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Allergic Rhinitis

Allergic rhinitis, occurs when allergens like pollen, dust mite droppings, pet hair or dander, insects, and mold trigger allergic reactions, resulting in symptoms such as sneezing, a sore throat, nasal congestion, a runny nose

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Allergic Rhinitis

Allergic rhinitis, commonly known as hay fever, occurs when allergens like pollen, dust mite droppings, pet hair or dander, insects, and mold trigger allergic reactions, resulting in symptoms such as sneezing, a sore throat, nasal congestion, a runny nose, and an itchy nose. While allergic rhinitis is lifelong, individuals can effectively alleviate symptoms through lifestyle adjustments, medications, and immunotherapy.

What is allergic rhinitis?

Allergic rhinitis occurs when minute airborne particles, known as allergens, are inhaled into the body through the nose or mouth. These allergens prompt the release of various chemicals, including histamine, which leads to allergic reactions. Common allergens include those derived from dust mites, pet dander, mold, and pollen from trees.

Allergic rhinitis manifests at different time courses classifiable into two main types: seasonal and perennial. These two forms are associated with distinct allergens. Specific allergens like pollen from trees or weeds trigger seasonal allergic rhinitis. On the other hand, perennial allergic rhinitis is due to a different allergen set, including cockroaches, dust mites, pet dander, molds, and fungi.

Furthermore, allergic rhinitis can have a genetic component, implying that individuals are more likely to experience it if a family member also has the condition. Additionally, there is an increased likelihood of allergic rhinitis in individuals with atopic eczema or asthma.

Signs and Symptoms of Allergic Rhinitis

Signs and Symptoms

Symptoms of perennial and seasonal allergic rhinitis can vary from person to person, categorized by the affected organs, including the nose, throat, eyes, and ears. Common symptoms of allergic rhinitis include:

  • Nose: Runny nose, nasal congestion, sneezing, postnasal drip, and facial pressure
  • Throat: Sore throat and itchiness 
  • Eyes: Pink eye, watery eyes and eye itchiness
  • Ears: Itching of the ears or Ear infection (Middle Ear) and otitis media with effusion. 

In addition to affecting the previously mentioned parts of the body, allergic rhinitis symptoms can interfere with sleep, resulting in symptoms of mouth breathing, snoring, frequent nocturnal awakenings, and daytime sleepiness or fatigue.

It's worth noting that while symptoms of allergic rhinitis may resemble those of the common cold, a key distinction is that the common cold is more likely to cause muscle aches or fever.

Causes

Allergic rhinitis is due to an oversensitive reaction to allergens in the air. In people with allergic rhinitis, their immune system mistakes allergens as harmful agents and release inflammatory mediators. Histamine is one of the substances released to fight off allergens. Histamine subsequently causes inflammation in mucous membranes of the nose, throat, and eyes to ward off the allergens, leading to common symptoms of allergic rhinitis, such as sneezing, nasal congestion, and runny nose. 

Allergens that can trigger the symptoms of allergic rhinitis include:

  • House dust mites.
  • Pollen from trees or spores from mold.
  • Pet hair or dander.
  • Saliva or waste of cockroaches.

Diagnosis

If you have symptoms like that of allergic rhinitis, consulting an allergist for diagnosis and treatment is ideal. A doctor may review your symptoms and take your medical history. In addition, your doctor will identify and confirm what allergens cause your body to react to allergens by conducting a skin prick test, a painless and accurate test that may cause slight discomfort. To perform the test, your doctor will arrange samples of allergens or apply drops of allergen extracts on your forearm and prick the area of your skin near the allergens using a needle or lancet to let the allergens get under the skin. If you are allergic to allergens, itchiness, redness, and irritation can occur in your skin after 15 minutes. 

Treatment and Prevention Allergic Rhinitis

Treatment and Prevention

Two primary treatment modalities that can help you manage allergic rhinitis are allergen avoidance and medications. The combination of both modalities works effectively for most people. The two modalities are as follows:

Allergen avoidance

Once you identify your allergens, reducing exposure to them can help prevent you from having allergic reactions. You can do the following to prevent allergic rhinitis:

  • Reduce allergens in the air with a vacuum cleaner or air conditioner equipped with filters.
  • If you are allergic to pollen, wear sunglasses and a hat to protect your eyes from pollens and change your outfits when you are home.
  • Close your car or home windows when pollen counts are high.
  • If you are allergic to dust mites, enclose your pillows and mattresses with dust mite covers or change your bed sheets weekly.
  • If you have a dog allergy, keep your dog off your couches, beds, or bedrooms as much as possible. Designate a specific area for your dog to stay in.
  • Do not touch or rub your face, eyes, or nose after playing with dogs, and wash your hands after playing.
  • If you are allergic to your cat, have it stay outside.

Medications

Some allergens are difficult or impossible to avoid. Therefore, avoiding allergens may not be effective in controlling symptoms. Under this circumstance, medications are beneficial as they can relieve symptoms of allergic rhinitis. Medications for allergic rhinitis come in various forms, including pills, liquids, nasal sprays, eye drops, and injections. Some allergic rhinitis  medications have side effects, such as drowsiness or an altered sense of taste. Therefore, discuss with your doctor before taking one. The following are examples of medications for allergic rhinitis:

Antihistamines

Antihistamines are common medications used to treat allergic rhinitis since they block the effects of histamine, a chemical that causes allergic reactions in the first place. Antihistamines come in many forms, such as liquids, eye drops, nasal sprays, pills, and inhalers. Although antihistamines can relieve itching, runny nose, and sneezing, they do not relieve nasal congestion. Examples of antihistamines are Cetirizine, Loratadine, Levocetirizine, and Fexofenadine.

Treatment and Prevention Allergic Rhinitis - Steroid nasal sprays

Steroid nasal sprays (Corticosteroid or glucocorticoid)

Intranasal corticosteroids can help relieve the symptoms of allergic rhinitis, given that they reduce the inflammation. With few side effects, steroid nasal sprays are considered a front-line therapy for controlling symptoms of allergic rhinitis. In addition, studies suggest that nasal steroids are more effective than oral antihistamines for symptom relief. For some, nasal steroids improve symptoms on the first day of use. However, nasal steroids will be the most effective when extensively used. Some can use lower doses when their symptoms improve.

Potential side effects of steroid nasal sprays include:

  • Dryness in the nose
  • Unpleasant taste or smell
  • Irritation
  • Crusting
  • Itchiness

Although taking steroids in other forms, such as a pill or inhaler, for a long time can lead to additional side effects, steroid nasal sprays contain low doses of steroids and do not cause those adverse effects. Nevertheless, doctors recommend using the lowest effective dose.

Antihistamine/glucocorticoid combination spray

According to results from three clinical trials, azelastine and fluticasone combination nasal spray improves symptoms of allergic rhinitis better than using either drug alone. However, the combination of nasal spray may have the side effects of both azelastine and fluticasone when used at the recommended doses, sprayed on each side of the nose twice a day. Possible common side effects include nosebleeds, headaches, and a change in the sense of taste.

Nasal decongestants

Decongestants help relieve nasal congestion, sinus pressure, and swollen nasal passages. If you develop severe symptoms of allergic rhinitis, take a nasal decongestant to reduce the swelling of the nasal passage for a few days before taking steroid nasal spray. This will allow the nasal spray to reach more areas. However, decongestants do not contain antihistamines, meaning they do not relieve some symptoms of allergic rhinitis.

Side effects of decongestants include increased blood pressure, irritation of the lining of the nose, drowsiness, and headaches. Therefore, consult your allergist before taking them.

Leukotriene inhibitors

When allergens get into the body, they stimulate the release of chemicals like histamines, leukotriene, and other chemicals that cause inflammation and symptoms of allergic rhinitis. Leukotriene inhibitors can relieve those symptoms by blocking the effects of leukotriene. Side effects of leukotriene inhibitors include mood swings, abnormal behaviors, vivid dreams, skin rash, headaches, and heartburn.

Immunotherapy

This treatment involves altering how the immunity system reacts to allergens by making it tolerant to each allergen. Immunotherapy commonly comes in the forms of subcutaneous immunotherapy or allergy shots and sublingual immunotherapy. Allergy shots contain a small amount of allergen you are allergic to, with the subsequent doses increasing gradually after each injection. The immune system continuously develops tolerance to the allergen until it stops the allergic reactions. Sublingual immunotherapy is limited to treating patients with house dust mite allergy only. Sublingual immunotherapy tablets should be taken once a day for at least three years.

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When you should see a doctor

If you are uncertain whether the symptoms you experience are due to allergic rhinitis, see an allergist for diagnosis and confirmation. In addition, seek medical attention if allergic rhinitis symptoms affect your daily life or do not improve after taking medications.

A note from MedPark Hospital

The symptoms of allergic rhinitis can significantly impact your quality of life, disrupting your ability to carry out your daily activities normally. Fortunately, lifestyle adjustments and medications can effectively alleviate these symptoms. It is advisable to consult with your doctor to explore strategies to prevent exposure to allergens or manage symptoms, ultimately contributing to an improved quality of life.

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Published: 01 Dec 2023

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