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Sinusitis

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Related Terms
  • Acute sinusitis, allergic fungal sinusitis, allergic reaction, allergy, allergy shots, Aspergillus,asthma, chronic sinusitis, congestion, endoscope, endoscopic examination, fungal infection, fungal rhinosinusitis, fungal sinusitis, fungus, head congestion, immunotherapy, inflammation, Mucor,nasal congestion, nasal inflammation, nasal passageway, nasal polyposis, nasal polyps, nasal sinuses, nasal tissue, nose, paranasal, paranasal sinuses, polyp, polypoidal, polypoidal masses, postnasal drip, rhinitis, sinus infection, sinuses.

Background
  • Sinusitis refers to inflammation of the nasal sinuses (the hallow cavities around the cheekbones, eyes, and nose), which may or may not be the result of an infection. Today, sinusitis is often referred to as "rhinosinusitis," since inflammation of the sinuses cannot occur without some rhinitis (inflammation of the nose) as well.
  • Sinusitis is most common during the winter season, and it may last for months or even years if not treated properly. According to the Centers for Disease Control and Prevention (CDC), more than 18 million visits to primary care physicians result in a sinusitis diagnoses each year.
  • There is an association between sinusitis and asthma, according to the CDC. Researchers estimate that more than 50% of patients with moderate-to-severe asthma also suffer from chronic sinusitis.
  • Allergic fungal sinusitis: Individuals who are allergic to fungi can develop allergic fungal sinusitis. This type of sinusitis is uncommon and usually occurs in individuals who have compromised (weakened) immune systems. However, recently, the occurrence of fungal sinusitis has increased in the general population. The most common pathogens are from Aspergillus and Mucor species. This condition is usually chronic (lasts longer than eight weeks) and recurrent.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Academy of Allergy Asthma & Immunology. Rhinitis & Sinusitis. .
  2. Asthma and Allergy Foundation of America. Rhinitis and Sinusitis. .
  3. National Institute of Allergy and Infectious Diseases. Sinusitis. .
  4. Natural Standard: The Authority on Integrative Medicine. .

Causes
  • Bacterial infections are usually the cause of acute sinusitis. When the sinuses are blocked for a long time, a secondary bacterial infection may develop, causing sinusitis.
  • Individuals who suffer from allergic asthma are more likely to develop sinusitis than nonallergic individuals. Certain allergens (like cigarette smoke, air pollution, dust mites, or mold spores) can trigger inflammation of the sinuses and mucous linings. The swelling prevents the sinus cavities from getting rid of bacteria and therefore increases the risk of secondary bacterial sinusitis.
  • Individuals suffering from allergic rhinitis (hay fever) or vasomotor rhinitis (nonallergic rhinitis) are also more likely to develop sinusitis.
  • Individuals who have compromised (weakened) immune systems (like chemotherapy patients) or immune system disorders (like HIV) are also more susceptible to sinusitis.
  • Structural abnormalities of the nose, including narrow drainage passages, tumors, polyps, or a deviated nasal septum, may also cause sinusitis.
  • The cause of chronic sinusitis is less clear. Some experts think it may be the result of an infectious disease. Fungal infections of the sinuses have also been linked to many cases of chronic sinusitis, but the evidence is still controversial.
  • Individuals who suffer from chronic or recurrent sinusitis usually have multiple factors that make them more susceptible to infection.

Symptoms
  • Symptoms for acute and chronic sinusitis are very similar, except chronic sinusitis symptoms last longer and often cause more fatigue.
  • Sinusitis can affect the nose, eyes, or middle ear. Symptoms often include thick nasal drainage, bad-tasting postnasal drip, plugged-up nose, cough, difficulty breathing, head congestion, headache, facial swelling, toothache, constant fatigue, tender cheeks, swollen eyelids, pain between the eyes, neck pain, and occasionally fever.
  • Individuals suffering from chronic sinusitis may also have nasal polyps, which are polypoidal masses (abnormal tissue growths) found in the mucous membranes of the nose and paranasal sinuses. Since nasal polyps often block the nasal passages and sinuses, they may cause breathing difficulty.

Diagnosis
  • Allergy testing may be conducted to detect specific allergens that might be causing the sinusitis.
  • Computerized tomography (CT) scans, which produce detailed images of the sinus cavities, may be used to identify inflamed areas.
  • Cultures (blood tests) may be used to detect a bacterial or fungal infection.
  • An endoscopic examination may be performed. During this procedure, a narrow, flexible fiber-optic scope is inserted into the nasal cavity through the nostrils. The physician is then able to see where the sinuses and middle ear drain into the nose.
  • Blood tests may be conducted to rule out other conditions that may be associated with sinusitis, like an immune deficiency disorder or cystic fibrosis.

Treatment
  • Chronic sinusitis is often difficult to treat successfully. Many individuals with chronic sinusitis still experience symptoms after taking antibiotics for a long period of time.
  • Allergen immunotherapy: Allergen immunotherapy (allergy shots) may help control chronic or recurrent sinusitis. During immunotherapy, the patient receives periodic injections, as determined by the allergist or immunologist, over the course of 3-5 years. The solutions in the injections contain dilutions of the substances the individual is allergic to. The treatment helps the immune system tolerate the allergens and lessens the need for medications.
  • Antibiotics: If a bacterial infection is present, an antibiotic will be prescribed. Antibiotics are usually taken for 3-12 weeks, or until the individual is symptom free for seven days. In addition, low doses of antibiotics and expectorants may be prescribed as preventive measures at times when symptoms are likely to be the worst, such as the winter season. Antibiotics are only used as a preventive treatment in patients who have chronic recurrent sinusitis.
  • Antihistamines and decongestants: Antihistamines or decongestants can be taken orally or administered in the form of a nasal spray. These medications may reduce backed-up mucus in the sinuses and provide temporary relief. Examples of these medications include Afrin®, Sudafed®, Allegra® and Claritin®. Decongestant sprays should not be used more than twice daily for three consecutive days, because rhinitis medicamentosa (rebound nasal congestion) may result.
  • Endoscopic sinus surgery: In cases that are persistent and continually resistant to treatment, endoscopic sinus surgery may be an option. During this procedure, the physician inserts an endoscope into the nasal passage. Then, depending on the source of obstruction, the physician may remove tissue or a polyp or shave down a bone that is blocking the passageway. Also, the physician may surgically enlarge a narrowed sinus opening to promote drainage.
  • Expectorants: Expectorants (like guaifenesin) may help thin the sinus mucus to promote drainage.
  • Nasal corticosteroids: Nasal corticosteroid sprays (like Flonase®, Beconase® or Nasacort®) may be used to reduce nasal inflammation.
  • Oral corticosteroids: Oral corticosteroids (like prednisone) are often used to relieve tissue swelling that contributes to sinus blockage. Since oral corticosteroids can produce serious adverse affects like hypertension, diabetes, cataracts, and stomach ulcers, they should only be taken when all other medications have failed.
  • Other: Several nondrug treatments may also relieve symptoms. These include breathing in hot, moist air, as well as washing the nasal cavities with salt water.

Integrative therapies
  • Strong scientific evidence:
  • Whey protein: Hydrolyzed whey protein formula may be effective in preventing certain allergies. However, additional research is needed before a definitive conclusion can be made.
  • Use cautiously in patients using any medications, because drugs may bind to human milk whey proteins. As a result, the levels of these drugs may be changed in the blood. Since whey protein may lower blood sugar levels, caution is advised in patients with diabetes or hypoglycemia. Caution is advised in those taking drugs, herbs, or supplements that affect blood sugar, increase the risk of bleeding, lower blood pressure, or affect the immune system. Whey protein may interfere with the way the body processes certain drugs, herbs, or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of these agents may change in the blood and may cause increased or decreased effects or potentially serious adverse reactions. Avoid use of excessive doses for long periods of time, because it may cause kidney damage or bone loss. Avoid in those with known allergy or hypersensitivity to milk or milk products. Avoid in pregnant or breastfeeding women.
  • Good scientific evidence:
  • Bromelain: Bromelain may be a useful addition to other therapies used for sinusitis (such as antibiotics) due to its ability to reduce inflammation and swelling. Studies report mixed results, although overall, bromelain appears to be beneficial for reducing swelling and improving breathing. Better studies are needed before a firm conclusion can be made.
  • Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or members of the Bromeliaceae family. Use cautiously in those with a history of bleeding disorders, stomach ulcers, heart disease, or liver or kidney disease. Use caution before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Butterbur: Good scientific evidence suggests that butterbur may be effective for allergic rhinitis prevention in susceptible individuals. Comparisons of butterbur to prescription drugs, such as fexofenadine (Allegra®) and cetirizine (Zyrtec®), have reported similar efficacy. Additional studies are warranted before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to Petasites hybridus or other plants from the Asteraceae or Compositae family (such as ragweed, marigolds, daisies, and chrysanthemums). Raw, unprocessed butterbur plant should not be eaten due to the risk of liver or kidney damage or cancer. Avoid if pregnant or breastfeeding.
  • Galphimia glauca: Research indicates that Galphimia glauca, alone or in combination with other agents, has been effective in the treatment of allergies, due to its reduction of nasal and ocular symptoms. Additional studies are needed before a firm conclusion can be made.
  • Use Galphimia glauca cautiously in patients with psychiatric disorders, as feelings of confusion and lack of concentration may occur. Use Zicam® Allergy Relief Nasal Pump (a Galphimia glauca combination product) cautiously in patients who have ear, nose, and throat sensitivity or those who are susceptible to nosebleeds. Use cautiously in patients taking central nervous system (CNS) depressants. As Galphimia glauca may increase the risk of bleeding, use cautiously in patients with blood disorders or those using anticoagulants or antiplatelets. Avoid in those with known allergy or hypersensitivity to Galphimia glauca, its constituents, or to members of the Malpighiaceae family.
  • Nasal irrigation: There is good evidence from clinical studies to recommend the use of nasal irrigation in the treatment of allergic rhinitis. One study demonstrated that reflexology massage may be equally effective; however, the advantages of irrigation (i.e., that it is inexpensive, is performed at home, and has minimal adverse side effects) make the technique beneficial. Methodological and statistical reporting are lacking in some of these trials. A well-conducted, randomized controlled trial that fully reports data would make the case for allergic rhinitis stronger.
  • Early research suggests that nasal irrigation may help treat chronic sinusitis, with improvements in sinus-related quality of life, decreases in symptoms, and reductions in medication use. Further research is needed before a conclusion can be made.
  • Nasal irrigation is generally well tolerated. Use cautiously in those with history of frequent nosebleeds. If the irrigation liquid is hot, the nose may become irritated.
  • Probiotics: Use of probiotic Enterococcus faecalis bacteria in hypertrophic sinusitis (sinus inflammation) may reduce frequency of relapses and the need for antibiotic therapy. Further research is necessary before a firm conclusion can be made.
  • Probiotics are generally considered safe and well tolerated. Use cautiously if lactose intolerant. Avoid if allergic or hypersensitive to probiotics.
  • Unclear or conflicting scientific evidence:
  • Acidophilus: Although not well studied in humans, some research has suggested that lactic acid-producing bacteria, such as L. acidophilus, may reduce allergic responses of the immune system. There is some evidence that milk fermented with L. acidophilus strain L-92 may relieve the symptoms of allergic rhinitis; however, immune parameters were not affected in studies examining L. acidophilus alone as a therapy for allergic rhinitis. Further studies are needed before a conclusion can be made.
  • L. acidophilus is generally well tolerated, with very few side effects. Lactose-sensitive people may develop abdominal discomfort or other side effects from L. acidophilus-containing products, due to small amounts of lactose left over from the manufacturing process. Avoid in patients with weakened immune systems or milk allergies. Avoid in those with a history of injury or illness of the intestinal wall or heart valve surgery. Use cautiously in those with heart murmurs. Avoid use with immunosuppressive prescription drugs, such as corticosteroids, due to an increased risk of infection. Antibiotics or alcohol may destroy L. acidophilus. Therefore, it is recommended that L. acidophilus be taken three hours after taking antibiotics or drinking alcohol. Some individuals may use antacids, such as famotidine (Pepcid®) and esomeprazole (Nexium®), one hour before taking L. acidophilus to decrease the amount of acid in the stomach.
  • Acupuncture: Although some studies suggest that acupuncture may offer possible benefits in nonallergic rhinitis, there is currently insufficient available evidence on which to base recommendations. Additionally, further well-designed studies are needed to determine whether or not acupuncture offers benefit to those with sinusitis.
  • Acupuncture should be avoided in patients with heart disease, pulmonary disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Pregnant women, the elderly, diabetics, people with a history of seizures, and those receiving radiation therapy and/or taking drugs that increase the risk of bleeding should also avoid acupuncture.
  • Applied kinesiology: Applied kinesiology (AK) has been used to diagnose a variety of allergies, including food intolerances, but currently there is little strong evidence to support this application.
  • AK techniques themselves are considered to be harmless. However, medical conditions should not be treated with AK alone, and AK should not delay appropriate medical treatment. There is not enough evidence available to suggest that AK is safe for use during pregnancy and breastfeeding.
  • Aromatherapy: Despite widespread use in over-the-counter agents and vapors, there is not enough scientific evidence to recommend use of eucalyptus oil as a decongestant-expectorant (by mouth or inhaled form).
  • Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
  • Astragalus: According to one study, astragalus, as part of a combination formulation, decreased runny nose in patients with seasonal allergic rhinitis. Additional well-designed trials are needed to confirm this finding.
  • Avoid with aspirin or aspirin-containing products or herbs or supplements with similar effects. Avoid in those with inflammation or fever, stroke, transplants, or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery or dental or diagnostic procedures with a risk of bleeding, and avoid use immediately after these procedures. Use cautiously in those with bleeding disorders, diabetes, high blood pressure, lipid disorders or kidney disorders. Use cautiously with blood thinners, blood sugar drugs, diuretics, or herbs and supplements with similar effects. Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid if pregnant or breastfeeding.
  • Black seed: Studies in patients with allergies found that black seed decreased subjective measures of severity of allergies. The effect of black seed on allergies is still not clear, and further research is required before a conclusion can be made.
  • Avoid with a known allergy or hypersensitivity to black seed, its constituents, black seed oil, or to members of the Ranunculaceae family. Allergic contact dermatitis has been reported after topical use of black seed or the oil from the seed.
  • Cat's claw: It has been suggested that cat's claw may help treat allergies and related respiratory diseases. However, there is currently limited scientific evidence to support this claim. More well-designed trials are needed to determine whether cat's claw is a beneficial treatment.
  • Avoid if allergic to cat's claw or Uncaria plants or plants in the Rubiaceae family, such as gardenia, coffee, or quinine. Avoid with history of conditions affecting the immune system (such as AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis, and lupus). Use cautiously in those with bleeding disorders or with a history of stroke, or in those taking drugs that may increase the risk of bleeding. Stop use two weeks before surgery or dental or diagnostic procedures with a bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding. Cat's claw may be contaminated with other Uncaria species. Reports exist of the potentially toxic Texan-grown plant Acacia gregii being substituted for cat's claw.
  • Cayenne: Limited evidence suggests that capsaicin nasal spray may help reduce nasal congestion in patients with chronic rhinitis. However, additional research is needed before conclusions can be made.
  • Cayenne is considered safe for most healthy people in amounts commonly found in foods. Avoid in patients with known allergy or hypersensitivity to plants in the genus Capsicum or the Solanaceae family, bell peppers, dihydrocapsaicin, tropical fruits (banana, kiwi), latex, paprika, or tree pollens. Use cautiously in patients under the following circumstances: in patients with acute anal fissures (or in those having just had surgery for anal fissures), addictive personalities, bleeding disorders (or in those taking agents that may increase the risk of bleeding), diabetes (or in those using blood sugar-lowering agents), gastrointestinal disorders (including ulcers), or heart disease (or in those using medications for cardiovascular (heart) disorders); or in those taking angiotensin-converting enzyme (ACE) inhibitors (blood pressure-lowering drugs), aspirin products, or theophylline. Avoid in pregnant or lactating women.
  • Choline: Oral tricholine citrate (TRI) effectively relieved allergic rhinitis symptoms in limited available research. Further research is needed before a firm conclusion can be made.
  • Choline is generally regarded as safe and appears to be well tolerated. Avoid if allergic to choline, lecithin, or phosphatidylcholine.
  • Cinnamon: Preliminary evidence suggests that cinnamon may have antiallergic properties. In human research, a combination product containing Cinnamomum zeylanicum, Malpighia glabra, and Bidens pilosa reduced allergic nasal symptoms in patients with allergic rhinitis. More well-designed trials are needed before a firm conclusion can be drawn.
  • Use cautiously if prone to atopic reactions or if taking cytochrome P450-metabolized agents, anticoagulants (blood thinners), insulin or blood sugar-altering medications, antibiotics, or cardiovascular agents. Avoid if allergic or hypersensitive to cinnamon, its constituents, members of the Lauraceae family, or balsam of Peru. Avoid if pregnant or breastfeeding.
  • Conjugated linoleic acid (CLA): Limited research suggests that CLA may reduce sneezing due to birch pollen allergy. Further research is needed.
  • Caution is advised in patients with diabetes or hypoglycemia, those at risk of diabetes, and those taking drugs, herbs, or supplements that affect blood sugar. Caution is advised when using medications that may also affect cholesterol, lower blood pressure, or increase the risk of bleeding. Use cautiously in patients with gastrointestinal disorders, heart disease, immune disorders, or skin disorders, and in those at risk for inflammatory disorders. Use cautiously in children and pregnant or breastfeeding women. Avoid in patients with liver disorders.
  • Elder: Elder may offer benefits for bacterial sinusitis, such as reducing excessive mucus secretion. Herbal preparations containing elder may result in less swelling of mucus membranes, better drainage, milder headache, and decreased nasal congestion.
  • Cyanide toxicity is possible. Avoid if allergic to elder or to plants related to honeysuckle. Some reports exist of allergies from contact with fresh elder stems. Use caution with diabetes, high blood pressure or urinary problems, or with drugs used for any of these conditions. Use caution with anti-inflammatories, diuretics ("water pills" for high blood pressure), or laxatives. Avoid if pregnant or breastfeeding.
  • Ephedra: Preliminary research suggests that ephedrine nasal spray may help treat allergic rhinitis. Additional research is needed.
  • Ephedra taken by mouth may cause serious side effects, including heart attack, seizure, and stroke. Therefore, ephedrine nasal sprays should only be used in the nose. The U.S. Food and Drug Administration (FDA) has collected thousands of reports of serious toxicity linked to ephedra (including over 100 deaths). Ephedra products are banned from dietary supplements because of serious health risks, including heart attack, heart damage, breathing difficulties, and fluid retention in the lungs. Avoid in those with history of high blood pressure, abnormal heart rate, heart attack, stroke, seizure, eating disorders, anxiety, prostate disease, mental illness, kidney disease, stomach ulcers, heart disease, eye disease, depression, diabetes, thyroid disease, or sleep problems. Avoid if pregnant or breastfeeding.
  • Eucalyptus oil: There is currently insufficient available evidence to evaluate use of eucalyptus oil as a decongestant-expectorant. Avoid in those allergic to eucalyptus oil or in those with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, lung disease, or the blood condition known as acute intermittent porphyria. Use caution if driving or operating machinery. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
  • Green tea: Limited research suggests that benifuuki green tea may reduce allergic reaction to the Japanese cedar tree. Additional studies are needed before a conclusion can be made.
  • Avoid if allergic or hypersensitive to green tea, its constituents, caffeine, tannins, or members of the Theaceae family. Use cautiously with diabetes or liver disease. Avoid if pregnant or breastfeeding
  • Honey: Currently, there is insufficient human evidence to recommend honey for the treatment of rhinoconjunctivitis.
  • Avoid if allergic or hypersensitive to honey, pollen, celery or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey, and it should be used cautiously in pregnant or breastfeeding women.
  • Horseradish: Several studies suggest that some horseradish constituents may offer antibiotic activity and may help treat sinusitis. Additional high-quality clinical studies are needed before a conclusion can be made.
  • Avoid if allergic or hypersensitive to horseradish (Armoracia rusticana), its constituents, or members of the Brassicaceae family. Large oral doses may provoke allergic reactions. Use cautiously in those with clotting disorders, hypotension (low blood pressure), thyroid disorders, kidney disorders and inflammation, gastrointestinal conditions, or ulcers. Use cautiously in those taking anticoagulants or antiplatelets (blood-thinning agents), antihypertensives (blood pressure-lowering agents), anti-inflammatory agents, or thyroid hormones. Use cautiously in those undergoing treatment for cancer. Avoid medicinal amounts of horseradish if pregnant or breastfeeding; according to herbal textbooks and folkloric precedent, horseradish has been used to induce abortion.
  • Hypnotherapy, hypnosis: It has been suggested that hypnotherapy may be effective for allergies and may help treat hay fever. However, further research is necessary.
  • Use cautiously in those with mental illnesses such as psychosis, schizophrenia, manic depression, multiple personality disorder, or dissociative disorders. Use cautiously in those with seizure disorders.
  • Kiwi: Conclusive data on kiwi's therapeutic benefits for preventing lung conditions and other respiratory problems are currently lacking. Kiwi and other fruits high in vitamin C may benefit lung conditions in children, especially wheezing. More research is warranted before a conclusion can be made.
  • Avoid if allergic or hypersensitive to kiwi, latex, birch pollen, banana, chestnut, fig, flour, melon, poppy seeds, rye grain, sesame seeds, and related substances. Kiwi is generally considered safe when taken in amounts naturally found in foods. Use cautiously with antiplatelet drugs such as aspirin, cilostazol, and clopidogrel. Use cautiously with hormone therapies or serotonergic drugs. Avoid if pregnant or breastfeeding, because clinical trials testing safety in supplemental doses are currently lacking. The amount normally found in foods appears to be safe in most people.
  • Lactobacillus GG (LGG): Preliminary research suggests that consumption of a fermented milk product containing Lactobacillus GG (LGG) may decrease nasal congestion in patients with allergy to Japanese cedar pollen. Further research on the effect of LGG alone is required before conclusions can be made.
  • Avoid in those with known allergy or sensitivity to dairy products, if LGG is taken as part of a dairy product. LGG is possibly safe when used during pregnancy, six months before delivery, and during breastfeeding for up to six months. Use caution in pregnant mothers and infants at risk of development of atopic dermatitis, due to the risk of the children developing wheezing bronchitis. Avoid in patients with injury to the lining of the intestine and those with below-normal immune function.
  • Luffa (Luffa operculata): Research has shown that a combination of herbs containing Luffa operculata may reduce symptoms of allergic rhinitis and sinusitis. However, well-designed clinical trials in support of Luffa operculata for any use are lacking, and the effects of Luffa operculata alone have not been determined. Further research is warranted before firm conclusions can be made.
  • Use cautiously in patients who suffer from nosebleeds, nasal irritation, or necrosis of the nasal pyramids, as Luffa operculata may cause nosebleeds. Avoid in those with known allergy or hypersensitivity to Luffa operculata or other members of the Cucurbitaceae family. Avoid in patients taking other medications or herbs via inhalation, as Luffa operculata may produce changes in the lining of the nose and sinuses, thereby changing the effect of the agents in the nasal spray.
  • MSM: According to preliminary clinical research, MSM reduces symptoms associated with seasonal allergic rhinitis. However, larger controlled trials are needed to confirm these findings.
  • Avoid if allergic or hypersensitive to MSM. Long-term effects of supplementation with MSM have not been examined. Avoid if pregnant or breastfeeding.
  • Omega-3 fatty acids, fish oil, alpha-linolenic acid: Population research suggests that consumption of fish once weekly or more was associated with reduced risk of child eczema. Maternal supplementation also decreased the risk of food allergy and IgE-associated eczema in the first year. Further research is required to determine the effect of omega-3 fatty acids on other symptoms of allergy.
  • Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, or linolenic acid or omega-3 fatty acid products that come from nuts. Use cautiously in those with high blood sugar levels, bleeding disorders, diabetes, low blood pressure, high levels of LDL cholesterol, tachycardia, or arrhythmia (altered heart rhythm). Use cautiously in those at risk for hormone imbalance or in those undergoing hormone replacement therapy. Use cautiously in patients with asthma, inflammatory bowel disease, liver disease, in patients at risk for colon cancer, or in those using drugs or herbs or supplements that treat any such conditions. Fish oil taken for many months may cause a deficiency of vitamin E and may increase the risk of vitamin A or D toxicity. Use large amounts cautiously. Use cautiously if pregnant or breastfeeding.
  • Onion: Research has shown that topical application of an alcoholic onion extract significantly reduced responses to allergies. Although this is intriguing, more research is needed in this area to establish the efficacy and dosing of topical onion extracts.
  • Avoid if allergic or hypersensitive to onion (Allium cepa), its constituents, or members of the Liliaceae family. Use cautiously in those with hematologic (blood) disorders, diabetes, hypoglycemia (low blood sugar), and hypotension (low blood pressure). Use cautiously in those taking anticoagulants or antiplatelets (blood thinners). Avoid medicinal doses if pregnant or breastfeeding.
  • Ozone therapy: According to limited research, irrigation of the paranasal sinuses with an ozone-oxygen mixture may help promote recovery from sinusitis. More well-designed trials are needed before a conclusion can be made.
  • The safety of various types of ozone therapy has not been systematically studied. Because ozone is a toxic gas, the safety of ozone therapy has been questioned. Serious side effects may occur from the introduction of ozone into the body, including shortness of breath, blood vessel swelling, poor circulation, heart problems, or stroke. A case of death has been reported due to gas embolism. Ozone therapy may lower blood sugar levels. Caution is advised when using medications, herbs, or supplements that may also lower blood sugar. Use cautiously in patients with respiratory disorders such as asthma. Ozone therapy is not recommended in pregnant or breastfeeding women, due to a lack of available scientific evidence.
  • Perilla: Preliminary evidence suggests some benefit of perilla extract for seasonal allergies. Further clinical trials are required before conclusions can be made.
  • Avoid if allergic or hypersensitive to perilla or members of the Lamiaceae or Labiatae family. Use cautiously in those with cancer, low HDL cholesterol, or immune disorders. Use cautiously in those taking NSAIDS or barbiturates. Avoid if pregnant or breastfeeding.
  • Probiotics: Only a few types and combinations of probiotics have been studied for allergies. They have been studied mostly in children, teenagers, and young adults. Further research is necessary before a firm conclusion can be made.
  • Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
  • Reflexology: Reflexology involves the application of manual pressure to specific points or areas of the feet called "reflex points" that are believed to correspond to other parts of the body. Results from early studies are not conclusive regarding the use of reflexology for chronic sinusitis.
  • Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation in those with osteoarthritis affecting the foot or ankle or with severe vascular disease of the legs or feet. Use cautiously in those with diabetes, heart disease, unstable blood pressure, cancer, active infections, past episodes of syncope (fainting), mental illness, gallstones, kidney stones, or a pacemaker. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
  • Shea butter: Shea butter is derived from the nut of the shea tree (Vitellaria paradoxa), which grows in West Africa. In human research, shea butter has been shown to produce relief from nasal congestion. Additional research is needed before a definitive conclusion can be made.
  • Avoid in those with known allergy or hypersensitivity to shea butter or its constituents. Use cautiously in those with allergies to latex. Use cautiously in those taking anticoagulants. There is currently insufficient available safety evidence for use of shea butter during pregnancy or breastfeeding.
  • Sorrel: Research suggests that an herbal combination preparation containing sorrel, Sinupret®, may have beneficial effects in improving symptoms of sinusitis when used with antibiotics. It is not clear if these same effects would be seen with sorrel alone or what dose may be safe and effective. For allergic rhinitis, there is not enough evidence to make a conclusion at this time. More research of sorrel alone is needed.
  • Avoid sorrel in those with a known allergy to sorrel or any of its constituents. Avoid large doses of sorrel, because there have been reports of toxicity and death. Many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. Sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding.
  • Soy: Soy formulas are commonly used by infants with sensitivities to milk-based formulas. There is currently little evidence to support the use of soy formulas for preventing food allergies. Further research is needed in this field.
  • Avoid if allergic to soy. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there are limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore they are not recommended. People who experience colitis (intestinal irritation) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, like increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Patients taking blood-thinning drugs like warfarin should check with a doctor and pharmacist before taking soy supplementation.
  • Spirulina: The anti-inflammatory properties of spirulina may help improve symptoms of allergic rhinitis. However, further high-quality studies are needed to confirm these findings.
  • Avoid if allergic or hypersensitive to spirulina or blue-green algae. Use cautiously with phenylketonuria (a genetic disorder of a liver enzyme that disrupts normal body functions), autoimmune diseases, bleeding disorders, diabetes, and osteoporosis. Use cautiously with products containing the blue-green algae species Anabaena spp., Aphanizomenon spp., and Microcystis spp.; in underweight patients or in those taking antiobesity agents or appetite suppressants; of in those consuming a high-protein diet. Avoid in children or if pregnant or breastfeeding.
  • Stinging nettle: For many years, a freeze-dried preparation of Urtica dioica has been prescribed by physicians and sold over-the-counter for the treatment of allergic rhinitis. Clinical trials demonstrating statistical significance over placebo and/or equivalence with other available treatments are needed to support the use of nettle in the treatment of allergic rhinitis.
  • Avoid if allergic or hypersensitive to nettle, the Urticaceae family, or any ingredient of nettle products. Use cautiously in those with diabetes, bleeding disorders, and/or low sodium levels in the blood. Use cautiously with diuretics and anti-inflammatory drugs. The elderly should also use nettle cautiously. Avoid if pregnant or breastfeeding.
  • Sulfur: Limited evidence suggests that a homeopathic nasal spray containing Luffa operculata, Galphimia glauca, histamine, and sulfur may have an effect on allergic rhinitis. Further research is needed to examine the effects of sulfur alone.
  • Avoid in individuals with a known allergy or hypersensitivity to sulfur or sulfonamides. Use cautiously in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Use cautiously in patients with kidney disease, sensitive skin, or gastrointestinal sensitivities. Avoid if pregnant or breastfeeding.
  • Thymus extract: Thymus extract may reduce symptoms of allergies due to its potential immune-stimulating effects. Nonetheless, more clinical trials are required before conclusions can be made involving thymus extract for this use.
  • Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to the potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid in those receiving immunosuppressive or hormonal therapy; and in those with thymic tumors, myasthenia gravis (a neuromuscular disorder), or untreated hypothyroidism. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
  • Vitamin E: Although thought to aid in reducing the nasal symptoms of allergic rhinitis, vitamin E intake may not be effective. Current evidence is limited, however, and more studies are needed before a firm conclusion can be drawn.
  • Avoid if allergic or hypersensitive to vitamin E. For short periods of time, vitamin E supplementation is generally considered safe at doses up to 1,000 milligrams daily. Avoid doses higher than 1,000 milligrams daily. Avoid in those with retinitis pigmentosa (loss of peripheral vision). Use cautiously in those with bleeding disorders. The recommended dose of vitamin E for pregnant women of any age is 15 milligrams; for breastfeeding women of any age, the recommended dose is 19 milligrams. Use beyond this level in pregnant women is not recommended.
  • Whey protein: According to a limited body of evidence, whey protein may have positive benefits in treatment of patients with atopic asthma or atopic dermatitis. Further research is required before conclusions can be made.
  • Use cautiously in patients using any medications, because drugs may bind to human milk whey proteins. As a result, the levels of these drugs may be changed in the blood. Since whey protein may lower blood sugar levels, caution is advised in patients with diabetes or hypoglycemia. Caution is advised in those taking drugs, herbs, or supplements that affect blood sugar, increase the risk of bleeding, lower blood pressure, or affect the immune system. Whey protein may interfere with the way the body processes certain drugs, herbs, or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of these agents may change in the blood and may cause increased or decreased effects or potentially serious adverse reactions.
  • Avoid long-term excessive intake because it may cause kidney damage or bone loss. Avoid in those with known allergy or hypersensitivity to milk or milk products. Avoid in pregnant or breastfeeding women.
  • Fair negative scientific evidence:
  • Grape seed: Grape seed has been used to treat immune system disorders due to its antioxidant effects. However, a well-designed human study of allergic rhinitis sufferers showed no improvement in allergy symptoms with administration of grape seed extract ingredients.
  • Avoid if allergic or hypersensitive to grapes or other grape compounds. Use cautiously if taking blood thinners such as warfarin, aspirin, NSAIDs, or antiplatelet agents. Use cautiously in those with bleeding disorders or taking drugs that may increase the risk of bleeding. Use cautiously with drugs processed through the liver's cytochrome P450 enzyme system. Use cautiously in those with blood pressure disorders or taking ACE inhibitors, such as lisinopril (Zestril®) and ramipril (Altace®). Avoid in those with disorders that increase the risk of bleeding or in those active bleeding disorders (stomach ulcers, bleeding into the brain, etc.). Avoid if pregnant or breastfeeding.

Prevention
  • When the sinuses are blocked for a long time, a secondary bacterial infection may develop causing sinusitis. Therefore, allergies should be treated quickly in order to reduce the risk of developing sinusitis.
  • Individuals with sinus problems and allergies should avoid environmental irritants, such as tobacco smoke and strong chemical odors, which may worsen symptoms.
  • Consider using a humidifier, which adds moisture to the air, to help keep the nasal passages open.
  • Low doses of antibiotics and expectorants may be prescribed as preventive measures at times when symptoms are likely to be the worst, such as the winter season.

Complications
  • If left untreated, sinusitis can develop into a chronic condition. Sinusitis can result in several complications if not treated properly.
  • Acute sinusitis may trigger an asthma exacerbation.
  • The sinus infection could spread to the lining of the brain, resulting in meningitis.
  • The sinus infection may spread to the eye socket and reduce vision or cause blindness.
  • The sinus infection may cause problems in the veins surrounding the sinuses and lead to aneurysms or blood clots.

Classifications
  • Acute: Acute sinusitis lasts for less than six months, and it is usually caused by a bacterial infection. Most cases of sinusitis are acute. When symptoms last between four and eight weeks, the condition is considered to be subacute.
  • Chronic: Symptoms of chronic sinusitis last eight weeks or longer, and the severity varies. Symptoms of acute and chronic sinusitis are very similar, except chronic sinusitis symptoms last longer and often cause more fatigue. According to the Centers for Disease Control and Prevention (CDC), chronic sinusitis affects nearly 35 million people in the United States.
  • Recurrent: When an individual suffers from three or more episodes of acute sinusitis per year, the condition is referred to as recurrent sinusitis.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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