Allergies

ENT allergies are caused by your immune system reacting to substances that are normally harmless. These substances (allergens) might be airborne particles like pollen from grasses, weeds or trees, dust mite droppings in house dust, mould spores in damp areas, or pet dander (tiny flakes of animal skin). When an allergic person inhales or comes into contact with these allergens, the body mistakenly identifies them as threats and releases a surge of histamine and other inflammatory chemicals. This causes the familiar allergy symptoms – blood vessels in the nose swell and produce mucus (leading to nasal congestion and runniness), the eyes may water and itch, and the throat or ears can get itchy as well. Some people are genetically predisposed to allergies (it can run in families), but environmental factors play a big role too. Living in an area with lots of pollen or exposure to irritants like cigarette smoke can make allergic reactions more likely or more intense. In short, the causes of ENT allergies boil down to an overactive immune response to specific triggers in your environment. Identifying which trigger is responsible for your symptoms is key – once we know, we can target it with the right avoidance strategies and treatments.

Yes – it may surprise some, but nasal allergies can indeed lead to ear issues and even temporary hearing changes. Here’s how it works: the middle ear (the space behind your eardrum) connects to the back of your nose via the Eustachian tube. When you have an allergic reaction in your nose, the lining of both the nose and the Eustachian tube can become swollen. Much like how your nose feels “blocked,” the tube can get blocked as well. If the Eustachian tube doesn’t ventilate the middle ear properly, you might feel fullness or pressure in your ears. Sounds can become muffled because the eardrum isn’t moving freely due to pressure imbalance or fluid that accumulates. Many people with allergic rhinitis experience moments of popping ears or reduced hearing clarity, especially during bad hay fever days. Allergies can also cause your ears to itch (particularly the ear canals or the roof of your mouth – another odd but common allergy symptom). Furthermore, chronic nasal allergies can contribute to otitis media with effusion – essentially fluid lingering behind the eardrum – which is more frequent in children but can occur in adults too. The good news is that these effects on the ears are usually reversible with proper allergy treatment. By decongesting the nasal passages and reducing inflammation, the Eustachian tubes can function normally again, allowing fluid to drain and pressure to equalise. If you’ve noticed hearing yourself speak as if from underwater or a new ringing in the ears coinciding with allergy season, it’s quite likely allergy-related. Always mention these ear symptoms to the specialist, as it helps paint a full picture. We will check your ears during the exam and ensure there isn’t another cause for hearing issues. In most cases, treating the allergies will clear up the ear symptoms and restore your normal hearing and comfort.

Diagnosing ENT allergies involves a combination of careful history-taking, physical examination, and sometimes specific tests. First, the specialist will talk with you about your symptoms – what you experience, when it happens, and if you’ve noticed any patterns (for example, symptoms worse outdoors, or in the bedroom, or after playing with a pet). This discussion is very important; often the timing and context of symptoms provide big clues about the allergen. Next, a physical exam of your ear, nose, and throat will be done. The doctor will look up your nostrils using a small lighted scope to see if the nasal lining is swollen or pale (allergic nasal tissue often looks pale or bluish and swollen). They may also check for nasal polyps (small non-cancerous growths that can form with long-term allergies). Your throat might be examined for signs of post-nasal drip (for instance, streaks of mucus or redness). And of course, your ears will be checked to see if the eardrums look normal or if there’s any fluid behind them. Depending on what we find, we might recommend further tests. The most direct way to identify specific allergies is through allergy testing. One common method is a skin prick test, usually done by an allergist or ENT with allergy training: a tiny drop of various suspected allergen extracts (like pollens, dust, cat dander, etc.) is placed on your forearm or back, and the skin is lightly pricked. If you’re allergic, a small bump and redness (like a mosquito bite) will appear at that site after about 15 minutes. It’s not particularly painful – more like a minor itch – and it gives quick results. Alternatively, sometimes a blood test (looking for IgE antibodies to specific allergens) is used, especially if skin tests are not advisable (for example, if you have a skin condition or can’t stop certain medications). In addition to allergy tests, if sinus issues are severe, an ENT might order a sinus CT scan to see if there’s any sinus blockage or inflammation. However, that’s usually only if we suspect complications like sinusitis that might need a different approach. In summary, diagnosis is about confirming that your symptoms are indeed due to allergies and pinpointing the allergic triggers. Once we have that information, we can formulate an effective treatment plan.

There is a range of effective treatments for ENT allergies, and often a combination is used for best results. The cornerstone for nasal allergies (allergic rhinitis) is typically medication to control the inflammation and histamine reaction. One of the most effective options is a corticosteroid nasal spray – used daily, these sprays significantly reduce nasal swelling, mucus, and sensitivity over time. Many patients find that after a week or two of regular use, their congestion and sneezing improve markedly. Alongside that, oral antihistamine tablets (such as cetirizine or loratadine) help relieve sneezing, runny nose, and itchiness. We tend to recommend the non-drowsy modern antihistamines for daytime use so you remain alert. If your eyes are very itchy or watery, anti-allergy eye drops can be added as well. For immediate relief of a very blocked nose, decongestant nasal sprays or tablets can shrink swollen tissues – but we use these with caution. The nasal decongestant sprays in particular should not be used for more than a few days in a row, because they can cause rebound congestion (we always explain this to patients to avoid “getting hooked” on something like oxymetazoline spray). Another helpful treatment is saline nasal irrigation. Rinsing the nasal passages with a saltwater solution (using a neti pot or a squeeze bottle) helps wash out allergens and soothe the mucous membranes – it’s a simple, drug-free way to get some relief and improve nasal breathing, and we often teach our patients how to do this safely at home.

For allergy-related ear problems, treating the nasal allergy often is enough to clear the ears. As the swelling in your nose goes down, the Eustachian tubes start working properly, and any fluid in the middle ear can drain. However, if you’re experiencing a lot of ear discomfort or pressure, sometimes we may add a short course of an oral decongestant or a steroid to speed up the opening of the Eustachian tube. We might also advise something called the Valsalva manoeuvre (gently blowing out with your nose pinched closed) or special ear exercises to help pop the ears – but only if appropriate. In the event that fluid in the ear persists even after allergy treatment, an ENT can drain it or place tiny ventilation tubes in the eardrums to prevent it building up (this is more common in stubborn cases, and we’d discuss if it’s necessary – often it isn’t once allergies are under control).

Besides medications for immediate symptom control, we will talk about allergen avoidance strategies as part of treatment. This means making some changes to reduce exposure to your triggers. For example, if dust mite allergy is confirmed, steps like using hypoallergenic mattress and pillow covers, washing bedding in hot water regularly, and keeping humidity low can really help. If pollen is a trigger, we might suggest keeping windows closed during high-pollen days, or showering after coming in from outdoors to rinse off pollen. These practical measures can complement your medications and sometimes lessen how much medicine you need.

For patients with moderate to severe allergies that are not sufficiently relieved by the usual measures – or for those who prefer a more long-term solution – immunotherapy is an excellent option. Immunotherapy involves exposing you to tiny amounts of the allergen in a controlled way to retrain your immune system to be less reactive. It can be given as injections (allergy shots, typically weekly or monthly at a clinic) or as sublingual drops/tablets that dissolve under the tongue at home (depending on the allergen, e.g., grass pollen tablets are common). Over the course of 1-3 years, immunotherapy can greatly reduce your sensitivity. It’s the closest thing to a “curative” approach for allergies. Not everyone chooses this route, but we will discuss it if it’s appropriate – for instance, if you have very bad hay fever that lasts many months each year, immunotherapy could dramatically improve your quality of life in the long run.

Lastly, if your allergies have led to complications like chronic sinusitis or nasal polyps, treatments targeting those may be needed. We might prescribe longer courses of nasal steroids or new biologic medications that shrink polyps. In some cases, an ENT surgical procedure can remove polyps or open sinus drainage pathways, but that is generally a last resort after trying medical therapy. Most patients won’t need surgery for allergies – thankfully, the combination of medicines and possibly immunotherapy works well for the majority. Our aim is to find the right mix for you: something that controls your symptoms, is feasible with your lifestyle, and has minimal side effects. We’ll work together to fine-tune the plan until you’re feeling significantly better.

Yes, absolutely. Adult-onset allergies are a recognized phenomenon. While many allergy sufferers do start showing symptoms in childhood or early adulthood, it’s entirely possible to develop allergies for the first time in midlife or even as a senior. We see this quite often in the Algarve: someone relocates here for the beautiful climate and after a year or two suddenly experiences their first bout of “hay fever.” What’s going on? One reason is new exposure – the plants and pollens in a new region can be different from those in your home country. Your immune system may never have been challenged by, say, olive tree pollen or certain Mediterranean grasses, until now. With enough exposure over time, a susceptible person’s immune system can start producing allergic antibodies and – voila – allergy symptoms appear. Another factor is that our immune system changes as we age. Sometimes as people get older, their immunity can weaken in some areas but oddly also become more prone to allergies. There’s even a medical term, “the allergic march,” describing how allergies can evolve over a lifetime. It’s not that uncommon for someone to have no allergies in their 30s and 40s, then develop sensitivities later. On the flip side, some folks who had bad allergies when younger might find they diminish after retirement age. The bottom line is that allergies can develop at any stage of life. So if you’ve been sniffly and sneezy and you’re puzzled because it never happened before, you’re not alone and it’s not “all in your head.” We will take your symptoms seriously. The good news is, even if you’re older, you can still get the same effective treatments. There’s no age limit on benefiting from allergy care. In fact, it’s all the more worthwhile to treat it – why spend your golden years in a sneezing haze if you don’t have to? With the right approach, you can enjoy your new environment without suffering from new allergies.