Hay Fever (Allergic Rhinitis)

Rhinitis is the medical term for nasal inflammation. It occurs when airborne irritants, allergens, or viruses trigger the release of a chemical called histamine. Histamine signals the body to release immune cells to fight off the invaders. In the case of allergic rhinitis, these invaders are often harmless, but the body mistakes them for a more dangerous infection. Inflammation then builds up in the fragile linings of the nasal passages, sinuses, and eyelids, producing mucus and causing itching.

Allergic rhinitis affects millions of people of all ages worldwide. Up to 20 percent of children and 30 percent of adults suffer from the condition, including an estimated 75 percent of asthmatics.

 

The Two Types of Allergic Rhinitis

Seasonal

Allergic rhinitis that primarily occurs during pollen seasons usually does not develop until after six years of age. It is the most common type of allergic rhinitis and is often referred to as “hay fever.” Spring and early summer are the most common triggers but depending on which plant the patient is allergic to, seasonal allergies may occur in the fall as well.

 

Perennial

Perennial rhinitis occurs throughout the year. This type of allergic rhinitis is commonly the result of environmental allergens such as dust or mold and is diagnosed more often in younger children, though anyone can develop it.

 

 

What Are the Symptoms?

Everyone experiences allergic rhinitis differently, but the most common symptoms are:

• Sneezing
• Congestion
• Runny nose
• Itchy nose, throat, eyes, and ears
• Nosebleeds

Children with perennial rhinitis may also have the following:

• Recurring ear infections
• Snoring
• Mouth breathing
• Fatigue
• “Allergic salute” — a line or crease across the bridge of the nose caused by a child rubbing a hand upward while sniffling

 

Common Triggers

The most common triggers for allergic rhinitis are:

• Pollen
• Dust mites
• Mold
• Animal dander

 

Diagnosing Allergic Rhinitis

We start with a thorough medical history and physical examination. In addition to the above symptoms, the patient may also have dark circles or creases under the eyes and swollen tissue inside the nose. An allergist can administer a skin prick test to assess which allergens are causing the most severe symptoms.

 

Is There a Treatment?

The best treatment for allergic rhinitis is to avoid the allergens that are causing the problem, but we know this is easier said than done. A variety of safe and effective medications are available to relieve symptoms, including:

 

Antihistamines

These medications block the release of histamine and decrease the itching, sneezing, and mucus production associated with rhinitis. They are easily purchased over the counter, but some prescription-only options are available as well. The most well-known antihistamines are diphenhydramine (Benadryl), loratadine (Claritin), and cetirizine (Zyrtec). Because histamine also helps you stay awake, many of these medications cause drowsiness. Consult your physician to determine the proper dosage.

 

Nasal Sprays

Corticosteroid nasal sprays open the airways and encourage mucus drainage by decreasing swelling and inflammation in the sinuses. They work best when used before the onset of symptoms, but can also help during a flare-up. While the best corticosteroid sprays are prescription-only, Flonase and Nasacort are good over-the-counter options.

Decongestant nasal sprays work similarly by constricting the blood vessels in the nose. This also reduces swelling and congestion and helps the sufferer breathe easier. Afrin and Sinex are the two most common products. They are not recommended for extended use, so always consult your doctor for advice on when and how long to use them.

 

Immunotherapy

If the above options do little to improve symptoms, your allergist may recommend immunotherapy based on the results of your skin prick test. Immunotherapy usually involves a three-to-five-year course of repeated injections of specific allergens to desensitize the body’s histamine response. Consult your physician for more information.

 

Allergy Prevention

While allergens can be difficult to avoid, the following preventative measures are effective in reducing exposure:

• Run an air purifier or air conditioner during pollen season
• Stay away from tall grasses and flowering trees
• Limit time spent in dusty places such as outbuildings, basements, and attics
• Wear a respirator or N95 mask when in dusty or moldy spaces
• Avoid contact with any pet or wild animal that may shed dander
• Remove pet hair from furniture, clothing, carpets, and curtains
• Place an anti-allergen cover over your mattress and pillow