FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

LARGER LEFT-SIDE AIR PASSAGE MAY EXPLAIN NON-SYMMETRICAL ALLERGY

Question: I have trouble with the left side of my nose becoming stopped up. My doctor said I have allergies and gave me an antihistamine. This has helped quite a bit, but why does this allergy condition only affect one side of my nose? Shouldn’t it occur on both sides of the nose?

Answer: Sensitive individuals have allergic reactions when they come in contact with an irritating substance that is called an allergen. This "allergic response" is actually the result of an inappropriate immune system reaction to an otherwise harmless substance. Doctors call the condition you have allergic rhinitis because it describes an allergic condition within the respiratory tract. Inhaling the offending allergen -- typically pollen, mold, animal dander or insect remains -- triggers the allergic response. Most of us describe this malady by its common name, allergies.

Allergies are a very common problem. Between 15 and 20 percent of the population suffers from them. Most individuals -- about two thirds of the total -- develop allergies before age 30. They can, however, appear for the first time at any age. The typical symptoms are some combination of nasal congestion, itching eyes and nose, sneezing and a runny nose. These usually begin as soon as 30 minutes after exposure to the offending allergen, and the overall allergic response may persist for several days. Of course, repeated exposure to the irritating substance just perpetuates the condition.

Your question correctly implies that congestion and other allergic symptoms are typically symmetrical -- affecting both sides of the nose equally. However, the extent of symptoms in either side of the nose can vary considerably. I’ll try to explain why. The allergic response causes the nasal tissue to swell and to also produce more mucus than normal. The swollen tissue blocks off the nasal passages and causes the stopped up nose feeling, while the increased mucus production causes the running nose.

I’m sure you have noticed that most people don’t have ears that are an exact mirror image of one another. The same is true of the delicate bones that make up the structures inside the nose. One side often has larger air passages than the other. Allergic swelling may be equal on both sides of the nose, but the side that has a larger air passageway will seem OK, while the other side will be blocked. This is the most likely cause for your condition. The left side of your nose probably has a smaller airway space, and therefore, is more easily obstructed by allergic swelling.

The best treatment for allergies is avoidance of the offending substance. Unfortunately, this is often an impractical solution. Antihistamines, both the prescription and non-prescription types, are good choices and are usually the first type of medicine to try. Obviously your doctor thinks so, too. There are a number of treatment options for allergic rhinitis. Your doctor will help you choose the best one for you. If they fail to clear the one-sided stopped up nose however, you should see an ear-nose-throat specialist (ENT) to clarify the exact cause of your symptoms.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.