Rhinitis (constant runny nose) is the sixth most common chronic condition in the world (in the US, 10,000 children are absent every schoolday due to allergic rhinitis), yet the treatment for rhinitis, sinusitis or nasal polyps rates among medicine's great failures.
There are two types of rhinitis: perennial; and seasonal (hayfever), a pollen sensitivity during late May to early August. Patients with rhinitis in early spring usually react to various wind-pollinated trees, weeds, shrubs or grasses.
Perennial rhinitis occurs all-year round and is like a cold that lasts forever.
Perennial rhinitis and sinusitis are frequent co-passengers, as the mucous membranes of the nasal passages and sinuses flow together. The continual allergic or fungal attack on these membranes often causes them to proliferate, leading to polyps, usually in the nasal passages. These polyps, in turn, make the problem worse by causing a physical obstruction in an already blocked nose.
What doctors tell you
The usual treatments for rhinitis are various drugs that only suppress the problem, such as antihistamines, which block the effects of histamine, a chemical released during an allergic reaction. Histamine is mainly responsible for the inflammation, sneezing and itching symptoms of rhinitis. Although antihistamines may be well tolerated, they commonly cause a dry mouth, nose and eyes, and drowsiness. The latest 'second-generation' drugs, such as Allegra and Clarityn, despite their claims, still come with a range of side-effects. Long-term use of topical steroid sprays, such as Beconase or Rhinocort, offers all the dangers of ordinary steroids.
The only conventional treatment of polyps is surgery, or a polypectomy. Although this can improve matters, it's often only for a few months until the polyps recur because the underlying cause has not been addressed. Some of my patients have undergone as many as 10 polypectomies.
Perennial rhinitis has at least four main causes:
* inhalant allergies, such as housedust, dust mites, moulds, animals and feathers
* food allergies or intolerance
* fungal/yeast problems
* magnesium deficiency, which can worsen any or all of the above causes.
You will know you have this problem if you are worse:
*in dusty environments or first thing in the morning
* in August or September, especially on humid days before thunderstorms. In the hours before a thunderstorm, there is a marked increase in mould counts and a marked increase in hospital admissions for asthma
* after sweeping up mould-ridden leaves or turning over a compost heap
* in any damp, musty dwelling, indicating a reaction to indoor moulds.
Another clue is if you are better in hot dry climates, such as the Algarve or Greek islands. Dust mites don't survive in high heat and are extremely thirsty for water, and can't live in desert-like environments. If you don't improve in these situations, suspect a food sensitivity or a fungal/yeast problem.
You can also test for inhalant sensitivity with prick tests and radioallergosorbent test (RAST; a blood test measuring immunoglobulin E reactivity).
Foods play a large part in perennial rhinitis. Milk sensitivity is very common and frequently described as 'mucus-forming', but any food can be implicated. Suspect a food sensitivity if you have:
* no history of inhalant sensitivity and a negative response to skin inhalant tests
* a history of food cravings
* abdominal distention after food, or puffy swelling of the ankles and fingers
* occasional bouts of a rapid heartbeat or sweating for no apparent reason
* weight problems and sudden, dramatic weight fluctuations from day to day.
Don't discount alcoholic drinks. Scotch whisky, for example, comprises wheat, corn, yeast and sugar. If you're sensitive to any of these, you'll notice an increase in rhinitis after drinking it. As alcohol is absorbed incredibly quickly, the response is more obvious than if ingested as food.
Food intolerance usually involves several food groups, so excluding only milk and cereals, for example, rarely succeed, as only part of the problem is addressed.
The role of fungus
If the problem isn't due to inhalants or food, it could be due to a fungus - fungal rhinitis (if it affects just the nose) or rhinosinusitis (affecting both the nose and sinuses).
Dr Jens Ponikau et al. reported on a new technique for collecting and testing mucus that showed that 202 of 210 patients with chronic rhinosinusitis had fungi in their mucus (Mayo Clin Proc, 1999; 74/9: 87784). They also detected eosinophils (a type of white blood cell commonly found in an allergic response) in the nasal tissues of nearly all of these fungal patients. Interestingly, most of these patients, however, were not sensitive to immunoglobulin E, suggesting that the rhinitis/sinusitis resulted from the body's immune response to fungi. Such a non-allergic response may explain why many patients fail to respond to antihistamines.
Three years later, the same team reported the results of fungal treatment for their patients (Immunology, 2002; 110: 862-6). Amphotericin B was applied intranasally (at a dose of 20 mL of a 100 mcg/mL solution) twice a day. Sinusitis symptoms improved in 75 per cent of the patients and almost half of these were shown, by endoscopic examination, to be totally disease-free. Other studies have reported similar findings.
As the source of these yeasts or fungi lies in the gut, further improvements may result from the more fundamental approach of restoring balance to the gut flora using an anti-Candida regime.
Don't forget the role of magnesium. A deficiency of this mineral can lead to instability of mast cells, which release histamine during an allergic response, thereby causing the symptoms of rhinitis. This was shown in animal experiments (using rats) carried out at Brigham Young University in Utah (J Am Coll Nutr, 1990; 9/6: 616-22).
The study concluded that both the blood and urine histamine levels of severely magnesium-deficient rats were significantly higher than those of other rats throughout the study, particularly after specific antigen challenges. The amount of antigen used in the challenges also had the effect of exacerbating the magnesium deficiencies in the blood and urine.
Although animal studies don't always apply to humans, similar findings were made in clinical trials at the University of Turin (Allergy, 1987; 42: 186-8). These results suggest that a magnesium deficiency can aggravate diseases that are caused by abnormal histamine release as a result of allergic responses to inhaled or food allergens.
Dr John Mansfield
Dr Mansfield runs the Burghwood Clinic (see www.burghwoodclinic.co.uk) and specialises in environmental and nutritional medicine.