Rhinitis, which occurs most commonly as allergic rhinitis, is an inflammation of the nasal membranes that is characterized by sneezing, nasal congestion, nasal itching, and rhinorrhea, in any combination.  Although allergic rhinitis itself is not life-threatening (unless accompanied by severe asthma or anaphylaxis), morbidity from the condition can be significant.
An allergen is an otherwise harmless substance that causes an allergic reaction. Allergic rhinitis, or hay fever, is an allergic response to specific allergens. Pollen is the most common allergen in seasonal allergic rhinitis. These are allergy symptoms that occur with the change of seasons.
Between 10 and 30 percent of the worldwide population may also have allergic rhinitis.
What are the types of allergic rhinitis
Allergic rhinitis takes two different forms:
• Seasonal: Symptoms of seasonal allergic rhinitis can occur in spring, summer and early fall. They are usually caused by allergic sensitivity to airborne mold spores or to pollens from grass, trees and weeds.
• Perennial: People with perennial allergic rhinitis experience symptoms year-round. It is generally caused by dust mites, pet hair or dander, cockroaches or mold. Underlying or hidden food allergies rarely cause perennial nasal symptoms.
Some people may experience both types of rhinitis, with perennial symptoms getting worse during specific pollen seasons. There are also nonallergic causes for rhinitis including irritants such as cigarette or other smoke, perfumes, cleaning products and other strong odors.
Symptoms of allergic rhinitis
Common symptoms of allergic rhinitis include:
- a runny nose
- a stuffy nose
- an itchy nose
- a sore or scratchy throat
- itchy eyes
- watery eyes
- dark circles under the eyes
- frequent headaches
- eczema-type symptoms, such as having extremely dry, itchy skin that can blister and weep
- excessive fatigue
Some people experience symptoms only rarely. This likely occurs when you’re exposed to allergens in large quantities. Other people experience symptoms all year long.
Symptoms also may be triggered by common irritants such as:
- Cigarette smoke
- Strong odors, such as perfume, or hairspray and fumes
- Laundry detergents
- Cleaning solutions, pool chlorine, car exhaust and other air pollutants (i.e., ozone).
Allergic rhinitis can be associated with:
- Decreased concentration and focus
- Limited activities
- Decreased decision-making capacity
- Impaired hand-eye coordination
- Problems remembering things
- Sleep disorders
- Missed days of work or school
- More motor vehicle accidents
- More school or work injuries
It is important that the irritability or other symptoms caused by ear, nose or throat trouble are not mistaken for attention deficit disorder. With proper treatment, symptoms can be kept under control and disruptions in learning and behavior can be avoided.
What causes allergic rhinitis?
When your body comes into contact with an allergen, it releases histamine, which is a natural chemical that defends your body from the allergen. This chemical can cause allergic rhinitis and its symptoms, including a runny nose, sneezing, and itchy eyes.
In addition to tree pollen, other common allergens include:
- grass pollen
- dust mites
- animal dander, which is old skin
- cat saliva
The two types of allergic rhinitis are seasonal and perennial. Seasonal allergies usually occur during the spring and fall season and are typically in response to outdoor allergens like pollen. Perennial allergies can occur year round, or at any time during the year in response to indoor substances, like dust mites and pet dander.
Risk factors for allergic rhinitis
Allergies can affect anyone, but you’re more likely to develop allergic rhinitis if there is a history of allergies in your family. Having asthma or atopic eczema can also increase your risk of allergic rhinitis.
Some external factors can trigger or worsen this condition, including:
- cigarette smoke
- cold temperatures
- air pollution
- wood smoke
To find the most effective way to treat allergic rhinitis symptoms, see an ENT /allergist. Your ENT /allergist may start by taking a detailed history, looking for clues in your lifestyle that will help pinpoint the cause of your symptoms. You’ll be asked, among other things, about your work and home environments (including whether you have a pet) your family’s medical history and the frequency and severity of your symptoms.
Sometimes allergic rhinitis can be complicated by several medical conditions, such as a deviated septum (curvature of the bone and cartilage that separate the nostrils) or nasal polyps (abnormal growths inside the nose and sinuses). Any of these conditions will be made worse by catching a cold. Nasal symptoms caused by more than one problem can be difficult to treat, often requiring the cooperation of an allergist and an otolaryngologist (ear, nose and throat specialist).
Your allergist may recommend a SKIN TEST / BLOOD TEST
SKIN TEST, in which small amounts of suspected allergens are introduced into your Skin. Skin testing is the easiest, most sensitive and generally least expensive way of identifying allergens.
Types of skin tests
- Prick or scratch test: In this test, a tiny drop of a possible allergen is pricked or scratched into the skin. Also known as a percutaneous test, this is the most common type of skin test. The results are known within 10 to 20 minutes.
- Intradermal test: A small amount of a possible allergen is injected under the skin using a thin needle. The site is checked for a reaction after about 20 minutes. This test is typically more sensitive than the prick or scratch test.
Management and Treatment
The first approach in managing seasonal or perennial AR should be to avoid the allergens that trigger symptoms.
- Stay indoors as much as possible when pollen counts are at their peak, usually during the midmorning and early evening (this may vary according to plant pollen), and when the wind is blowing pollens around.
- Avoid using window fans that can draw pollens and molds into the house.
- Wear glasses or sunglasses when outdoors to minimize the amount of pollen getting into your eyes.
- Wear a pollen mask (such as a NIOSH-rated 95 filter mask) when mowing the lawn, raking leaves or gardening, and take appropriate medication beforehand.
- Don’t hang clothing outdoors to dry; pollen may cling to towels and sheets.
- Try not to rub your eyes; doing so will irritate them and could make your symptoms worse.
- Indoor exposure
- Keep windows closed, and use air conditioning in your car and home. Make sure to keep your air conditioning unit clean.
- Reduce exposure to dust mites, especially in the bedroom. Use “mite-proof” covers for pillows, comforters and duvets, and mattresses and box springs. Wash your bedding frequently, using hot water (at least 130 degrees Fahrenheit).
- To limit exposure to mold, keep the humidity in your home low and clean your bathrooms, kitchen, and basement regularly. Use a dehumidifier, especially in the basement and in other damp, humid places, and empty and clean it often. If mold is visible, clean it with mild detergent and a 5 percent bleach solution as directed by an allergist.
- Clean floors with a damp rag or mop, rather than dry-dusting or sweeping.
- Exposure to pets
- Wash your hands immediately after petting any animals; wash your clothes after visiting friends with pets.
- If you are allergic to a household pet, keep the animal out of your home as much as possible. If the pet must be inside, keep it out of the bedroom so you are not exposed to animal allergens while you sleep.
- Close the air ducts to your bedroom if you have forced-air or central heating or cooling. Replace carpeting with hardwood, tile or linoleum, all of which are easier to keep dander-free.
If your symptoms can’t be well-controlled by simply avoiding triggers, DR may recommend medications that reduce nasal congestion, runny nose, sneezing and itching. They are available in many forms — oral tablets, liquid medication, nasal sprays, and eyedrops. Some medications may have side effects, so discuss these treatments with your allergist.
- Intranasal corticosteroids
- Intranasal corticosteroids are the single most effective drug class for treating allergic rhinitis. They can significantly reduce nasal congestion as well as sneezing, itching and a runny nose.
- These sprays are designed to avoid the side effects that may occur from steroids that are taken by mouth or injection. Take care not to spray the medication against the center portion of the nose (the nasal septum). The most common side effects are local irritation and nasal bleeding. Some older preparations have been shown to have some effect on children’s growth; data about some newer steroids don’t indicate an effect on growth.
- Antihistamines are commonly used to treat allergic rhinitis. These medications counter the effects of histamine, the irritating chemical released within your body when an allergic reaction takes place. Although other chemicals are involved, histamine is primarily responsible for causing the symptoms. Antihistamines are found in eye drops, nasal sprays and, most commonly, oral tablets and syrup.
- Antihistamines help to relieve nasal allergy symptoms such as:
- Sneezing and an itchy, runny nose
- Eye itching, burning, tearing and redness
- Itchy skin, hives, and eczema
- There are dozens of antihistamines; some are available over the counter, while others require a prescription. Patients respond to them in a wide variety of ways.
- Generally, the newer (second-generation) products work well and produce only minor side effects. Some people find that an antihistamine becomes less effective as the allergy season worsens or as their allergies change over time. If you find that an antihistamine is becoming less effective, tell DR, who may recommend a different type or strength of antihistamine. If you have excessive nasal dryness or thick nasal mucus, consult a DR before taking antihistamines. Contact DR for advice if an antihistamine causes drowsiness or other side effects.
- Proper use: Short-acting antihistamines can be taken every four to six hours, while timed-release antihistamines are taken every 12 to 24 hours. The short-acting antihistamines are often most helpful if taken 30 minutes before an anticipated exposure to an allergen (such as at a picnic during ragweed season). Timed-release antihistamines are better suited to long-term use for those who need daily medications. Proper use of these drugs is just as important as their selection. The most effective way to use them is before symptoms develop. A dose taken early can eliminate the need for many later doses to reduce established symptoms. Many times a patient will say that he or she “took one, and it didn’t work.” If the patient had taken the antihistamine regularly for three to four days to build up blood levels of the medication, it might have been effective.
- Side effects: Older (first-generation) antihistamines may cause drowsiness or performance impairment, which can lead to accidents and personal injury. Even when these medications are taken only at bedtime, they can still cause considerable impairment the following day, even in people who do not feel drowsy. For this reason, it is important that you do not drive a car or work with dangerous machinery when you take a potentially sedating antihistamine. Some of the newer antihistamines do not cause drowsiness.
- A frequent side effect is excessive dryness of the mouth, nose, and eyes. Less common side effects include restlessness, nervousness, overexcitability, insomnia, dizziness, headaches, euphoria, fainting, visual disturbances, decreased appetite, nausea, vomiting, abdominal distress, constipation, diarrhea, increased or decreased urination, urinary retention, high or low blood pressure, nightmares (especially in children), sore throat, unusual bleeding or bruising, chest tightness or palpitations. Men with prostate enlargement may encounter urinary problems while on antihistamines. Consult your DR if these reactions occur.
- Important precautions:
- Follow your DR’s instructions.
- Alcohol and tranquilizers increase the sedation side effects of antihistamines.
- Do not use more than one antihistamine at a time, unless prescribed.
- Keep these medications out of the reach of children.
- Know how the medication affects you before working with heavy machinery, driving or doing other performance-intensive tasks; some products can slow your reaction time.
- Some antihistamines appear to be safe to take during pregnancy, but there have not been enough studies to determine the absolute safety of antihistamines in pregnancy. Again, consult your DR or your obstetrician if you must take antihistamines.
- While antihistamines have been taken safely by millions of people in the last 50 years, don’t take antihistamines before telling your DR if you are allergic to, or intolerant of, any medicine; are pregnant or intend to become pregnant while using this medication; are breastfeeding; have glaucoma or an enlarged prostate; or are ill.
- Never take anyone else’s medication.
- Decongestants help relieve the stuffiness and pressure caused by swollen nasal tissue. They do not contain antihistamines, so they do not cause antihistaminic side effects. They do not relieve other symptoms of allergic rhinitis. Oral decongestants are available as prescription and nonprescription medications and are often found in combination with antihistamines or other medications. It is not uncommon for patients using decongestants to experience insomnia if they take the medication in the afternoon or evening. If this occurs, a dose reduction may be needed. At times, men with prostate enlargement may encounter urinary problems while on decongestants. Patients using medications to manage emotional or behavioral problems should discuss this with their allergist before using decongestants. Patients with high blood pressure or heart disease should check with their allergist before using. Pregnant patients should also check with their allergist before starting decongestants.
- Nonprescription decongestant nasal sprays work within minutes and last for hours, but you should not use them for more than a few days at a time unless instructed by your allergist. Prolonged use can cause rhinitis medicamentosa, or rebound swelling of the nasal tissue. Stopping the use of the decongestant nasal spray will cure that swelling, provided that there is no underlying disorder.
- Oral decongestants are found in many over-the-counter (OTC) and prescription medications and may be the treatment of choice for nasal congestion. They don’t cause rhinitis medicamentosa but need to be avoided by some patients with high blood pressure. If you have high blood pressure or heart problems, check with your allergist before using them.
- Nasal sprays
- Nonprescription saline nasal sprays will help counteract symptoms such as dry nasal passages or thick nasal mucus. Unlike decongestant nasal sprays, a saline nasal spray can be used as often as it is needed. Sometimes an allergist may recommend washing (douching) the nasal passage. There are many OTC delivery systems for saline rinses, including neti pots and saline rinse bottles.
- Nasal cromolyn blocks the body’s release of allergy-causing substances. It does not work in all patients. The full dose is four times daily, and improvement of symptoms may take several weeks. Nasal cromolyn can help prevent allergic nasal reactions if taken prior to an allergen exposure.
- Leukotriene pathway inhibitors
- Leukotriene pathway inhibitors (montelukast, ) block the action of leukotriene, a substance in the body that can cause symptoms of allergic rhinitis. These drugs are also used to treat asthma.
- Immunotherapy may be recommended for people who don’t respond well to treatment with medications or who experience side effects from medications, who have allergen exposure that is unavoidable or who desire a more permanent solution to their allergies. Immunotherapy can be very effective in controlling allergic symptoms, but it doesn’t help the symptoms produced by nonallergic rhinitis.
- Two types of immunotherapy are available: allergy shots and sublingual (under-the-tongue) tablets.
- • Allergy shots: A treatment program, which can take three to five years, consists of injections of a diluted allergy extract, administered frequently in increasing doses until a maintenance dose is reached. Then the injection schedule is changed so that the same dose is given with longer intervals between injections. Immunotherapy helps the body build resistance to the effects of the allergen, reduces the intensity of symptoms caused by allergen exposure and sometimes can actually make skin test reactions disappear. As resistance develops over several months, symptoms should improve.
- • Sublingual Immunotherapy: This type of immunotherapy was approved by the Food and Drug Administration in 2014. Starting several months before allergy season begins, patients PUT DROPS under the tongue daily. Treatment can continue for as long as three years. Only a few allergens (certain grass and ragweed pollens and house dust mite) can be treated now with this method, but it is a promising therapy for the future.
- Eye allergy preparations and eyedrops
- Eye allergy preparations may be helpful when the eyes are affected by the same allergens that trigger rhinitis, causing redness, swelling, watery eyes, and itching. OTC eye drops and oral medications are commonly used for short-term relief of some eye allergy symptoms. They may not relieve all symptoms, though, and prolonged use of some of these drops may actually cause your condition to worsen.
- Effective for the treatment of bacterial infections, antibiotics do not affect the course of uncomplicated common colds (a viral infection) and are of no benefit for noninfectious rhinitis, including allergic rhinitis.
3. Nasal surgery:
SURGERY IS PART OF TREATMENT NOT CURATIVE. It may help if patients have nasal polyps or chronic sinusitis.
If you develop symptoms that resemble that ofAllergic Rhinitis and that appear or become more serious at work, you may be suffering from occupational rhinitis.
Occupational rhinitis, or work-related rhinitis, is a condition in which symptoms are triggered or further aggravated by allergens in the workplace. These symptoms can include sneezing, a runny nose, and watering eyes. Common triggers include cleaning products, chemical fumes, certain types of dust, and corrosive gases.
If your allergy symptoms appear at work or seem to get worse there, consult your DR, who can help you identify potential triggers and develop a treatment plan.
Complications of allergic rhinitis
Unfortunately, allergic rhinitis itself can’t be prevented. Treatment and management are keys to achieving a good quality of life with allergies. Some complications that can arise from hay fever include:
- inability to sleep from symptoms keeping you up at night
- development or worsening of asthma symptoms
- frequent ear infections
- sinusitis or frequent sinus infections
- absences from school or work because of reduced productivity
- frequent headaches
Allergic rhinitis in children
Children can develop allergic rhinitis too, and it typically appears before the age of 10. If you notice that your child develops cold-like symptoms at the same time each year, they probably have seasonal allergic rhinitis.
The symptoms in children are similar to those in adults. Children usually develop watery, bloodshot eyes, which is called allergic conjunctivitis. If you notice wheezing or shortness of breath in addition to other symptoms, your child may have also developed asthma.
If you believe your child has allergies, see your doctor. It’s important to receive the correct diagnosis and treatment.
If your child does have significant seasonal allergies, limit your child’s exposure to allergens by keeping them inside when pollen counts are high. Washing their clothes and sheets frequently during allergy season and vacuuming regularly may also be useful. Many different treatments are available to help your child’s allergies. However, some medications can cause side effects, even in small doses. Always talk to your doctor before treating your child with any over-the-counter allergy medication.
The outcome of treatment depends on your condition. Seasonal allergic rhinitis usually isn’t severe, and you can manage it well with medications. However, severe forms of this condition will likely require long-term treatment.