Allergic rhinitis and related nasal or upper respiratory conditions involve inflammation of the mucous membranes in the nasal passages, caused by a hypersensitive response of the immune system to an airborne allergen or irritant. Allergic rhinitis can be seasonal (intermittent) or year round (persistent, perennial) and may be mild, moderate or severe, as determined by how much it interferes with daily activities or with sleep.
The specific allergens that trigger rhinitis (commonly called hay fever, though neither hay or fever play a role) vary from person to person and often include pollen, mold, animal dander, or dust. Symptoms usually first appear between ages 10 and 20, and tend to diminish later in life. Allergic rhinitis is exceedingly common (as many as 25 percent of young adults are afflicted with it) and is highly treatable.
What Causes Allergic Rhinitis?
- Airborne pollen from various seasonal plants, including grasses, flowers, trees, and ragweed.
- Mold spores.
- Animal dander (small scales of dead skin or dried saliva, shed from the hair of certain mammals).
- Household dust, which may contain house dust mites, animal dander, or cockroaches.
- Hereditary factors affecting immune sensitivity.
- Overuse of decongestant sprays.
- A hypersensitivity to medications, including aspirin and other nonsteroidal anti-inflammatory drugs.
- Hormonal disturbances that may occur with pregnancy, oral contraceptive use, or hypothyroidism.
Symptoms of Allergic Rhinitis
- Frequent sneezing
- Profuse nasal discharge (usually clear and watery)
- Nasal congestion and itching
- Red, watering, itching eyes
- Puffiness and dark circles around the eyes
- Possible cough or wheezing
- Impaired sense of taste or smell
- Itching in the back of the throat
- When seasonal allergies flare up, try to stay inside a climate-controlled environment as much as possible, or travel to pollen-free areas. Consider relocating to such areas if symptoms are sufficiently severe.
- If necessary, avoid or isolate furred animals.
- To eliminate dust mites commonly found in bedding, use machine-washable polyester pillows, seal your mattress in a zippered cover, and launder bed linens frequently. Use air filters in bedrooms.
Allergic Rhinitis Diagnosis
- Patient history and physical examination.
- Skin tests. The skin is scratched or pricked with a number of needles, each containing a small amount of an allergen; a specific allergen is implicated if the area becomes red or itchy, or a raised welt appears.
- Analysis of nasal secretions.
- Blood tests to reveal a heightened antibody count, indicating an allergic response.
- A fiber optic rhinoscope can be used to visualize the inner nose and sinuses.
- Sinus CT scan may be performed in cases of severe or recurrent sinusitis.
How to Treat Allergic Rhinitis
- Antihistamines are the first line of treatment for allergic rhinitis. Many nonprescription varieties are available, although they may cause drowsiness or drying of the mucous membranes. Newer nonsedating antihistamines are available by prescription; these include fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec).
- Avoiding smoking is often helpful.
- Short-term use of decongestants may be beneficial. (Combinations of antihistamines and decongestants are also available.)
- Special eyedrops may be prescribed when eye symptoms persist despite other treatment.
- Inhaled or oral corticosteroids may be prescribed to reduce extreme inflammatory symptoms. Nasal sprays containing steroids are commonly prescribed to reduce nasal congestion.
- Allergy shots (immunotherapy injections) may improve allergic rhinitis symptoms and quality of life. People who take beta-blockers cannot receive allergy shots.
- Singulair,a prescription medication (leukotriene inhibitor) used to treat asthma may also help reduce seasonal allergy symptoms.
- When all else fails, an allergist may gradually administer increasing amounts of the offending allergen (immunotherapy or allergy shots), which may eventually help desensitize the patient to the allergen.
When to Call a Doctor
Call a doctor if allergic rhinitis interferes with normal activities or if over-the-counter antihistamines cause excessive drowsiness (your doctor can prescribe a non-sedating antihistamine).
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media