Allergic Rhinitis Nose - Managing Your Allergies: Allergies
Content provided by the Faculty of the Harvard Medical School
Allergic rhinitis (nose)
Allergic rhinitis (nose)
Rhinitis, or inflammation of the mucous membranes of the nose, is the most common allergy in the United States, affecting about 40 million Americans. Each year, $4.5 billion is directly spent on the condition, and there’s an additional indirect cost of about four million lost work and school days. There are two categories of rhinitis: allergic rhinitis caused by allergens, and non-allergic rhinitis caused by irritants, such as fragrances, tobacco, and wood smoke. Pregnancy can also bring on non-allergic rhinitis symptoms, as can certain medications and conditions, such as a thyroid hormone deficiency.
Generally, an allergic rhinitis reaction occurs when you breathe airborne outdoor or indoor allergens. Within minutes, thanks to mast cells releasing histamine and other chemicals, the whole shebang of sneezing, runny nose, nasal congestion, and itchy eyes is in full swing. Regular exposure to these allergens leads to persistent symptoms.
Outdoor allergens
When the trigger is pollen — from trees, grasses, or weeds — or mold, and your allergies kick in seasonally, the common term is “hay fever.” But allergic rhinitis can also be a year-round condition that can lead to and exacerbate other allergies, such as allergic asthma and allergic conjunctivitis. And repeated exposure to allergens hypersensitizes the nasal mucosa, so that ever lower levels of allergens can spark a reaction, as well as making you sensitive to nonspecific irritants.
Pollen, the male cells of trees and flowering plants, is essential for fertilization. Some pollens, such as the pollens of bright “flashy” flowers, which are gathered by insects and bees, are too heavy to become airborne and rarely play a role in allergies. On the other hand, the pollens of “plain” flowers and many trees, grasses, and weeds don’t attract insects and need to be light and dry to float, wafted by winds, before sinking to the ground at the end of the day. Pollen molecules are microscopic and multitudinous, and they contain soluble allergens that dissolve in the mucosa that lines the respiratory and alimentary tracts of the body, where they can have an ill-fated meeting with IgE antibodies. It takes only a minuscule amount of pollen to trigger an allergic reaction. The spores of molds — which are types of fungus — cause allergies in much the same way as does airborne pollen.
Common outdoor allergensThe dominant allergens differ in various climates and hence in different parts of the country. | |
| Trees | oak family, elm, western red cedar, ash, birch, poplar, hickory, sycamore, maple family, walnut, cypress |
| Weeds | ragweed family, tumbleweed, sagebrush, pigweed, cockleweed, Russian thistle |
| Grasses | timothy, orchard, sweet vernal, Bermuda, sour dock, redtop, bluegrass |
| Molds | Alternaria, Cladosporium, Aspergillus |
Indoor allergens
Fleeing to the safety of your home may not be a solution. Within your cozy — and seemingly clean — home await dust mites and cockroach droppings, animal dander, and indoor mold. Your home is a welcoming environment for many of these allergens. Bedding, carpets, draperies, and damp drywall can harbor millions of microscopic allergens. They can be spread by vacuuming, which sucks up the allergens and puts them back in the air.
Diagnosing allergic rhinitis
Whether you have mild hay fever or a year-round condition, it’s advisable to find out what triggers your allergic reaction so you can take steps to avoid it. Begin by providing your allergist with a detailed description of the circumstances around your allergic attacks. For instance, in which months of the year are your symptoms worst? What triggers your allergies — your pets, vacuuming, making the bed?
Your doctor may suggest skin testing. The prick test continues to be the test of choice for allergic rhinitis because it can identify specific allergens. But if nothing shows up with the prick test, your allergist may move on to the more sensitive but less specific intracutaneous test. If you have troublesome eczema or can’t come off antihistamines, your allergist may order a RAST (radioallergosorbent test), which can detect IgE antibodies circulating in your blood.
Treating allergic rhinitis
Except for very minor allergies, it’s a good idea to treat your allergic rhinitis and not just suffer through it. Apart from helping you feel better, timely treatment will lessen the likelihood of complications arising from chronic allergic rhinitis, such as sinus infections and blocked ears. If you also have asthma, you may find that your asthma will improve if you treat your allergic rhinitis. About 38% of allergic rhinitis sufferers also have allergic asthma, which can add wheezing and difficulty breathing to the already annoying sneezing and sniffling.
Getting the jump on hay feverSeasonal hay fever can be very debilitating. To reduce hay fever symptoms, start taking your allergy medicines (antihistamines, nasal steroids, and so forth) several weeks before you anticipate your allergy season will start. Clinical trials have demonstrated that this strategy is more effective than starting the same medicines after you have already developed symptoms. In addition, make sure you take the practical steps described in this report to reduce your exposure to outdoor molds and pollens. |
Antihistamines are often used to treat allergic rhinitis because they are available over the counter. This category of medications works best for sneezing; itchy, runny noses; and itchy, watery eyes. Antihistamines work less well for nasal congestion, where nasal steroids are more effective. There are many products available, both with and without a prescription. However, the newer, non-sedating antihistamines are preferable over the older products. An antihistamine nasal spray, azelastine (Astelin), is also available.
Newer non-sedating antihistamines
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Antileukotrienes are as effective as antihistamines and may be of value in treating both rhinitis and asthma.
Anti-inflammatory medications dampen the fires of nasal inflammation. Nasal corticosteroid sprays in particular have proved valuable in the treatment of allergic rhinitis when antihistamines alone aren’t enough. And as with antihistamines, ask your doctor about the newer, more potent prescription products.
Immunotherapy or allergy shots are a good option for both seasonal and perennial allergic rhinitis patients. Not only are shots effective during the treatment period, but their effect remains long after the treatment has ended because they fundamentally change how your immune system responds to allergens. However, you need to be prepared to make a time commitment for this treatment because it can take many months to build up to a level where the therapy is effective.
During the initial stage, you need shots once or twice a week. Once you’re up to the therapeutic maintenance dose, the interval between shots is typically two to four weeks. An interesting finding is that immunotherapy may prevent children who have allergic rhinitis from developing asthma and other allergies.
Immunotherapy doesn’t work for everyone, perhaps because the offending allergen is not correctly identified in the first place or because non-allergic triggers are more dominant in some individuals. In the same vein, manufacturers’ ability to purify the allergen can lead to inconsistencies among products. Other reasons for failure include using too little of the allergen to induce tolerance.
Once again, it is important to be vigilant about limiting your exposure to your known triggers, which underlines the importance of accurately diagnosing what you are allergic to. The better prepared you are, the better chance your allergy shots will have of controlling your symptoms.
Non-allergic rhinitis
Some people, especially adults, suffer from persistently blocked sinuses and runny noses with episodes of sneezing. But when they have a skin test, the results are negative. Even though the inflammatory response within the nose looks the same as it does in allergic rhinitis, no offending allergen can be found. The reasons for this are not clear. Possibly the allergens have not yet been identified. Or there may be some other failure of the immune response that sets up a reaction that mimics the allergic response. Non-allergic rhinitis can be treated with avoidance of triggers if the trigger can be identified. Antihistamines and steroid nasal sprays may also be useful, as may be the antihistamine nasal spray azelastine (Astelin).
Nasal steroids
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Some people have symptoms that are intermittent and provoked by irritants such as cold air, rapid temperature changes, smoke, and fragrances — a condition often called vasomotor rhinitis. These patients often test negative for an allergic response on a skin test. But in this case, because the irritant can often be identified, avoidance is a good first option. If the irritant cannot be identified or avoided, an anticholinergic drug such as nasal ipratropium (Atrovent) may help prevent these intermittent symptoms.
| Last updated: | August 21, 2006 |
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| Reviewed By: | Faculty of Harvard Medical School |
Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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