Allergies causing nasal polyps

What are nasal polyps?

Nasal polyps are formations that grow inside the nose, as if they were “pears” hanging from the mucosa of the nasal ethmoid area. They are completely benign lesions of inflammatory origin. They can affect any person, being very infrequent to appear in children under 10 years of age and having a higher incidence in patients already suffering from other allergic diseases (allergic rhinitis, asthma, etc). In general, it is estimated that they affect 2 – 5% of the population. The size they can reach is very variable and the symptoms they will produce will depend on that size and their exact location inside the nose.

Generally, it is a disease that affects both sides of the nose, not having to be a symmetrical affectation on both sides. Polyps can be multiple or be a single solitary polyp. They are a relapsing disease, which means that once cured or controlled, they can reappear.

What are the causes?

The fundamental cause is an allergic basis. There may be other influencing factors, such as genetic predisposition or environmental pollution, but their incidence is higher in people suffering from other allergic conditions such as bronchial asthma and allergic rhinitis. Nasal polyps also appear in patients affected by chronic sinusitis in whom there is no allergic component, being in these cases secondary to the infection.

What symptoms can they present?

In addition to the well-known allergy symptoms (sneezing, nasal itching and continuous mucus drip), the symptoms they present are due to nasal obstruction, which translates into: having to breathe through the mouth (dryness and throat irritation), smell alterations (referred by patients as “I can’t smell and food doesn’t taste like anything”), headaches and predisposition to suffer from repeated sinusitis. It is very common for patients to report that “their nose is full of mucus and they cannot blow it”. It should be taken into account that not all polyps produce symptoms: we can find patients affected by polyposis who do not report any symptoms and, on the contrary, a single polyp can be very symptomatic.

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What is the treatment and what are the results?

Treatment should be aimed at improving nasal breathing and sinus ventilation, which then leads to a lower risk of sinusitis and a better quality of life. Once these two aspects have been controlled, persistence of treatment is essential to avoid recurrence.

To begin with, corticosteroids applied directly inside the nose are best, which achieves a very high level of control. Corticosteroids in tablets or injections have very good control of the disease in crises and as initial treatment, but because of their side effects, they should not be maintained as continuous treatment if it can be avoided. Corticosteroids applied directly in a spray directly into the nose have virtually no side effects on the rest of the body.

If symptoms persist, surgical treatment is performed, which is undoubtedly the best, but as it is the most aggressive, it is never used from the outset. It is also essential to treat concomitant diseases such as those already mentioned (allergic rhinitis or asthma) in order to achieve good control. If the polyps cause sinusitis crises, antibiotic treatment is mandatory, which will not only control the infection but will also prevent the worsening of the sinus infection.
infection but will also prevent worsening of the polyposis.

Can they be prevented in any way, and are there any predisposing characteristics?

As it is an allergy-related disease, the best way to prevent its occurrence is good allergy control. The same applies to any disease that accompanies nasal polyposis (asthma, cystic fibrosis). The inspection of the rest of the pathologies is fundamental for the follow-up of polyps. In the event that we operate to remove them, it is essential to persist with treatment to try to prevent recurrence.