Allergies or sinusitis? What every allergy sufferer should know, according to an ENT surgeon

Every spring, millions of people across the UK reach for antihistamines and assume their blocked nose, sneezing and general sense of feeling run down are simply the price of tree pollen season.

For most, that is a reasonable conclusion – recent research indicates that around 49% of people in the UK suffer from the side effects of hay fever. However, if your symptoms are more severe, you may have a sinus infection.

As an ENT surgeon specialising in nasal and sinus conditions, Mr Annakan Navaratnam sees an increase in patients through the spring and summer months. Some arrive having self-managed for years. Others have been taking medication that was never quite right for their symptoms. So here is Annakan’s take on allergy awareness.

Start with good medical treatment, and use it properly

The mainstay of allergy treatment is medical, and for most people with nasal symptoms, that means a topical nasal steroid. These are highly effective, but there is one thing I find myself saying repeatedly in clinic: a significant number of patients are not getting the benefit they should because they are using them incorrectly.

The common mistake is to tilt the head back, insert the nozzle and take a sharp sniff. What that does is carry the medication straight through to the back of the throat and voice box, which is not where you need it. The spray needs to stay in the nose. The technique is to aim slightly to the side of the nasal passage, not straight up and breathe gently rather than inhaling forcefully.

I have a YouTube video on this specifically because it genuinely changes results for people who have felt the treatment wasn’t working.

I also want to address the concern about steroids that comes up regularly. The systemic absorption of a topical nasal steroid such as fluticasone propionate (trade name Pirinase or Flixonase), known as bioavailability, is approximately 0.1%. That is an extremely low figure, and it means that using these medications as directed is safe, including for children.

Paediatric patients with persistent nasal symptoms or a chronic runny nose that has never been properly explained are worth reviewing, as allergy is frequently the underlying cause and is very treatable.

Get tested, not just treated

People often assume their symptoms are hay fever because they come on in spring, but allergy testing can reveal something quite different. House dust mite allergy, for instance, is perennial and causes symptoms year-round that patients frequently attribute to other causes. Knowing what you are reacting to matters because it opens up treatment options beyond symptom management.

One of those options is desensitisation, also known as immunotherapy. For confirmed house dust mite allergy that is not adequately responding to medication, sublingual immunotherapy involves daily exposure to a small amount of the allergen over an extended period, typically around three years, and can lead to meaningful long-term improvement in how the immune system responds.

This is not something I manage directly, but I can refer patients to the appropriate specialist when indicated.

When allergies and sinus disease overlap

One of the things I see regularly is patients who have been managing what they think is straightforward hay fever, but who are experiencing sinusitis on top of it. When allergies are poorly controlled or longstanding, the resulting inflammation can spread to the sinus cavities.

The symptom that should prompt that suspicion is a sense of facial pressure or fullness, particularly around the cheeks and forehead, or a feeling that you permanently have a cold that never quite arrives. That picture is less consistent with allergic rhinitis alone.

In those cases, a nasal endoscopy in clinic, which is quick and well-tolerated, allows me to look directly at the nasal passages and the sinus openings. If polyps are present, or if a CT scan reveals significant sinus disease, then surgical treatment becomes relevant and the results can be very good.

I have patients who struggled for years and saw a transformative difference after endoscopic sinus surgery, including in younger patients, where the concern about operating is sometimes greater than it needs to be.

Structure matters too

There is another reason nasal sprays sometimes fail to deliver their benefit, and it has nothing to do with technique. If you have a significantly deviated nasal septum, medication simply cannot reach the parts of the nose it needs to.

The spray enters a blocked or restricted passage and fails to penetrate adequately. In those cases, addressing the underlying structural issue with septoplasty enables everything else, including allergy management, to work as it should.

Get ahead of the season

This is a point I make to hay fever patients every year. Rather than waiting until symptoms are already at their worst, start taking antihistamines in February or March, before the pollen season fully establishes itself. Getting ahead of the inflammatory response is considerably more effective than trying to bring it under control once it has taken hold.

Know when to seek specialist input

There is a clear pathway here, and knowing where you are on it is useful. If you have tried a nasal steroid correctly, used antihistamines consistently, given the treatment a few months to work, and you are still not seeing sustained improvement, that is the time to consider referral. The next step is typically testing to identify specific allergens and, where appropriate, imaging such as a CT scan to assess the sinuses.

Allergy Awareness Week is a useful moment to reflect on whether you have been treating symptoms rather than understanding them. Persistent nasal symptoms that respond partially but never fully resolve, symptoms that are present year-round rather than seasonally, or the kind of general malaise that sits alongside nasal congestion without feeling specifically like hay fever, are all worth a proper assessment.

If your nasal symptoms have not been properly explained or adequately managed, a specialist consultation will give you a clearer picture of what is driving them and the most appropriate next steps.