The purpose of this subject is to demonstrate how allergic methods of diagnosis and treatment are incorporated into our otolaryngologic practice. The keystone to proper management of nasal allergy is identifying the causes. This calls for the use of the methods of etiologic diagnosis such as allergic history, cytologic examination, skin test and provocation test.
The cytologic examination of nasal secretions is essential in every case of rhinorrhea in order to determine the presence of allergy. As a quick method of staining nasal smears, I have introduced the one-minute technic using Hansel stain which is now available in Japan. A predominance of eosinophils in nasal smear is diagnostic of nasal allergy. Skin testing for allergy survey is a great aid in the evaluation and managment of nasal allergy. Scratch and intradermal tests are routine in our practice. For the purpose of detecting causative allergens, I have usually used extracts of inhalants such as house dust, pollens, molds and animal danders. Scratch test is technically easier to perform and many allergens may by examined at one time, while intradermal test is more useful for determining the starting point of hyposensitization.
The routine performance of the provocation test is a valuable help in ascertaining the actual allergen. Instead of using the traditional nasal or sniff test, I have performed the provocation test by placing the diagnostic allergen disk (supplied by Torii and Co., Tokyo) on the anterior end of the inferior turbinate. Specific hyposensitization therapy is the best indication when the offending allergen is ascertained. In our practice this therapy is confined to treatment of house dust, pollen and mold allergies.
When the offending allergen is not ascertained, nonspecific treatment is indicated. Since the appearance of effectiveness of both specific and nonspecific therapies is gradual, the symptomatic treatments with drugs such as antihistamines, minor tranquilizers and steroids are indicated. Steroids, however, should be used when the patient is not responding to other forms of treatment. Because of adverse effects, local use is desirable.
When the patients are properly indicated, surgical treatments such as conchotomy, polypectomy and septal operation are of benefit to relieve nasal obstruction. In our practice the local treatment for nasopharyngitis coexisting with nasal allergy in almost all the patients is the routine procedure of the management of nasal allergy. The tip on the management of nasal allergy is to design a good combination of the method of treatments according to etiologic factors and symptoms.
