allergic rhinitis

(Hay Fever)

Allergic Rhinitis Symptoms, Causes & Treatment

Common symptoms of allergic rhinitis include sneezing, nasal itching, runny nose, nasal blockage, cough, headache, ear itching and or blockage, tendency to develop ear infections and sinus infection.

It is not unusual to have eye symptoms of itching, runny or swollen eyes in association with allergic rhinitis.

Some patients develop asthma symptoms such as shortness of breath, wheezing, or cough in association with allergic rhinitis.

Flare up of eczema (dry, inflamed patches of skin) can occur during the allergy season for a small population of patients.

Inflammation of the mucus membrane of the nose and adjoining sinuses which is caused by the immunologic reaction of the body to harmless things like pollen, molds, dust mites, animal dander is called allergic rhinitis.

The term hay fever usually refers to seasonal allergic rhinitis.

Allergic rhinitis is caused by many seasonal and perennial allergens.

Molds, dust mites, animal dander and cockroaches are some of the year-around allergens.

Grass, tree and ragweed pollens are primarily seasonal outdoor allergens. Seasonal pollens depend on wind for cross-pollination. Plants such as goldenrod and dandelions that depend on insect pollination do not usually cause allergic rhinitis.

Mold spores grow in damp and warm environment. While mold spores can be measured indoors year-round, the highest mold spore counts occur in early spring, late summer and early fall.

Dust mites are microscopic creatures that live in beds, carpets and upholstered furniture. They thrive in warm (>70 degrees F) and humid climate (75%-80% humidity). They eat the skin we shed and are found inside our homes.

Other important indoor allergens are animal allergens. The major cat allergen is secreted through the sebaceous glands of its skin. These proteins are capable of staying in the air for up to six hours and can be measured for months after a cat is removed from an indoor environment.

Allergic Rhinitis affects about 20 percent of the western adult population and up to 42 percent of children. It ranks as one of the most common illnesses in the U.S.

While onset can occur at any age, two-thirds of all allergic rhinitis patients have symptoms before the age of 30. While allergic rhinitis has no sexual predilection, boys up to the age of 10 are twice as likely as girls to experience symptoms.

There is strong genetic predisposition to allergic rhinitis. A child is about 30 percent more likely to have this disorder when one parent has a history of allergies; the risk increases to 50 percent if both parents have a history of allergies.

Diagnosis of allergic rhinitis is initiated by taking a thorough history. A detailed physical examination is performed. This, followed by allergy testing, concludes the diagnosis.

Allergy Testing:

Most allergists perform skin tests to diagnose allergies. Skin tests are usually performed on the back in adults and on the arms in young children. The appointments usually take 1.5 to 2 hours and results are known at the end of the visit.

Treatments vary depending upon the severity of the disorder and specificity of the allergens in question. Such treatments can broadly be classified as follows:

Avoidance: Avoidance measures are available for dust mites and animals.

Non Medicinal: Nasal washes: For patients with milder symptoms nasal washes can be used alone. For patients with more severe symptoms, they can be used in conjunction with other medications. Nasal saline spray can be used if nasal washes are hard to perform.

Medicinal: Nasal steroids:These are nasal anti-inflammatory medications. They are very effective in controlling all the symptoms of allergic rhinitis. Nasal cromolyn sodium is a milder anti-inflammatory which is available over the counter and can help selected patients.

Leukotriene antagonists: These are oral anti-inflammatory medications. They are milder and can be used in selected patients

Oral steroids: Oral steroids are reserved for patients with severe symptoms of allergic rhinitis. They are used for a short duration because of side effects.

Oral antihistamines: Histamines cause a number of symptoms in allergic rhinitis. Oral antihistamines block the effect of histamine. These antihistamines may be sedating and short acting or they may be non-sedating and long acting.

Antihistamines nasal sprays: These have the advantage of working topically and help with a number of symptoms of allergic rhinitis.

Oral decongestants: Nasal blockage can be treated with oral decongestants, which can be short acting or long acting. They can be used alone or in combination with antihistamines. Oral decongestants can raise heart rate and blood pressure and should therefore be used with caution.

Nasal decongestant sprays: These are topical decongestants and are not recommended for long term use because of rebound effects.

Nasal anticholinergic sprays: These help reduce nasal drainage and are used for symptomatic relief for nasal drainage.

Immunotherapy (Allergy Shots Or Allergy Injections): Immunotherapy slowly desensitizes patients to what they are allergic to and improves all the symptoms of allergic rhinitis. Small and incremental doses of allergens are injected subcutaneously during the build up phase. Once the maintenance dose is reached, injections are continued for 3-5 years. Immunotherapy also helps allergy-induced asthma. There is about an 80% success rate with this treatment.

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