Allergic rhinitis is an abnormal reaction of the body to a normal environmental stimulus like pollen. Allergic rhinitis, or hay fever, is the itchy eyes, sneezing, stuffiness, and runny nose that happen when the body is exposed to things that cause allergy (allergens). The immune system normally works in the body to protect us from things that might do us harm, like bacteria or other infections. As part of this immune system, the body produces antibodies which serve to catch things in the body which should not be there, like harmful bacteria. The type of antibody that is overproduced in people with allergic rhinitis is called IgE. When the body comes in to contact with allergens (like pet dander, pollen or insect stings), it reacts with full force to block them like it would against an infection by gathering up the allergen, releasing histamine, and giving you symptoms of allergic rhinitis. There are many common allergens (substances that trigger allergies): pollen, pet or animal dander, cockroaches or dust mites living in your home, and mold. Allergic rhinitis can occur year-round or can have seasonal variation (called hay fever). In fact, almost one in five people have “hay fever”. The seasonal types of hay fever are most often triggered by tree pollen (worst in spring), grass pollen (worst in late spring and summer), weed pollen (worst in fall), and fungal and mold spores (worst in summer). Even though allergic rhinitis goes by the name “hay fever”, allergies to hay itself are actually rare. Year round causes of allergic rhinitis include cockroaches, dust mites, pet dander, and mold or fungal spores. Risk factors for developing allergies include: having family members with allergies or asthma, being male, being a firstborn child, and being exposed to cigarette smoke at a young age. If you have allergies, you may be at higher risk for other medical conditions like anaphylaxis (a severe allergic reaction which may lead to swelling in the throat which restricts breathing), allergies to other substances, asthma (a condition characterized by difficulty breathing and wheezing), atopic dermatitis or eczema (a condition characterized by itchy patches of skin), infections of the sinuses or ears, and fungal infections in the sinuses or lungs (allergic fungal sinusitis and allergic bronchopulmonary aspergillosis). Allergic rhinitis cannot be cured, but many treatment options exist to decrease allergy symptoms.
Itchy or watery eyes, runny nose, congestions, sneezing, itchy nose, cough, sinus pressure, allergic shiners (bluish discoloration under the eyes), decreased sense of smell, decreased sense of taste, difficulty sleeping, fatigue, being irritable
The diagnosis of allergic rhinitis is based mostly on clinical history and physical exam. Your doctor will want to know at what time of year and under what circumstances your symptoms are the worst (indoors or outdoors, for example). Your doctor or allergist may recommend trying to remove potential allergens to see if symptoms improve. To find the cause of allergies, an allergist may recommend a skin prick test. The skin prick test uses a set of tiny needles which inject very small amounts of allergen under the skin. If any of those areas become inflamed or swollen, the doctor can tell which allergens cause your allergies. Your physician will have you wait in the office after placing these allergens in the skin to monitor your reaction. Sometimes, a blood test can also be done to look for antibodies to common allergens. If other conditions are expected, your doctor may want to do some other testing
Treatment of allergies usually starts with avoiding contact with whatever allergen causes symptoms. For seasonal allergic rhinitis, your doctor may recommend a variety of methods to decrease your exposure to the allergen. Methods for decreasing exposure to allergens depend on your allergy. If you are allergic to pollen or molds, you should close your windows during the season when the allergens are worst, avoid hanging laundry outside where allergens in the air can stick to it, equip your house with an air filter that can trap allergens (you will need to buy one that specifically says it traps allergens), use air conditioning wherever you can, decrease your early morning activity (when pollen is the worst), avoid being outdoors on windy days, avoid outdoor activities that release dust and pollen like raking leaves or mowing the lawn (or wear mask during these activities), and use a dehumidifier to dry out indoor air to reduce mold growth. If you are allergic to dust mites, wash your sheets at high temperature and cover your mattress with allergy covers, vacuum frequently (and use a HEPA filter on your vacuum), you may also want to decrease the amount of carpeting in your house, especially in the room where you sleep. If you are allergic to cockroaches, you need to cockroach-proof your house. This process involves cleaning your dishes and garbage daily as well as keeping the floors and counters free of crumbs, closing cracks where roaches might enter the house, and fixing leaks in faucets. To properly clear roaches from your house, you may want to consult a professional exterminator. If you are allergic to pet dander (flakes of skin from your pets) you can try giving the pet baths weekly and keeping them out of the bedroom. If these measures do not work, the best way to get rid of the allergen is to get rid of the pet. Often, avoiding the allergen is very difficult (as with allergies to pollens or pet dander). If allergens cannot be avoided, you may want to try nasal washes either with saline spray or a Neti pot to wash the allergen from the nasal passages. Over-the-counter medication options include antihistamines like diphenhydramine (Benadryl), newer antihistamines like loratidine (Claritin), and decongestants like pseudoephedrine (Sudafed). Prescription medication options include inhaled nasal corticosteroids, oral corticosteroids, nasal atropine, leukotriene modifiers and cromolyn sodium which all work to decrease symptoms from allergies in different ways. You should talk to your doctor about your medication choice as all of these regimens have different benefits and side effects. Your allergist may recommend special shots called immunotherapy designed to decrease your allergy symptoms. These shots are purified allergen given over a period of years to desensitize the body to the allergen. The ultimate goal of immunotherapy is to decrease your body’s response to allergens. Allergic rhinitis can really limit your life, so it is important to get your symptoms under control. Also, children are less likely to develop asthma when their allergic rhinitis symptoms are treated.
