The Post-Antibiotic Era: Sinusitis
Dr. John Overholt • December 3, 2018
Appropriate Antibiotic Use: Part III
This post will deal with one of the most common diagnoses seen by allergists: sinusitis. Here are some staggering statistics.
- Sinusitis remains one of the top reasons for seeing a doctor in the U.S., accounting for almost 14 million physician visits annually.
- Overall, 1 in 5 antibiotic prescriptions in the U.S. are written for presumed sinusitis, and most of these are unnecessary.
- Despite studies showing that antibiotics don’t help for acute sinusitis, 86% of patients who sought treatment for acute sinusitis received antibiotics.
...if you're having persistent sinus symptoms or have required antibiotics three or more times in a year, it's time to see an allergist.
So what is sinusitis? Sinusitis is usually taken to mean infection of the sinus cavities. It is broadly divided into acute sinusitis and chronic sinusitis. Acute sinusitis is mostly due to the common cold virus (rhinovirus) and can present with low-grade fever, pain, pressure, and discolored secretions. It usually lasts 7-10 days and resolves on its own. Bacterial infections complicate less than 5% of cases of acute sinusitis. Chronic sinusitis can present with similar symptoms, though they are usually less severe, and also may cause significant fatigue, cough and occasionally drainage. Unlike acute sinusitis, it is frequently bacterial.
The biggest problem in managing chronic sinusitis is making a diagnosis. The symptoms are non-specific and don’t correlate well with the gold standard diagnostic test, a sinus CT. Indeed, the exact same symptoms can be infectious, allergic, both or neither. This illustrates the importance of allergy testing and sinus imaging in the management of chronic sinusitis. In general, if you’re having persistent sinus symptoms or have required antibiotics three or more times in a year, it’s time to see an allergist. They can find out precisely what’s wrong with you and come up with a treatment plan to get you better.
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If you spend any time browsing the internet or social media, you’ve likely seen advertisements for mail-in allergy kits. They promise to test for hundreds of food intolerances and environmental sensitivities using just a few strands of your hair or a quick saliva swab. It sounds incredibly convenient, painless, and comprehensive. But if it sounds like a gimmick, it probably is. While these mail-in tests are heavily marketed, they often lack scientific backing and can leave patients feeling more confused than comforted. The Science of Allergy Testing. What Are We Looking For? To understand why hair and saliva tests don't work, we have to look at how the immune system reacts to allergens. When you have a true allergy, your body produces a very specific type of antibody called IgE (Immunoglobulin E) . These antibodies bind to mast cells (allergy cells), which are on high alert to protect you from perceived invaders like pollen, dust mites, or specific food proteins. The fundamental flaw with mail-in hair and saliva kits comes down to basic biology: Wrong Locations: Mast cells and IgE antibodies are not traditionally found in your hair follicles or saliva. Unreliable Results: Because these testing methods are looking in the wrong place, they are highly unstandardized and unvalidated. You are highly likely to get a flood of false positives or false negatives that are impossible to interpret accurately. What the Experts Say: Major medical organizations strongly advise against these methods. The National Institute of Allergy and Infectious Diseases (NIAID) explicitly recommends against using hair analysis for food allergy evaluations due to a lack of diagnostic value. Furthermore, the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma & Immunology (ACAAI) have issued strong practice guidelines stating that hair analysis should not be used to evaluate food allergies. The Big Misconception: IgE vs. IgG Many mail-in companies charge anywhere from $150 to upwards of $600 for "sensitivity" panels. When patients produce these multi-page reports, the testing is almost always checking for IgG (Immunoglobulin G) antibodies, not IgE. There is a massive difference between the two:
