Allergic Sinusitis, Allergic Migraine, and Sinus Headaches

Sinus headache, sinusitis, and migraine are phenotypic diagnoses frequently elaborated by otolaryngologists, neurologists, and primary care general practitioners under different per-spectives. These conditions present with very similar phenotypes that are investigated, diagnosed, and treated according to the physician’s perspective. Some patients present fluid phenotypes that sometimes appear to be one condition and, sometimes, another condition. Due to the similarity of the phenotypes, a multidisciplinary approach is highly recommendable. To prescribe an adequate treatment, defining the endotypes responsible for the phenotypes is essential. The role of hy-persensitivity conditions is better understood, especially the role of non-IgE-mediated hyper-sensitivities. The eosinophil is a typical type II Gell and Coombs hypersensitivity marker. However, it is not the sole one. Personalized approaches to identify non–IgE-mediated hyper-sensitivities dwelt in the in vivo and ex vivo provocation tests. A suggestion from an allergologist to colleagues from other specialties is to ensure, at least, a minimum investigation for allergic eti-ology in patients complaining of sinus headaches and/or migraines. This approach aims pre-scribing proper eviction measures and curative treatments, such as one of the several available presentations of allergen-specific, multiallergen group-specific, or allergoid immunotherapies. Here, the author provides the perspective of an allergologist updating an immunological point of view under the premises of IgE-mediated and non–IgE-mediated hypersensitivities.