Allergic Rhinitis

(Allergies, Hay Fever, Pollinosis)

In this condition factsheet:

• The Facts
• Causes
• Symptoms and Complications
• Making the Diagnosis
• Treatment and Prevention

The Facts

Allergic rhinitis, also called hay fever or pollinosis, literally means "allergic nose inflammation," where rhino means "to do with the nose" and the ending -itis simply refers to inflammation.

Allergic rhinitis can either be intermittent or persistent. In many people with intermittent allergic rhinitis, an allergen – something that triggers an allergy – sets their symptoms off at about the same time each year. Spring attacks are usually due to tree pollen, while grass pollens dominate in the summer and weed pollens in the autumn. Most people with allergic rhinitis are sensitive to more than one allergen.

Persistent allergic rhinitis is defined as having symptoms more than 4 days a week or for more than 4 weeks a year. This condition is most common in people with allergies to allergens that are present all year. Naturally, people who are allergic to house dust mites or to their own pets tend to suffer year-round. Allergic rhinitis affects about 20% of Canadians.

Causes

Allergic rhinitis is an allergic condition like asthma, meaning that the body tends to overreact to certain types of outside substances. One way it overreacts is by producing antibodies that signal your immune system to release histamine and other chemicals. These chemicals cause the symptoms of allergic rhinitis including sneezing, itchy or runny nose, itchy or watery eyes, and even coughing.

Allergic rhinitis can be inherited, but you probably don't inherit particular allergies, such as to cat dander or ragweed. Instead, you just inherit the tendency to be allergic. Children are more likely to develop allergic rhinitis if one of their parents is affected, and are even more likely again if both parents have allergic rhinitis.

Symptoms and Complications

Most people with allergic rhinitis know they have it, although it can sometimes be confused with the common cold.

Symptoms include runny nose; sneezing; itchy nose, mouth, throat, or eyes; and congestion. Other symptoms can also occur, such as tearing of the eyes, coughing, sore throat, wheezing, and headache.

People with mild allergic rhinitis have symptoms but they are not troublesome and do not interfere with daily activities such as school, work, or sleep. With moderate/severe allergic rhinitis, the symptoms are troublesome and affect daily life.

Making the Diagnosis

Your doctor can often diagnose allergic rhinitis based on the history and details related to your symptoms. It is important to take note of these details, such as factors that make it better or worse, and the timing of your symptoms. Knowing this information will help give your doctor or allergist vital clues as to what's provoking the symptoms, which makes diagnosis easier.

By getting the details of where you live and work, and when you suffer most, a doctor or an allergist can make a very short list of possible causes. Although it is not necessary for diagnosis, your doctor or allergist may suggest allergy testing, such as a skin prick test, to help identify the allergens causing your symptoms.

Allergists perform a skin test by using small, standardized doses of all the most common allergens to narrow down the diagnosis. They can test for an allergy to a specific substance by gently scraping/pricking the skin with each of these common allergens. The appearance of a rash confirms what you're allergic to. Sometimes a blood test may be done.

Treatment and Prevention

The best way to prevent allergic rhinitis is to avoid the allergen. This may mean changing your habits, or even giving away a pet or moving to another house if the symptoms are unbearable and don't respond to medications.

Here are some tips you can try to minimize exposure to allergens:

Pollen:

• Keep windows and doors closed
• When using air conditioning, use the indoor cycle
• Shower/bathe after outdoor activity to remove pollen from your hair and skin
• Monitor the pollen count. Try to avoid going outside when the pollen count is high.

Indoor molds:

• Avoid using humidifiers and cool mist vaporizers, as mold often grows in them. If you must use them, clean them often.
• Do not put carpet or furniture in your basement if it is damp or prone to flooding
• Remove houseplants (a common source of mold)

Dust mites:

• Avoid carpeting your bedroom and main living areas
• Clean while the allergic person is not at home, or if the allergic person must do the cleaning, have them wear a facemask
• Wash bedding in hot water (>55 °C) at least every other week.
• Use zippered, allergen-proof casings on mattresses and box springs
• Wash bed sheets, pillowcases, and blankets in hot water frequently.

Keep in mind that it is not always possible to control the environment or to eliminate or avoid allergens, especially those that are airborne. Many people need medication treatment for relief. Fortunately, most people respond well to medications. The therapy of choice will depend on your symptoms, the severity of your symptoms, your past response to medications, and other medical conditions that you have, if any.

Treatment for mild symptoms is usually antihistamines taken either orally (e.g., diphenhydramine*, cetirizine, loratadine, fexofenadine, desloratadine, bilastine, rupatadine), as a nose spray (e.g., azelastine), or as an eye drop (e.g., olopatadine). Your doctor or pharmacist can help you choose the medication best suited to your needs. For example, many oral antihistamines are now "non-drowsy." People with certain medical conditions (e.g., glaucoma, prostate problems) should consult their doctor before using certain antihistamines.

It is important to know that some products contain antihistamines plus decongestants for symptom relief. However, nasal decongestant use should be limited to 3 to 5 days, otherwise it may make the symptoms worse. Seeking advice from a health professional is recommended as those with medical conditions such as high blood pressure must use caution with decongestants.

A corticosteroid nose spray (e.g., budesonide, ciclesonide, fluticasone, mometasone) can be tried if antihistamines aren't working. Corticosteroid sprays can be used if rhinitis symptoms are chronic and are the preferred treatment for symptoms that are moderate to severe. For seasonal allergies, some people may find that nasal sprays, eye drops, and inhalations containing sodium cromoglycate are effective in preventing allergic rhinitis if treatment is started before allergy season and used on a regular basis.

An anticholinergic nose spray (e.g., ipratropium) may also be used to help reduce runny nose symptoms. Another medication called montelukast may be tried when other medications have not worked, or have not been tolerated. Saline nose sprays and lubricant eye drops may also help with nose and eye symptoms.

Women who are pregnant or breast-feeding and children should consult their doctor or pharmacist before beginning treatment for allergic rhinitis.

If allergen avoidance and medical treatment for allergic rhinitis aren't effective, allergen immunotherapy may be an option. Allergen immunotherapy can be given as shots or as pills placed under the tongue. With shots, small amounts of the allergen are injected regularly while slowly increasing the dosage. The hope is that the immune reaction becomes weaker and weaker as the body gets used to the presence of the allergen. Rarely, the person may have a system-wide immune reaction called anaphylaxis, which can be fatal.

Immunotherapy pills, called "sublingual allergy tablets" (or SLIT) are placed under the tongue, typically on a daily basis. These pills are less likely to cause anaphylaxis but are only available for certain types of allergies. The first dose is usually taken at the doctor's office, after which subsequent doses can be taken at home.

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