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Non-Allergic Rhinitis (Vasomotor)

Non-Allergic Rhinitis (Vasomotor)

Non-allergic rhinitis is a chronic condition that can occur at any age but is more common in adults. The most common symptoms are nasal congestion, post-nasal drainage, and headache, although runny nose, sneezing and itching of the nose may occur in some non-allergic individuals. Many non-allergic patients have recurrent sinusitis and middle ear infections or middle ear fluid collection.

Initial evaluation requires that surgical conditions (growths in the nose, crooked nasal septum, etc.) and general medical conditions (thyroid disease, pregnancy, etc.) are not responsible for the chronic symptoms. We recommend that ever patient have a family practitioner, internist, or pediatrician to follow them for their general medical care. If the history and physical examination are not positive for surgical or general medical problems, the patient most likely has the most common nasal problem of non-allergic or allergic nasal disease.

Non-allergic rhinitis is a very difficult topic to fully understand. The actual defect resulting in the symptoms commonly found is not known. We do know that the difficulty arises in the inability to correctly change the size of blood vessels and the quantity of mucus produced by mucus glands in the nose. Under normal circumstances the nose warms or cools the air entering the nose to 98 degrees F., increases the humidity to at least 80%, and filters unwanted substances resulting in relatively clean air at 98 degrees F. and 80% humidity entering the lungs regardless of current environmental conditions. These changes occur almost instantly with each breath. The non-allergic individual has lost the ability to make the necessary changes either from an ineffective blood vessel and mucus gland controlling mechanism, temperature and humidity sensing mechanism, or both. The end result is inappropriate blood vessel size and/or excess mucus production which can result in nasal congestion, post-nasal drainage, and headaches.

Many individuals with non-allergic nasal disease will have a significant amount of irritation, inflammation, and hyperreactivity in the nose contributing to the persistent, chronic nature of the disease.

Nasal allergy on the other hand usually presents with runny nose, sneezing, and itching but some patients can also have nasal congestion, post-nasal drainage, and headaches. With nasal allergy we usually see definite problems at certain seasons of the year or a correlation with exposures to dust, animal dander, mold or mildew exposures and in some patients’ extreme reactions to certain foods. Allergy symptoms also involving the eyes usually are redness, itching and watering of the eyes.

It is possible for an individual to have problems with both non-allergic rhinitis and allergic rhinitis, and this makes the problems at times more difficult to clearly diagnose and treat.

Several tests can be used to differentiate non-allergic rhinitis from allergic rhinitis. Skin testing, as one might expect, displays positivity in patients with allergic rhinitis, whereas a negative skin test will be obtained in patients with non-allergic rhinitis. In addition, the blood IgE levels and eosinophils (the allergy cell) are elevated in patients with allergic rhinitis but not in non-allergic rhinitis.

Non-allergic rhinitis often is triggered by drafts, temperature changes (especially cold air), by scented cosmetics (both men’s and women’s cosmetics), by cigarette and tobacco smoke, as well as fireplace smoke, scented or perfumed soaps. Many types of aerosol sprays, even scented deodorants can cause problems. Paint fumes, insecticides, bug sprays,
varnishes, and even the odor from new clothing, carpeting or furniture can cause problems. Kerosene, lighter fluids, oil and gas fumes can cause problems. House dust may act as an irritant, and should be avoided.

Do not overuse over-the-counter decongestant sprays or nose drops because these can cause “rebound” nasal congestion. All nasal decongestant sprays should be discontinued following 3 days of continuous use. Medications will be prescribed to help with this problem. A good part of the treatment is avoiding known problems and exposures, and working by trial and error to find medications that work best in your case. Medications that may be tried include: Astelin© nasal spray, decongestants, decongestant-antihistamine combinations, intranasal steroid sprays, and possibly an atropine-derivative nasal spray (Atrovent©).

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Food Allergies and Theme Parks

By Eve Chen, USA TODAY

There’s a lot more to theme park food than funnel cakes and turkey legs. Many parks pride themselves on their array of dining options for guests, but not just for flavor. More than 6% of Americans have a food allergy, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics. The most common food allergens are milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans and sesame, according to the U.S. Food and Drug Administration. With those, allergy-safe options can be a matter of life and death.

“I had my first reaction when I was a baby to nuts, and I’ve had serious reactions since that have brought me to the ER – thankfully not too many in recent years,” said Allie Bahn, who helps travelers with food allergies through her Miss Allergic Reactor website and Allergy Travels Facebook group. Bahn has four of the top nine food allergies and other specific allergens, like potatoes. “It can be certainly life-threatening, so it’s different than avoiding foods just because of something bothering your stomach.”

Here are seven ways travelers with food allergies can safely navigate theme parks and what parks are doing to help:

Do your research.

Some parks flag top allergens on their websites and apps.

“It’s listed by restaurant, by item, and it talks about each item what would be the allergen that could be present in that item … A lot of folks who have been living with allergies know what they can and can’t eat, and they’re just looking for a map of ‘Where can I get what I need?’ ” said Cedar Fair corporate chef Charles Walker, who helped roll out new dietary guides for guests earlier this year. As someone with food allergies himself and family members with food allergies, Walker added, “This was near and dear to my heart to really make sure this guest-facing platform was very user-friendly.”

For more personalized help, Cedar Fair’s parks and many others have phone lines and email addresses listed on their websites just for guests with special dietary needs.

“I’m a big fan of contacting places ahead of time,” Bahn said.

Don’t go hungry.

Bahn recommends eating a hearty meal before heading to the park. “So you already have something nice and warm in your stomach, hoping that you’ll be able to find something (else) when you’re there,” she said. She also recommends having plans for a meal after leaving the park, so at least those two meals are covered.

Pack snacks. Not all parks allow outside food, but when permitted, Bahn recommends packing snacks for backup. “Don’t make assumptions that you definitely can’t eat. I think there’s always the ability to try to do as much research ahead of time and then see how it goes once you get there, but having a plan in place is always really helpful,” she said.

Always carry medication or epinephrine. Bahn says she’s carried an epinephrine auto-injector with her for as long as she can remember. “Don’t lock it up in a locker where you can’t quickly access it in case of an emergency,” she said. “It should be on you at all times.”

Ask questions.

“Ask if they have ingredients that you can see,” Bahn said. Some park restaurants have binders of ingredients guests can look at, but it’s best to confirm everything is up to date with chefs, who are happy to speak with guests with food allergies. Sometimes, when creating menus, chefs will intentionally avoid using common allergens like peanuts to make foods more accessible. Chefs can also sometimes adjust dishes for allergies.

“Our festival chefs will go through (the menu) and make sure, based off of the dietary needs, if a dish is safe, if there’s anything (the guest) can have from those kiosks, or if there’s a way, we can make that dish for them safe,” said Kevin Downing, executive chef of EPCOT Festivals at Walt Disney World. Cedar Fair’s Walker echoed, “If you have a very, very specific allergy, we’ll do whatever we can to accommodate.”

Advocate for yourself.

“Explain your food allergies. Advocate for yourself,” Bahn said. She recommends carrying a Chef Card that can be given to chefs, stating each allergy, its severity, and the need for clean utensils and surfaces to be used in food preparation to avoid possible cross-contamination. “It makes everybody’s life, I think, a lot easier and really gets the point across that this is a severe food allergy and not just dietary preference,” she said.

When an allergy-related order comes into Connections Eatery kitchen at EPCOT, Chef Scott Tosh said. “It prints up special, so the special diets-trained cast member will prepare that food. We put an allergy pick in it. If there’s two items – one’s allergy, one’s not – we serve them with separate trays.” Bahn said Disney parks have always been great with her needs, even when she was a kid and people were generally less aware of food allergies.

Trust your gut.

Bahn recommends double-checking all food before digging in.

“I think I have been able to sort of save myself from some potential reactions because of advocating and double checking, trusting my gut,” Bahn said of no place in particular. “There’s plenty of times where I’ve decided not to eat, even if I’ve ordered something because I just felt like I didn’t get all my questions answered in a way that I felt was safe. And that’s OK too. Being able to politely and kindly decide not to eat and walk away and make a different plan is OK, as well. It’s your safety. It’s your health.”

https://www.usatoday.com/story/travel/experience/theme-parks/2023/12/14/food-allergies-theme-park-tips/70911517007/

The post Food Allergies and Theme Parks appeared first on Oklahoma Allergy and Asthma Clinic.

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