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Nothing to Sneeze At

Posted on April 18, 2019 in Surgery

More to allergies than meets the eyes and nose

Dr. Leonard Brown, left, with fellow otolarynologists Dr. William H. Merwin (seated) and Dr. Drue Manning in their Farragut clinic.
Dr. Leonard Brown, left, with fellow otolarynologists Dr. William H. Merwin (seated) and Dr. Drue Manning in their Farragut clinic.

Allergies. Almost everyone has them. And almost everyone either tries to ignore them or manage them with over-the-counter drugs. But allergies aren’t just part of living in the Great Smoky Mountains. Those itchy, watery eyes and runny noses are telling us something about our health.

“Not managing your allergies can lead to dizziness, asthma, and sinus surgery, and to recurrence of sinus surgery,” said Leonard W. Brown, MD, a Fort Sanders Regional Medical Center otolaryngologist who has performed more than 10,000 sinus surgeries. “They don’t realize that they are looking at a health issue that may be more than a nuisance.”

In fact, said Dr. Brown, 40 percent of children with untreated allergies will eventually develop asthma. He also noted that there are indications that Meniere’s disease, which is characterized by vertigo and tinnitus (a ringing or roaring sound in the ear), may be associated with uncontrolled allergies.

Furthermore, said Dr. Brown, allergies are often the reason for fatigue, which can hinder activity levels. “People get fatigued from being bombarded with all the pollens. There are studies indicating that controlled allergies can increase academic and athletic performance. There are more hours lost from work every year from sinus allergy than from things like back pain. It’s one of top reasons why people miss work.”

Dr. Brown said Knoxville is always among the top 10 worst states for pollen allergy, a phenomenon likely linked to the natural abundance of the trees and flora in the Great Smokies. That does not mean, however, that no allergens are present during the winter.

“Many allergies are year-round,” said Dr. Brown. “Dusts and molds are year-round. We pollinate year-round.  So even in the winter, we are pollinating. Mountain cedar? It’s a pollinator, and it’s pollinating usually in January and February. People say, ‘It can’t be the trees!’ Well, yes, it can – we have a lot of mountain cedar here.”

Dr. Brown said first-time patients in their 50s and 60s often question an allergy diagnosis, saying, “I’ve never had a problem with allergies all my life!” But he noted that, similar to high cholesterol, people who have not been tested may not know they have an allergy until symptoms become a problem.

That is why Dr. Brown strongly urges allergy testing to pinpoint the cause(s) of symptoms. The testing may involve drawing blood, skin pricks, intra-dermal titration, tablets under the tongue or a combination of a skin prick and intra-dermal test called modified quantitative testing, or MQT.

Depending on the findings and the patient’s age, health and other factors, the patient may then begin allergy immunotherapy, a series of shots that help desensitize the body’s reaction to certain allergens.

“When you do allergy testing, you have a lot of false negatives,” said Dr. Brown. “There are false positives, too. But a false negative means you did the testing and it says there’s not an allergy, but there really is. So being able to do several methods of testing that identify those give us more treatment options.

“I would say 90 percent of our adult patients will be off shots in three to five years, with expected long-term desensitization. That’s tremendous because we used to look at five years minimum and maybe up to 20 years of shots.

Dr. Brown recalled a physician friend who battled allergies for years, but dismissed his advice to get allergy tested. “He said, ‘Dr. Brown, it’s voodoo.’ So I said, ‘let’s try it,’ and he did. About a year and a half later, I could tell he wasn’t having as many problems.  I asked him, ‘Well, what do you think now about allergy testing?’ He looked at me sort of sheepishly and said, ‘It works.

Sinus surgery is one of many types of surgical specialties offered at Fort Sanders Regional Medical Center. To learn more about the various procedures and technologies available, visit