Allergic Rhinitis

Allergic rhinitis is a collection of symptoms, mostly in the nose and eyes, which occur when you breathe in something you are allergic to, such as dust, dander, or pollen.

This article focuses on allergic rhinitis due to outdoor triggers, such as plant pollen. This type of allergic rhinitis is commonly called hay fever.


Causes

An allergen is something that triggers an allergy. When a person with allergic rhinitis breathes in an allergen such as pollen or dust, the body releases chemicals, including histamine. This causes allergy symptoms such as itching, swelling, and mucus production.

Hay fever involves an allergic reaction to pollen. (A similar reaction occurs with allergy to mold, animal dander, dust, and similar inhaled allergens.)

The pollens that cause hay fever vary from person to person and from region to region. Large, visible pollens are seldom responsible for hay fever. Tiny, hard to see pollens more often cause hay fever. Examples of plants commonly responsible for hay fever include:

  • Trees (deciduous and evergreen)
  • Grasses
  • Ragweed

The amount of pollen in the air can play a role in whether hay fever symptoms develop. Hot, dry, windy days are more likely to have increased amounts of pollen in the air than cool, damp, rainy days when most pollen is washed to the ground.

Some disorders may be associated with allergies. These include eczema and asthma.

Allergies are common. Your genes and environmental may make you more prone to allergies.

Whether or not you are likely to develop allergies is often passed down through families. If both your parents have allergies, you are likely to have allergies. The chance is greater if your mother has allergies.


Symptoms

Symptoms that occur shortly after you come into contact with the substance you are allergic to may include:

  • Itchy nose, mouth, eyes, throat, skin, or any area
  • Problems with smell
  • Runny nose
  • Sneezing
  • Tearing eyes

Symptoms that may develop later include:

  • Stuffy nose (nasal congestion)
  • Coughing
  • Clogged ears and decreased sense of smell
  • Sore throat
  • Dark circles under the eyes
  • Puffiness under the eyes
  • Fatigue and irritability
  • Headache

Exams & Tests

The health care provider will perform a physical exam and ask you questions about your symptoms. Your history of symptoms is important in diagnosing allergic rhinitis, including whether the symptoms vary according to time of day or the season, exposure to pets or other allergens, and diet changes.

Allergy testing may reveal the specific substances that trigger your symptoms. Skin testing is the most common method of allergy testing. See the article on allergy testing for detailed information.

If your doctor determines you cannot undergo skin testing, special blood tests may help with the diagnosis. The RAST test can measure the levels of specific allergy-related substances, especially one called immunoglobulin E (IgE).

A complete blood count (CBC), specifically the eosinophil white blood cell count, may also help reveal allergies.


Treatment

The best treatment is to avoid what causes your allergic symptoms in the first place. It may be impossible to completely avoid all your triggers, but you can often take steps to reduce exposure.

There are many different medications available to treat allergic rhinitis. Which one your doctor prescribes depends on the type and severity of your symptoms, your age, and whether you have other medical conditions (such as asthma).

For mild allergic rhinitis, a nasal wash can be helpful for removing mucus from the nose. You can purchase a saline solution at a drug store or make one at home using one cup of distilled water (or water that has been boiled & cooled to room temperature) half a teaspoon of salt, and pinch of baking soda.


Medications used to treat allergic conditions may include:

Antihistamines

Antihistamines work well for treating allergy symptoms, especially when symptoms do not happen very often or do not last very long.

Antihistamines taken by mouth can relieve mild to moderate symptoms, but can cause sleepiness. Many may be bought without a prescription. Talk to your doctor before giving these medicines to a child, as they may affect learning.

Newer antihistamines cause little or no sleepiness. Some are available over the counter. They usually do not interfere with learning. These medications include fexofenadine (Allegra), loratadine (Claritin) and cetirizine (Zyrtec).

Azelastine (Astelin), Astepro and Patanase are antihistamine-based nasal sprays that are used to treat allergic rhinitis.

Corticosteroids (Nasal and Lung sprays)

Nasal corticosteroid sprays are the most effective treatment for allergic rhinitis. Anti-inflammatory lung sprays are also very effective in the treatment and management of asthma. Although these products contain a corticosteroid, they are considered very safe, especially when used as prescribed.

These products work best when used daily, but they can also be helpful when used for shorter periods of time, especially during the times of the year when the patient’s symptoms are most active.

Some of the nasal sprays are approved for the pediatric population age 2 and up.

Decongestants

Oral decongestants are drugs that constrict the blood vessels in the nose, thus decreasing nasal congestion. Sudafed is a popular oral decongestant available over the counter, without a prescription. They typically have no effect on nasal itchiness, runny nose, or watery eyes.

Since decongestants may act throughout your body and not just in your nose, they should be used with caution in patients with heart disease, thyroid problems, or high blood pressure. Although often very effective at relieving symptoms of stuffy nose or sinus congestion, they often have side effects such as jitteriness, irritability or difficulty sleeping at night (such as many people experience with coffee)

Topical Decongestants are nasal sprays (i.e.,Afrin or Neo-Synephrine) available over the counter. Since they are applied directly to the effected site, they relieve nasal congestion rapidly and can quickly open clogged nasal passages.

Nasal decongestant sprays can be effective at relieving the symptoms of the common cold. However due to the potential that the nasal mucosa can become dependent on these sprays for congestion they should not be used for more than 3 days in a row. However, the nasal mucosa can become “dependent” on these sprays for congestion especially if they are used for more than 3 days in a row.


Other Medications

The leukotriene inhibitor Singulair is a prescription medicine approved to help control asthma and to help relieve the symptoms of seasonal allergies.

Specific illnesses that are caused by allergies (such as asthma and eczema) may require other treatments.