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Allergic Rhinitis

Allergic rhinitis

What is allergic rhinitis?

Allergic rhinitis is an inflammatory condition of the nose caused by allergic reaction. The particles which invoke this allergic response are called allergens. Some allergens, such as grass, pollens, and mold spores, cause symptoms mostly during the seasons in which they are most abundant in the air. This condition of seasonal allergies is sometimes known as "hay fever," although you'll see later that the name is somewhat misleading. Other allergens, such as those on dust mites, cockroaches, or pets, can cause symptoms year-round.

Many people - almost forty million in America - suffer misery of a blocked or dripping nose, itchy eyes, and sneezing caused by allergic rhinitis.

Fortunately, allergic rhinitis can usually be treated with medications under the guidance of a primary care physician. Some individuals with severe or constant symptoms may need to see an allergy specialist.

What are the symptoms?

Allergic rhinitis can range from mild to severe. If you get occasional itchy eyes and a stuffy nose, you are likely to have mild disease. If you have acute, constant or near-constant symptoms, including congestion that in turn can cause headaches, this is categorized as being severe. You may get ´allergic shiners´, blue-hued puffy bags under your eyes which appear when swelling in the nose prevents proper drainage of blood from the eyes.

If you have allergic rhinitis, initial contact with a specific allergen has sensitized your immune system so that the inflammatory reaction is overly strong. The symptoms of allergic rhinitis appear with subsequent exposures to the allergen. Symptoms include watery or itchy eyes, nose, mouth or throat; sneezing; coughing; and sinus or nasal congestion. Severe congestion can cause headache or facial pain, Symptoms can also impair sleep, leading to fatigue irritability and poor concentration.

Individuals with allergic rhinitis commonly have other related conditions, such as allergic conjunctivitis (itchy eyes due to allergic reaction), asthma, or eczema.

Allergic rhinitis may feel like a cold, but the symptoms are not exactly the same. With allergic rhinitis, nasal discharge is thin and watery and there is no fever. Symptoms begin upon reexposure to allergens and continue until the allergen is removed. If you have a cold, nasal discharge is usually thick and can be yellow or green. Fever may be present. A cold begins one to three days after being exposed to the cold virus and normally lasts for several days.

What are the risk factors?

Although allergic rhinitis which varies by season is sometimes called hay fever, hay is not a common cause of the disease. Hay is actually a rare allergen and there is no fever involved in hay fever. In the early nineteenth century, British doctors observed itchy eyes, sneezing fits, and coughing in rural dwellers who were exposed to cut grass or hay. The doctors assumed the sufferers were allergic to these, but the most likely culprit was mold or pollen. The word ´fever´ was added because the condition caused nervousness, which used to be called a ´fever´ in those days.

Allergic rhinitis can be partially hereditary. If your parents have allergies, you will be likely to suffer too. Symptoms usually appear in childhood or youth and might either improve or worsen with age but severity tends to diminish slowly over many years.

Sufferers of allergic rhinitis might be allergic to one thing or to many. After exposure to an allergen, your body misidentifies it as an invader and produces immunoglobulin E (IgE), an antibody. This process is called sensitization. Thereafter, every time you encounter the allergen, symptoms appear. Allergic rhinitis affects boys more than girls, but affects grown men and women equally If you are exposed to dust, mold or pets when young, or cigarette smoke as a baby, you have more risk of developing the illness.

Which is the right time to seek medical advice?

If symptoms are mild, you should be able to control them with over the counter medications. If you suffer despite the medications or you have side effects from them, you should see a primary care physician or allergy specialist for a complete diagnosis and proposed treatment program.

How is it diagnosed?

Your doctor will ask about your symptoms, how you have been treating them, and your personal and family medical history. He or she will examine you to look for more clues about your allergies. The physical examination and medical history might be enough to formulate a treatment program. But if the diagnosis is not clear, you might need to undergo skin tests. In a skin test, tiny amounts of purified allergens are injected into the skin on your back or arm. These areas are observed for signs of an allergic reaction. Allergies can also be identified using blood tests.

What are the treatments?

When your doctor is satisfied that he has identified your allergens, he can help you plan to avoid them if possible. If it is impossible to avoid them altogether, you may need oral medications, eye drops, or a nasal spray to control your symptoms. Medications for allergic rhinitis include the following:

Nasal corticosteroids

Corticosteroid nasal sprays are usually prescribed first because they tend to be the most effective method of controlling symptoms. Common corticosteroids include beclomethasone (Beconase), triamcinolone (Nasacort), fluticasone propionate (Flonase), flunisolide (Naserel), budesonide (Rhinocort) and mometasone (Nasonex). These take several days to start clearing symptoms. Usually, nasal corticosteroids are safe to use for prolonged periods. Most nasal steroids do not stunt childhood growth or reduce bone density, unlike inhaled or oral steroids, but doctors do try to prescribe the lowest dose possible because of risks associated with steroids. You might experience mild side effects such as irritation, a crusty bleeding nose, a bad taste or smell. The bleeding nose might be worse in the winter but you can relieve it by applying petroleum jelly inside your nostrils before using the nasal steroid, using an water-based nasal steroid rather an alcohol-based, or using a saline nasal spray to restore moisture.

Antihistamines

Antihistamines, in the form of oral medication or nasal sprays, can reduce sneezing, itching, and nasal symptoms.. They block histamine, which is one of the chemicals released in response to allergens. You can buy oral antihistamines over the counter and common ones include chlorpheniramine (Chlor-Trimeton), clemastine (Tavist) and diphenhydramine (Benadryl). Sleepiness can be a side effect of these medications so it is wise not to take them before using machinery or driving. There are newer antihistamines available over the counter, such as loratadine (Claritin), which are less likely to cause drowsiness. Other prescription only, non-sedating oral antihistamines include fexofenadine (Allegra) and cetirizine (Zyrtec). Azelastine (Astelin) is a prescription antihistamine nasal spray that causes drowsiness although it is effective for allergic rhinitis.

Decongestants

Decongestants are available over the counter and are often used with antihistamines. They constrict blood vessels to reduce buildup of secretions. They can be in the form of a nasal spray, tablets, or liquids. Nasal spray decongestants include oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine). These may cause rebound congestion if used for more than a few days. Oral decongestants (Actifed, Sudafed, and others) can raise blood pressure so are best avoided by people with hypertension. Another side effect of oral decongestants is worsening of pre-existing prostate enlargement.

Cromolyn sodium

Cromolyn sodium is available over the counter as a nasal spray (NasalCrom) and prevents the release of histamine to counter allergic rhinitis symptoms. It is not known to have any serious side effects but is best used several times a day before the onset of symptoms.

Leukotriene modifier

Montelukast (Singulair) blocks the action of leukotrienes, immune system chemicals which cause symptoms such as excess mucus production. It comes in tablet form and is available on prescription. It can treat both asthma and allergic rhinitis. It can cause side effects such headache and, less frequently, abdominal pain.

Nasal atropine

Ipratropium bromide (Atrovent) can relieve a severe stuffy nose by preventing the nasal glands from producing too much fluid. It is available as a prescription nasal spray. It does not affect sneezing and has mild side effects such as nosebleeds, a sore throat and nasal dryness. More side effects including dizziness, difficult urination and blurred vision have been noted but rarely. Ipratropium bromide is not recommended for anybody with glaucoma or an enlarged prostate.
Immunotherapy
Your doctor might recommend allergy shots (desensitization therapy or immunotherapy) if traditional allergic rhinitis medications are not successful for you. Allergy shots involve regular injections containing purified allergen extracts over the course of several years. This gradually desensitizes you to certain allergens which reduce your symptoms. After successful immunotherapy you will not need less, if any, allergic rhinitis medications. If your allergens include dust mites, tree, grass or weed pollen or cat dander, immunotherapy might be very effective. Immunotherapy in children can help prevent asthma developing from the hay fever. An infrequent side effect can be anaphylaxis, a serious allergic reaction that is life threatening.

What medicines can you take?

The most suitable medication depends on the severity and type of symptoms.
Strong prescription antihistamines can reduce the symptoms of hay fever quickly. Short-acting antihistamines, which are usually available over the counter, can relieve less severe symptoms but might cause sleepiness. Loratadine (Claritin) used to be available on prescription only but is now available over the counter in a lot of countries. It does not seem to cause drowsiness.

The only antihistamine available as a nasal spray in Aselastine (Asteline). Longer-lasting antihistamines such as fexofenadine (Allegra) and cetirizine (Zyrtec) can be just as effective without causing so much drowsiness. Montelukast (Singular), zafirlukast (Accolate) and other new leukotriene receptor antagonists are also effective for allergic rhinitis and do not have the side effects common with first generation antihistamines, such as drowsiness. These medications are taken once a day and are long-acting. Corticosteroid nasal sprays, which include fluticasone (Flonase or Flixonase), beclomethasone (Beconase), budesonide (Rhinocort), mometasone (Nasonex) and triamcinolone (Nasacort), can be efficacious without oral antihistamines and are relatively safe.

What are the possible complications?

Allergic rhinitis can affect the quality of your life, whether mild or acute. Feeling stuffy and sneezing or having itchy eyes can be tiresome and annoying. If you find it hard to sleep because of symptoms, your concentration can be impaired the next day. Many people with allergic rhinitis also have asthma. Signs of asthma are a shortness of breath, wheezing, dry cough, a tight feeling in the chest, and difficulty breathing. Also common in allergic rhinitis sufferers is eczema (or atopic dermatitis), which causes red, itchy and swollen patches on the skin.
Allergic rhinitis causes sinus congestion and if left untreated, may result in sinusitis, an infection or inflammation of the membrane lining the sinuses. The symptoms of this are tender and swollen cheeks, nose, forehead and eyes. Allergic rhinitis can lead to otitis media (a middle ear infection) in children, causing a buildup of fluid in the middle ear, pain and a fever.

How can you prevent allergic rhinitis?

Western countries have a higher prevalence of allergic conditions but researchers have not discovered why. It is wise to limit a child’s exposure to potential allergens, especially if there is a family history of allergic rhinitis, asthma, or eczema. Balanced diet, regular exercise, and adequate rest can help maintain the function of your immune system.

It is possible to limit the signs and symptoms of allergic rhinitis by reducing your exposure to them. You can reduce your exposure to mold or pollen by keeping the windows and doors closed during pollen season, not going outside on windy dry days, and using air conditioning in your house, office, and car. Avoid yardwork when pollens and molds are in the air. A dehumidifier can reduce indoor humidity and a high-efficiency particulate air (HEPA) filter can be used in your bedroom. If you are allergic to dust mites, you can consider wooden floors or laminate instead of carpets or rugs in your bedroom. Vacuum your carpets every week using a special vacuum cleaner which has a small-particle or HEPA filter and use a dehumidifier to reduce the indoor humidity.

Allergy-proof covers are available for box springs, mattresses, and pillows. Bedding should be washed in water heated to at least 130 degrees Fahrenheit.
If cockroaches cause allergic symptoms, consider professional pest extermination to get rid of them. Other ways of dealing with them include fixing any leaky pipes or faucets, blocking crevices and cracks where they might enter, and storing all food (pet food too) in sealed containers. Food crumbs and spills should be cleaned up immediately and plates should not be left unwashed overnight. Garbage should be emptied daily. Consider using a liquid soap as cockroaches can subsist on soap bars. If you are allergic to your pets, bath them weekly, keep them outside if possible, and do not let them in your bedroom. If you must touch a pet, wash your hands immediately afterwards. If your symptoms are severe, it might be better not to keep any pets at all.