Postnasal Drip, Immunotherapy, and Asthma: Is There a Link?

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postnasal dripQuestion

My patient has both chronic postnasal drip syndrome (PNDS) and asthma, and received only 2 shots of immunotherapy. He experiences asthma exacerbation whenever he is exposed to wood, paper, carpet, or dust. (The immunotherapy shot has since been stopped.) Is PNDS linked to the development of asthma? How long does an allergic reaction to allergy shots last, and can it be managed?

Response from  William W Storms, MD
 
Director, The William Storms Allergy Clinic, Colorado Springs, Colorado; Clinical Professor, University of Colorado Health Sciences Center, Denver, Colorado

This question pertains to a patient with postnasal drainage and asthma who received 2 immunotherapy shots and had asthma exacerbations when exposed to wood, carpet, paper, or dust.

 

The first question is whether PNDS is linked to the development of asthma. No one really knows, but we do know that in patients with upper airway disease (allergic rhinitis), those same allergens may trigger an asthma attack. In fact, the link between allergic rhinitis and allergic asthma has long been a subject of debate, and various therapeutic agents that are used to manage one entity have shown benefit in treating the other.[1] It is difficult to predict which patients will develop asthma after their allergic rhinitis, and the disease needs to be dealt with on a case-by-case basis.

The second part of the question asks about the length of time that an allergic reaction occurs following allergy immunotherapy. This varies from patient to patient, and some patients may experience an aggravation of their asthma for hours or days afterward. In those patients, it is important to get the rhinitis and the asthma under control with pharmacotherapy and then consider restarting immunotherapy at a much lower dose, and then gradually increasing the dosage. If repetitive reactions occur, then the immunotherapy should be discontinued.

References

  1. Casale TB, Dykewicz MS. Clinical implications of the allergic rhinitis-asthma link. Am J Med Sci. 2004;327:127-138.
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