Allergies Are Not Just a Stuffy Nose. Here’s a Look at Other Symptoms

by Jennifer Fink •

Ears

Several double-blind studies have shown that intranasal allergen challenges can result in Eustachian tube dysfunction, and “histologic studies have also shown that levels of eosinophils, CD3 T cells, interleukin (IL)-4 levels, and messenger RNA levels for IL-5 are increased at both ends” of the tubes, according to a 2017 review (Otolaryngol Clin North Am. 2017;50:1091-1101).

“When you have swelling in the nose and nasopharynx due to allergies, you can get edema and swelling around the Eustachian tube orifice,” said Peter C. Weber, MD, professor of otolaryngology–head and neck surgery at Boston University School of Medicine. “That can cause negative pressure within the middle ear, which can pull the eardrum medially. If that pull is strong enough or goes on long enough, the cells there can secrete fluid and you end up with serous otitis media.”

Although the relationship between allergy and otitis media with effusion (OME) has been “historically controversial,” a 2019 study from Iran that compared 37 children with OME to 52 children without OME found that allergic rhinitis prevalence was “noticeably higher” among OME patients than the control group (Iran J Otorhinolaryngol. 2019;31:209-215). While 24.3% of the children with OME had allergic rhinitis, only 5.8% of the control group did. Studies from Korea and Japan have also noted a link between allergy and OME. One Korean study found that 33.8% of children with OME also had allergic rhinitis, compared to 16% of children without OME (Int J Pediatr Otorhinolaryngol. 2013;77:158-161). Researchers in Japan have reported that more than 87% of patients with OME were found to be atopic or have allergy symptoms (Acta Otolaryngol. 1988;458:41-47).

A nasopharyngoscopy can be used to evaluate the ear, turbinates, nasopharynx, and Eustachian tube opening, “to see whether there’s any reactive tissue that might be a glimmer into a possible diagnosis of allergic rhinitis,” Dr. Weber said. Clinicians might note some “edema, hypertrophy, and boggy, pale mucosa,” he added.

If those signs are present, Dr. Weber may refer the patient for allergy testing. In some cases, he’ll treat the patient with antihistamines and nasal sprays before allergy testing in an effort to relieve the patient’s discomfort. After the patient is better and after they have been off medication for a while, allergy testing can reveal whether allergies may be a contributing factor. If so, immunotherapy may be beneficial. A 2008 study of 89 patients with OME (children and adults) revealed that all 89 subjects were atopic. Allergy immunotherapy significantly improved 5.5% and completely resolved 85% of chronic OME (Int J Pediatr Otorhinolaryngol. 2008;72:1215-1223).