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by Carson-DeWitt R

Allergic Rhinitis

(Hay Fever; Seasonal Allergies)

Definition

Allergic rhinitis is irritation and inflammation in the nasal passages after exposure to allergens. Allergens are substances that cause an abnormal response of the immune system. The response can includes swelling of the nasal passage, runny or itchy nose, watery eyes, congestion and congestion pain, and sneezing. It may be:
  • Seasonal (intermittent) allergic rhinitis (sometimes called hay fever or rose fever)—This occurs during times of the year when allergens are in the air, like spring, summer, and fall. The most common allergens are tree, grass, or weed pollens.
  • Perennial (persistent) allergic rhinitis—This condition is caused by allergens that may be present year round. These may include chemicals, dust, dust mites, cockroaches, animal dander, or mold spores. Symptoms may be present any time of year.

Causes

An allergic reaction occurs when your body's immune system overreacts to an allergen. When you breathe in an allergen, cells in your nasal passages release a chemical called histamine. Histamine causes your nose to feel itchy and creates swelling and mucus production in the nasal passages.
Site of Histamine Production
Nasal passage
This area has swelling and increased mucus production after contact with an allergen.
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Risk Factors

Factors that increase your chance of having allergic rhinitis include:

Symptoms

Exposure to the allergen can cause:
  • Sneezing
  • Itching in the nose, eyes, throat, and ears
  • Red, watery eyes
  • Runny nose, nasal congestion
  • Congestion with sinus pressure
  • Postnasal drip and cough
  • Headache
  • Dark circles under your eyes

Diagnosis

The doctor will ask about medical history and a description of symptoms. Allergic rhinitis is most often diagnosed based on description of symptoms. A referreal to an allergy specialist may also be made.
The doctor may also try to find out which allergens are causing the problems through tests such as:
  • Skin Prick Test—A tiny bit of an allergen is placed under the skin with a needle. The doctor watches to see if the skin in that area becomes red, raised, and itchy. This can be done for multiple allergens at the same time.
  • RAST Testing—A small sample of blood is taken and tested for different allergens.
  • Provocation Testing—You breathe in air containing an allergen. The doctor will watch to see if you have an allergic reaction, such as wheezing or trouble breathing. This test is usually reserved for research settings.

Treatment

Minimizing exposure to the allergen is the most effective way to treat allergies. Specific steps will depend on allergen such as:
Dust mite reduction:
  • Wash pillows and bed sheets regularly in hot water.
  • Remove carpeting, feather pillows, and upholstered furniture, especially in bedroom.
  • Keep clothes off bedroom floor.
  • Use acaricides solutions to kill dust mites.
  • Keep humidity levels < 50%.
  • Use double-bag vacuum bags and HEPA filters.
Mold exposure reduction:
  • Wear facemasks when working with soil, leaves, or compost.
  • Try to avoid moist, damp areas within the home.
  • Use a dehumidifier in places like your basement that may encourage mold growth.
  • Repair leaky roofs or pipes.
Animal allergen reduction:
  • Removal of pet from home is most efficient option. It may take 4-6 months to clear the home of pet allergens.
  • If you wish to keep pets, keep your pet out of bedroom and off of furniture.
  • Frequent vacuuming or removal of rugs
Pollen reduction:
  • Be aware of pollen levels and limit your exposure on high days:
    • Stay indoors and keep windows closed.
    • Consider using an air purifier inside
    • Do not dry clothes outside.
    • Shower once you get home. Keep clothes contaminated with pollen out of the bedroom.
General reduction techniques:
  • Use petroleum jelly on the nostrils. The jelly may catch some of the allergens before they pass into the nose.
  • Nasal filters—device inserted into the nostrils that can filter allergens before they reach the nose
  • A Neti Pot, nasal sinus rinse, or saline nasal spray may help clear irritants from the nasal passage after exposure. It may also help loosen congestion.
Though reducing allergens can help, it is not possible to completely eliminate all allergens. Other treatments may help reduce the body's reaction to the allergen:

Medications

Medications can help to minimize the reaction of the immune system to reduce symptoms like swelling and mucous production. They may be given alone or in combination. Options include:
  • Nasal corticosteroid (glucocorticoid)—often considered most effective for allergic rhinitis
  • Antihistamine—may be pills taken by mouth or as nasal spray
These medications are most effective when delivered before exposure to allergen and through time of exposure.
Other medications that may be added include:
  • Nasal mast cell stabilizers
  • Leukotriene receptor antagonists
  • Anticholinergics
Decongestants may be recommended for severe congestion. Decongestants are not appropriate for everyone and do not stop symptoms, only temporarily relieve some pressure. Overuse of nasal decongestant sprays can actually make symptoms worse.

Immunotherapy

Immunotherapy gradually introduces your body to an allergen through injections or pills placed under the tongue. The goal is to make your body's immune system less sensitive to those allergens and reduce or eliminate allergic rhinitis. This therapy requires several treatments over an extended period of time. It may only be recommended for people who have poor management with medication alone.
The therapy is delivered in small amounts over weeks, months, or even years. Immunotherapy is only available for specific allergens but more may become available after appropriate testing.

Prevention

The reason that allergic rhinitis develops is not clear, so there are no clear steps to prevent it. Exclusive breastfeeding in first few months of life may help decrease the risk of allergies later in life.

RESOURCES

American Academy of Allergy, Asthma, and Immunology
http://www.aaaai.org
Asthma and Allergy Foundation of America
http://www.aafa.org

CANADIAN RESOURCES

Allergy Asthma Information Association
http://aaia.ca
Health Canada
http://www.hc-sc.gc.ca

References

Allergic rhinitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February , 2015. Accessed February 3, 2015.
Allergic rhinitis (hay fever). American College of Allergy, Asthma, & Immunology website. Available at: http://www.acaai.org/allergist/allergies/types/rhinitis/Pages/default.aspx. Accessed February 3, 2015.
Managing Indoor Allergen Culprits. American Academy of Allergy Asthma and Immunology website. Available at: http://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Libraries/EL-indoor-allergies-managing-patient.pdf. Updated February 2011. Accessed February 3, 2015.
Rhinitis. American Academy of Allergy Asthma & Immunology website. Available at: http://www.aaaai.org/conditions-and-treatments/allergies/rhinitis.aspx. Accessed August 18, 2014.
Wheatley L, Togias A. Allergic Rhinitis. N Engl J Med 2015; 372:456-463. Accessed at: http://www.nejm.org/doi/full/10.1056/NEJMcp1412282.
8/11/2006 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Durham SR, Yang WH, Pedersen MR, et al. Sublingual immunotherapy with once-daily grass allergen tablets: a randomized controlled trial in seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2006;117:802-809.
8/27/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Kim JM, Lin SY, Suarez-Cuervo C, et al. Allergen-specific immunotherapy for pediatric asthma and rhinoconjunctivitis: a systematic review. Pediatrics. 2013 Jun;131(6):1155-67.

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