Allergic Rhinitis

Allergic Rhinitis or Nasal Allergy

Allergic rhinitis is the medical term for hay fever or rose fever. Symptoms include sneezing fits, runny nose, nasal congestion and itchy nose. Symptoms may also include red, watery and itchy eyes.

Someone with allergic rhinitis may clear their throat frequently, make funny clicking noises when their palate itches, mouth breathe, grimace or make funny faces as they try to scratch their nose without using their hands and complain of frequent bloody noses.

TYPES OF ALLERGIC RHINITIS

There are two types of allergic rhinitis—perennial (year-round) rhinitis and seasonal rhinitis.

  • Perennial allergic rhinitis is due to allergens that are present to some degree all year. These allergens include house dust mites, molds, animal dander and cockroaches.
  • Seasonal allergic rhinitis is due to tree pollen in the early spring to the beginning of summer, grass pollen in late May through early July and weed pollen in July through the second frost in the fall or winter. There is also an outdoor mold season that occurs in the typically damp month of April and also from August until the second frost. These time frames apply to Indiana and may vary depending on where you live.

TREATMENT

Like all allergic diseases, avoidance is the most effective treatment. Without avoidance, there is often very little hope that any other form of therapy will work. It is important, especially for indoor allergens, that avoidance measures be used first before starting a course of allergen immunotherapy.

After avoidance, the next treatment approach is medication. Medicines used to treat allergic rhinitis include:

Antihistamines such as the following:

  • Allegra®
  • Claritin®/Clarinex
  • Zyrtec®/Xyzal
  • Benadryl®
  • Atarax
  • Tavist
  • Astelin
  • Others (there are numerous antihistamines available)

Decongestants such as the following:

  • Sudafed® (limited access)
  • Intranasal decongestants (like Afrin®)

Topical agents such as the following

  • Topical corticosteroids
  • Beconase
  • Nasacort
  • Rhinocort
  • Nasarel
  • QNasl
  • Flonase
  • Omnaris®
  • Mast cell stabilizers
  • Anticholinergic agents
  • Atrovent

Antihistamines work against symptoms that are triggered by histamine. Histamine causes a runny, itchy nose and sneezing fits. An antihistamine helps with these symptoms. Antihistamines do very little for congestion. If congestion is an issue, then a decongestant is needed.

Allergy shots or allergen immunotherapy (used to desensitize the patient) are frequently used for treatment. Allergy shots may help with various types of allergic rhinitis. Clinical models testing for allergic rhinitis caused by grass, ragweed, trees, house dust mites and alternaria (a mold) showed a positive effect with allergen immunotherapy. The studies for these allergens showed decreases in medication use, symptoms and complications of allergic rhinitis.

Oral immunotherapy may be available soon. The FDA has not approved any products for general use. However, this form of allergy therapy has been around for a long time, but only recently have well-performed studies shown efficacy. These new studies have originated in Europe and there are studies ongoing in the United States. The products showing promising results in Europe are not available here in the United States. The products being used in studies in the United States are not available for commercial use. Current use here is confined to research study purposes only.

COMPLICATIONS

Quality of life concerns may be an issue with allergic rhinitis. A recent report claimed those with allergic rhinitis have poorer quality of life than those who suffer from asthma. Allergic rhinitis may lead to poor sleep, especially when nasal congestion is extreme and unrelenting.

Allergic rhinitis may be an underlying factor of sinus disease. There is also evidence that one in three children who suffer from chronic fluid in the middle ear (serous otitis media) may have allergy as a potential contributing factor. Nasal blockage caused by allergic rhinitis may lead to mouth breathing, which in turn may cause dental malocclusion, which is poor alignment of the teeth.

INTERESTING FACTS ABOUT ALLERGIC RHINITIS

  • Allergic rhinitis is one of the most common allergic conditions. Onset can begin in childhood, adolescence or early adulthood. The average age of onset for perennial allergic rhinitis is 9 years and 10 years for seasonal allergic rhinitis. It is rare to see allergic rhinitis in a child younger than 3 and nasal allergy would not be an issue in a child younger than 1.
  • Hay fever and rose fever are two great examples of misnomers in medicine in that the condition is not due to hay or roses and it does not cause a fever. Rose fever traditionally refers to symptoms that occur in the month of June when roses bloom. Rose pollen is too large to be the responsible allergen. Grass pollen triggers those who suffer nasal symptoms during this time of year. The “haying” season starts in August. Those who suffer symptoms during this time of the year likely suffer from the ragweed allergen. Allergic rhinitis is a more accurate name than hay fever or rose fever. Allergic rhinitis is simply an inflammation of the nose that has allergy as the cause.
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