Allergic Rhinitis

What is allergic rhinitis?

Allergic rhinitis is a reaction of the lining of the nose to particles in the air.

How does it occur?

Allergic rhinitis occurs when the nose and usually also the ears, eyes, sinuses, and throat come into contact with allergy-causing substances. The allergy-causing substances are called allergens. The most common allergens are pollens, molds, dust, and animal dander. Some allergens are present only during certain seasons, for example, ragweed in the fall. The allergic reaction they cause is called seasonal allergic rhinitis or hay fever. Other allergens are present year-round, such as the mites in house dust. These allergens cause a type of rhinitis called perennial allergic rhinitis.

When the lining tissues of the nose and sinuses come into contact with allergens, a chemical called histamine is released from cells in the nose. Histamine causes the nose lining to swell, itch, and make too much mucus.

What are the symptoms?

Common symptoms of allergic rhinitis are

• itchy, runny nose
• sneezing
• nasal and head congestion.

Other possible symptoms include

• fatigue and lethargy
• itchy throat
• postnasal drainage
• itchy, watery eyes.

How is it diagnosed?

Your healthcare provider will ask about your symptoms, medical history, and family history.

Your provider may swab the lining of your nose to obtain a sample of mucus. About 50% of people with allergies have cells in their mucus that indicate allergy.

It may take some detective work to figure out exactly what you are allergic to. You may have tests for specific allergies. For most people the best tests are skin scratch or prick tests. For these tests your healthcare provider or an allergy specialist places tiny amounts of suspected allergens under your skin and looks for reactions. These allergy tests will identify which of many possible allergens are causing your symptoms. In some cases you may have blood tests to look for antibodies to suspected allergens.

Allergy tests are expensive. Your healthcare provider will probably recommend that you try treating your symptoms with medicine first. If medicines do not control your symptoms, you may need allergy tests.

How is it treated?

The first step is to try to avoid contact with the things you are allergic to. For example, using an air conditioner and special filters rather than an attic fan lessens the amount of pollen that gets into your home. Putting plastic covers on mattresses may help you avoid dust and mold. You may also cover pillows with plastic.

The second step is treatment with medicine. Your healthcare provider may suggest that you first try decongestants for mild symptoms. You may have some side effects from decongestants, such as a rapid heart rate or trouble sleeping. Sometimes these medicines can also raise your blood pressure.

Antihistamine medicines can help treat and prevent allergy symptoms. There are different types of antihistamines. Drowsiness is a common side effect of some of them. This may not be a problem if a dose at bedtime is all you need. Or you might try the medicine for several days despite the drowsiness. Often the drowsiness goes away after you have taken the drug for 3 to 5 days. Or you may want to try the newer antihistamines that don't usually cause drowsiness. Some antihistamines require a prescription. Others you can buy without a prescription.

Some people take antihistamines only on the days they are having symptoms. Others start the medicine at the beginning of their usual allergy season and continue taking it until the season is over.

It is safe to take antihistamines and decongestants together if you do not have a medical reason for not taking either type of medicine.

Your healthcare provider may prescribe a nose spray. There are several steroid nose sprays that can be used daily to treat or prevent symptoms. A different and nonprescription nose spray containing a medicine called cromolyn is also available. Depending on your other allergy symptoms, a nose spray may be the first and only medicine you need.

If your symptoms are severe in spite of medicines, your healthcare provider may suggest allergy shots. A mixture is prepared that contains the allergens identified in your allergy tests. The mixture is injected into your skin in tiny but increasing amounts over the course of many months. Over time, the shots make you less sensitive to the allergens. Usually after 4 to 6 months of allergy shots you will begin to have relief from your allergies. However, you will probably need to continue the shots for 2 to 3 years or longer.

Proper treatment of allergy symptoms is the best way to prevent complications of allergic rhinitis, such as ear and sinus infections.

How long will the effects last?

If you have had allergies since you were a child, you will probably have them the rest of your life. New allergies can develop any time, even if you have not had allergies before. Allergy symptoms depend not only on the season and weather but also on location. This means your allergies may wax and wane, depending on where you are living.

How can I help prevent allergic rhinitis?

There are no known ways to prevent the development of allergic rhinitis. Once allergies have developed, you can try to limit exposure to the things that cause them, for example, pollens or animals. In severe cases, you may need to move to another area, but you may develop allergies there as well.