Rhinitis, sinusitis and their interference with driving

Rhinosinusal allergy

Some studies have shown that the number of patients seeing a physician for treatment of asthma and allergy has doubled in recent years

An estimated 15% of the population suffers from allergy to some external substance, and, in fact, 80% of vasomotor disorders of the rhinosinusal mucosa are of allergic origin.

Symptoms

The nose and the eyes are the parts of the body most frequently affected by allergy, which is manifested by profuse watery discharge from the nose, nasal blockage, and often by facial pain and headache from sinus congestion.

Itching or tingling in the nose causes bouts of sneezing, with more than 5 per minute.

An inconvenient sneeze at 90 km per hour prevents the driver from properly controlling the car for a few seconds; in this time, the automobile will have traveled 25 meters. If this situation is repeated by a series of sneezes, which is quite common in allergic persons, the risk during driving is multiplied.

In a succession of 20 sneezes, a car traveling at a speed of 120 km per hour can cover about 660 meters, during which time the allergic person does not have his/her eyes open or full control of the car.

There may also be itching in the hard and soft palates, pharynx and external ear canal, as well as possible coughing and wheezing from bronchospasm and asthma.

Allergic conjunctivitis causes itching of the surface of the eye, leading to persistent rubbing with increased redness and edema, chemosis, foreign body sensation, photophobia and tearing.

The patient may manifest urticaria, eczema and pruritus, as well as digestive symptoms such as diarrhea and abdominal pain.

The majority of the 6 million Spaniards who suffer from this disease admit that it prevents them from performing their usual work activities (62%), driving (32%), physical exercise (45%), and adversely affects their leisure time (56%). Forty percent of allergy sufferers have increased symptoms of stress.

Treatment

Only 25% of affected patients are treated by physicians, the remainder resort to friends’ recommendations or self-medication.

The usual treatment of allergy are antihistamines which generally have serious contraindications for driving such as drowsiness, depression, diminished alertness and delayed reaction time, effects that are unknown by the patient who self-medicates.

If we add to this the fatigue caused by the clinical condition and the lack of sleep at night, driving can be dangerous.

Since some years ago, there are “new” antihistamines, such as astemizole and terfenadine, which maintain their antiallergic potency with minimal sedative effects.

However, they present a serious risk when mixed with alcohol, because they cause drowsiness and increased reaction time, even in small doses.

Tips

When traveling by car during the allergen season, it is recommended to keep the windows closed and even to use the filters in the air ducts of newer cars that include them as part of the standard equipment.
It is recommended to wear sunglasses, if possible, with protective sidepieces.
It is advisable to know the pollen forecasts in advance, and, in any case, to avoid driving in the later hours of the day when the pollen particles descend with the cooling of the air.
If the patient is asthmatic, other persons should not smoke or use sprays or perfumes in his/her presence.
Physicians should caution their patients that some antiallergic medications have side effects that may limit driving so that they are especially careful when driving or simply not drive.
They should be told that they should never drive when sleepy.

Rhinitis

Acute viral rhinitis is characterized by rhinorrhea, sneezing, nasal obstruction and ocular irritation. Other common symptoms are chills, headache and tiredness.

Chronic purulent rhinitis initially manifests as mucous rhinorrhea and nasal obstruction, and may progress over time to chronic hypertrophic rhinitis, especially if the irritating effect of cigarette smoke is added.

Predisposing factors for this condition include gout, some types of rheumatism, and allergy.

Vasomotor rhinitis is characterized by hyperreactivity of the nasal mucosa due to autonomic dysfunction, with a large psychogenic component.

It is usually associated with tingling in the fingers, muscle cramps, epigastralgia, palpitations and eyelid twitching.

It is triggered by cold, heat, pollution, strong odors, stressful situations, etc.

Tips

Persons who suffer from vasomotor rhinitis are recommended to purchase a vehicle with air conditioning to avoid abrupt changes in temperature and not to use air fresheners.
Treatment with vasoconstrictors and antihistamines may produce added drowsiness, with the consequent risk for driving.
Drivers who smoke inside the vehicle with the windows closed favor progression and complication of their rhinosinusal condition. They should therefore not smoke for this reason and because it also favors distraction.

Ethmoiditis

It is often a sequela of an upper respiratory tract infection such as a cold, and is characterized by frontoorbital pain that is increased by eye movement, and eyelid edema.

Tips

Driving is not permitted because of reduced visual capacity.

Sinusitis

It is usually characterized by frontal or periorbital pain, a sensation of tightness in the face, nasal obstruction and rhinorrhea. It may be accompanied by general symptoms, such as tiredness and fever.

The most common rhinosinusal complications are:

Dacryocystitis, which is manifested by tearing and inflammation of the inner corner of the eye, which is red and swollen. Surgery is required if the disease becomes established.
Inflammation of the eyelids with edema, which if pronounced in the inner part of the orbit, is accompanied by exophthalmos, diplopia and chemosis.
Phlegmon of the orbit is very serious and requires surgery if the eye is immobile, with mydriasis and an insensitive cornea.
Involvement of the intraorbital nerves may cause paralysis, loss of corneal sensitivity, and alterations in ocular accommodation. But the most serious lesions are those affecting the optic nerve, if papillitis is produced with unilateral reduction of visual acuity, or retrobulbar neuritis without papillitis, with unilateral reduction of visual acuity with a normal papilla.
Infection of the veins of the orbit can cause thrombophlebitis of the cavernous sinus, which presents with severe orbital and occipital pain and signs of orbital phlegmon, with diplopia, reduction of visual acuity and severe illness.

Other rare and serious complications are osteomyelitis of the cranial vault, meningitis and encephalitis.

Tips

In all cases of sinusitis, regardless of the severity of the clinical condition, driving is difficulty and risky because vision and hearing are often affected.
The physician will advise against driving in all patients with rhinosinusal complications until resolution of the disease without symptoms or sequelae.