Allergies, chronic sinus problems and asthma are increasing in western societies. No one is exactly sure why this is happening, but some suspect it has to do with being too clean. The “cleanliness hypotheses” states that people are not routinely exposed to things that can cause allergies, particularly as children. When they do get exposed to an allergen, the body sees it as foreign and develops a reaction to it. Although this may or may not be the case, it’s interesting to note that allergies and asthma are uncommon in developing or underdeveloped countries, but they are rampant in developed countries.

We do know that people with bad allergies can often develop chronic sinus problems and even asthma. The inflammation that occurs in the airways is similar whether it’s in the nose and sinuses or in the lungs, leading to the term “one airway” inflammation. Even aggressive medical treatment may not prevent this progression from occurring. In some cases, the combination of the sinus inflammation and the asthma can ultimately lead to the need for sinus surgery.

Is there anything that can be done to prevent this progression from happening? There is growing evidence that earlier management of allergies or sinus inflammation can reduce the risk of developing asthma. Immunotherapy ( allergy shots, or now sublingual drops or tablets) in allergic and asthma-prone children has been shown in a couple of studies to reduce asthma development.

Now, sinus surgery may also be preventative in some people. We recently presented research at the American Rhinologic Society’s spring meeting that suggests just that. Using a 60-million patient database, we investigated patients who failed medical treatment and ultimately had sinus surgery. There were a couple of interesting findings:

1. Allergic patients with chronic sinusitis were more likely than non-allergic patients to develop asthma.

2. Early surgical treatment (less than two years after a sinusitis diagnosis) resulted in less long-term asthma than in those who had surgery later (four to five years after a sinusitis diagnosis).

So what does this tell us, and what are the take-home messages? The sinuses and lungs are connected. Things that cause inflammation in the sinuses can also do so in the lungs — particularly allergies. In people who have allergies and chronic sinusitis, keeping the sinuses under control helps the lungs, and keeping the lungs under control helps the sinuses. Aggressive treatment, whether with allergy immunotherapy or sinus surgery, may help reduce the risk of developing a worse airway disease, like asthma.

The final word is not out, but a shift may be happening. In the future, we might be recommending surgery and immunotherapy early on, rather than as a last resort when patients feel really bad.

One final thought. Maybe it is time to allow our children to play in the mud and the leaves, not wash their hands every five minutes and let them be kids. It might reduce the potential that they develop asthma, sinus problems or asthma. The jury is still out.

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Allergies, Sinuses and Asthma: Can Sinus Surgery Help? originally appeared on usnews.com