Allergic Rhinitis

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What is allergic rhinitis?

If you have ever heard of hay fever, then you can meet ‘its’ second name – allergic rhinitis.

Allergic rhinitis is a reaction caused by the immune system when irritants find their way into the respiratory system.

These irritants to the immune system of the respiratory pathway are called allergens.

Allergens, on their own, are not harmful. What actually happens is how the immune system perceives them. They are perceived by the immune system as a threat. The irritant that mostly induces allergic rhinitis is called pollen. Allergic rhinitis is seasonal, that is, they are brought on when there is a change in season.

From the statistics provided by the American Academy of Allergy, Asthma & Immunology (AAAAI), approximately 8% of US residents will develop allergic rhinitis. 10-30% of the entire population of the world will also have some form of allergic rhinitis.

Symptoms of allergic rhinitis

The symptoms are peculiar to allergic rhinitis:

• sneezing
• a runny nose
• a stuffy nose
• an itchy nose
• coughing
• a sore throat
• scratchy throat
• excessive fatigue
• itchy eyes
• watery eyes
• dark circles at the lower eyelid
• frequent headaches
• symptoms of eczema i.e. dry and itchy skin
• hives

One or two of these symptoms will be experienced once you are exposed to an allergen.

Fatigue and headaches will be felt much more in the long term and not immediately.

You can get exposed to allergens in large or little quantities. Most people who are exposed to large amounts of allergens might not experience severe symptoms. Whereas others can get exposed to little quantity and severe symptoms are triggered.

If you have allergies that take more than 7 days to resolve, you should see a doctor.

What causes allergic rhinitis?

Allergic rhinitis is a development triggered by allergens when they come in contact with your respiratory tract. When allergens interact with your respiratory system, histamines are produced.

Histamines are the ‘mastermind’ behind allergic reactions and the symptoms that come with them.

There are other allergens that can cause allergic rhinitis:

• grass pollen
• dust mites
• animal dander (i.e. old skin)
• cat saliva
• mold

Allergic rhinitis is common in spring because it is at this time of the year that pollens are produced from trees and plants.

But during fall and summer, weeds and grasses release pollen more.

Types of allergic rhinitis

Perennial and seasonal are the two types of allergic rhinitis.

Seasonal allergies are experienced when allergens pollen are much in the air particularly during fall and spring.

Perennial allergies are allergies that are developed at any time of the year. They are mostly caused by pet dander and dust mites.

Risk factors for allergic rhinitis

Anyone can have allergies. The risk is even higher when a family member has a history of allergic rhinitis. Eczema and asthma are other factors that can increase the chances of one having allergic rhinitis

The following are external factors that can cause allergic rhinitis:

• cigarette smoke
• chemicals
• cold temperatures
• humidity
• wind
• air pollution
• hairspray
• perfumes
• colognes
• wood smoke
• fumes

How is allergic rhinitis diagnosed?

With a physical examination, mild forms of allergic rhinitis can be diagnosed.

More tests may be needed to determine how best you can be treated.

Skin prick test is one such test. This test involves the placing of different substances on your body and then watching for reactions. The presence of a tiny red bump on your skin is an indicator that you are allergic to that substance.

A radioallergosorbent test (RAST), is another test that can be used to diagnose allergic rhinitis.

A small sample of blood will be collected from you for this purpose. The blood will be assayed to find out if a special type of antibody, immunoglobulin E, is present in your blood.

Treatment for allergic rhinitis

Several methods are available by which allergic rhinitis can be treated. Home remedies, medications and, alternative medicine are different methods that can be utilized for the treatment of allergic rhinitis.

Your doctors can help you adopt the right method for your allergy.

Antihistamines

Antihistamines are great treatment options for allergies. They prevent the further release of histamines. Most of them are OTCs (over-the-counter drugs)

• levocetirizine (also referred to as Xyzal)
• diphenhydramine (aka Benadryl)
• cetirizine (Zyrtec)
• fexofenadine (that is, Allegra)
• desloratadine (also called Clarinex)
• loratadine (popularly known as Claritin)

Antihistamines are available online

If you intend to take any medication, tell your doctor about it.

Decongestants

Decongestants are used for short-term treatments for allergic rhinitis. The short-term is a period of three days. Anything more than this can cause what is called a rebound effect. A rebound effect is a worsening of the symptoms. They are very good for reducing the pressure in the sinus. Stuffiness in the nose can also be reduced with decongestants.

Decongestants can be found over the counter as:

• phenylephrine (Sudafed PE)
• oxymetazoline (Afrin nasal spray)
• cetirizine with pseudoephedrine (Zyrtec-D)
• pseudoephedrine (Sudafed)

Decongestants should not be used when a sleep disorder, heart disease, hypertension, bladder incontinence, stroke, or anxiety is present.

Eye drops and nasal sprays

Eye drops, as well as nasal sprays, are good for reducing most of the symptoms especially itchiness. But they are only good for short-term use because their extended use can result in the worsening of the symptoms.

Immune responses such as inflammation can be checked by corticosteroids. Unlike decongestants, eye drops, and nasal sprays, they don’t have rebound effects. That means they can be used for a very long time without worsening the symptoms. Corticosteroids are readily available as over-the-counter drugs.

Nasal sprays made of steroids can be used for the long-term treatment of symptoms.

They can also be found as prescription and over-the-counter drugs.

With the assistance of your doctor, you will be guided to know which medication is suitable for long-term or short-term use.

Immunotherapy

Immunotherapy or allergy shots are recommended when the symptoms of the allergy is severe.

It is mostly used together with medications. Allergy shots are potent for the reduction of your immune system’s response to specific allergens. The allergy shots have to be given for a very long time.  

An allergy shot has the first phase called the buildup phase where an allergy shot will be taken 1 -3 times a week for 3-6 months. During this time, your body becomes used to the shot.

The next phase is the maintenance phase. Here, you will be made to take allergic shots 2-4 times a week for a period of 3-5 years. Most times, a change may not be seen until about a year after the maintenance phase had begun. At this point, the symptoms should have disappeared.

Sometimes, allergic shots can cause more severe allergen reactions. To ensure that you don’t have such, your allergist will ask you to wait for some 30-45 minutes. During this time, any unpleasant reaction you might have can be attended to.

Sublingual immunotherapy (SLIT)

In SLIT, a tablet of allergen mixture will be put under your tongue. It works the same way an allergen shot works. The only difference is that it is in tablet form.

It is also good for the treatment of asthma allergies induced by cat dander, ragweed, grass, tree pollen, and dust mites.

Oralair is a SLIT that is good for grass allergies. It is also suitable for home remedies.

But your first dose will be administered in the hospital by your doctor. It must be taken for a specific time frame as will be determined by your doctor.

Itchy ears, itchy mouth, irritating throat, and in rare cases anaphylaxis are some of the side effects of SLIT.

Home remedies

The type of allergens responsible for your reactions determines the home remedy approach.

Seasonal (pollen) allergies can be managed by using air conditioners rather than leaving the windows open. Adding a filter that has been designed for allergies will be a good step to take.

Dehumidifiers or high-efficiency particulate air (HEPA) filters can help in the controlling of allergies when you are at home.

Allergies caused by dust mites can be limited by ensuring that your blanket and sheets are washed in very hot water (above 130 °F). HEPA filters can be added to your vacuum. You can do weekly vacuuming, too.

Alternative and complementary medicine

Alternative medicine, although having little scientific proof of effectiveness, can be useful in combating allergic rhinitis symptoms.

Another challenge with alternative medicine is that their dosage is difficult to determine.

Some of these drugs as you will be reading from this article have been reported to be beneficial for seasonal allergies by the National Center for Complementary and Integrative Health (NCCIH). Your doctor should be aware of your decision to try alternative medicine.

They are:

• honey (organic varieties)
• nasal saline irrigation
• acupuncture
• butterbur supplements
• probiotics

Alternative treatments are substances derived from natural substances and plants. They can interfere with medications and hence cause side effects, too.

 If you must try any of these alternative treatments, you should do it with caution and ensure you carry your doctor along before, during, and after their use.

Complications of allergic rhinitis

You might not be able to prevent allergic rhinitis completely. Like all allergies, allergic rhinitis can be successfully treated and managed. Complications of hay fever are:

• inability to sleep
• absenteeism from school or work due to low productivity
• frequent headaches
• ear infections
• worsen symptoms of asthma

Allergic rhinitis in children

Children can develop allergic rhinitis too.

Children are likely to have allergic rhinitis before they clock ten. When your child repeatedly has cold-like symptoms at a specific time of the year, your child might be suffering from seasonal allergic rhinitis. The symptoms children have are similar to those experienced by adults.

Allergic conjunctivitis is one of the symptoms children commonly develop.  Shortness of breath is a sign that your child might also have asthma.

When you see your child with these symptoms, you should see your doctor at once for proper medical attention. Helping your child have less contact with allergens can make him overcome frequent seasonal allergen attacks. You can do this by not allowing the child to play outside when pollen counts are extremely high. Wash the child’s clothes and bed-spread often when allergy season is on. Regular vacuuming will also help. Speak to your doctor before you get any over-the-counter allergy drugs for that child.

Outlook

Treatment, most times, determines the outlook of allergic rhinitis.

Seasonal allergic rhinitis can be well treated with medications. It is not always severe. But when it does, treating it can take a very long time.

Preventing allergies

Many measures have been found to be beneficial in the prevention of allergic rhinitis. Take a good read on them.

Pollen

From the stand of AAAAI on allergic rhinitis prevention, medications should be given before the season of allergy attacks. That is, if someone is sensitive to pollens from trees in springtime, antihistamines should be taken before this time so that an allergy’s chance of occurring is minimal. Staying indoors during times when pollens peak in the air can limit exposure to them.

Windows should be closed most of the time especially when it is the season of allergies.

Try to avoid laundry line-drying.

Dust mites

Dust mite exposure can be limited. You can achieve this by mopping wet floors rather than sweeping them. Use HEPA filter vacuums for your carpet. Hard surfaces should be dusted often.

Use hot water to wash your bedding at least once every week.

Allergen-blocking pillows can be used to limit how much you are exposed to dust mites.

Pet dander

Limit your exposure to animals that make you develop allergies. You can also make it as a point of duty to clean all surfaces as often as possible. When you play with pets, wash your hands immediately. All furry pets must stay out of your bed. All clothes that have come in contact with pets must be washed immediately.

Tips to prevent allergies

1. Stay more at home when there are high pollen counts.
2. Limit outdoor exercise in the morning hours.
3. Endeavor to take showers once you get inside whenever you have stayed outdoors for a long period of time.
4. Ensure your windows aren’t kept open always particularly when it’s allergy season.
5. If you have to do some work in the yard, make sure your nose and mouth are covered.
6. Be careful not to rake leaves
7. Don’t attempt to mow the lawn.
8. Minimize dander on your dogs by bathing twice a week.
9. You can keep your carpet free of dust mites by lifting your carpet and clean.