camera, the doctor then can inspect your nasal passages and sinuses, see behind your nose and tongue, and check out your vocal cords and throat. Nasal endoscopy will show if the lining of your nose or sinuses is inflamed or infected, which could be causing your symptoms.

In some cases, inflammation results in nasal polyps. These polyps are soft, noncancerous (benign) growths that develop on the lining of nasal passages. Polyps often cause a chronic stuffy, runny nose, and they can lead to sinus infections. Nasal endoscopy also might reveal that you have chronic sinusitis, a sinus inflammation that causes fluid to build up and eventually plug the sinus cavity. One result of chronic sinusitis can be a persistent cough.

These are just two possibilities. Other, less likely culprits could be cancer or structural problems within your nose, such as a crooked wall between the nostrils (deviated nasal septum) or unusually small openings between your sinuses and nasal cavity.

An ear, nose and throat specialist has the tools and expertise to diagnose these and other conditions. Once the underlying problem has been found, treatment likely is available.

— Robert Gillham Jr., M.D., Allergy, Mayo Clinic, Jacksonville, Fla.