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Rhinitis (also called Hay Fever):

Hay Fever is one of the most common ailments in the United States, affecting over 50 million Americans.  Symptoms of allergic hay fever include: sneezing, runny nose, sinus congestion, itchy watery eyes and may include respiratory disorders, like asthma.  If you are experiencing these symptoms, chances are you have hay fever or allergic rhinitis.  Hay Fever has a significant impact on the quality of life of those who suffer from it.  Hay Fever, especially in infants and children, can increase the incidence of hear infections. Allergic rhinitis has a significant impact on the quality of life of those who suffer from it, sometimes causing sleep disturbances and learning difficulties, especially in children.  Controlling allergic rhinitis is especially important in those who suffer from asthma, since allergic rhinitis can be a trigger for increasingly severe asthma. 

What is Allergic rhinitis?
Allergic rhinitis, or hay fever, is an allergic reaction triggered by proteins called allergens. These substances are harmless to people who do not suffer from allergies, but in those who do, allergens cause serious changes in the immune system.  In people with allergic tendencies, allergens trigger an immune response, causing an immunoglobin called immunoglobin E (or IgE) to bind to cells called mast cells.  These mast cells in turn release caustic chemicals into the body, such as histamines and leukotrienes.  In patients with allergic rhinitis, these substances affect the nasal lining of the nose, causing irritation and inflammation of the nasal passages (the nasal sinuses).  

What are the types of Allergic Rhinitis and What causes them?

• Seasonal Allergic Rhinitis, also often referred to as Hay Fever, is usually considered an outdoor allergy. It is most often caused by airborne allergens like pollen from trees, grasses and weeds or from mold spores.
• Perennial Allergic Rhinitis is usually considered an indoor allergy. It is most often caused by the components of house dust, which includes animal protiens (usually from the animals skin, called dander), mold spores, dust mite particles and cockroaches.

Diagnosis
If you have allergic rhinitis, an allergist can help determine which specific allergens are triggering your symptoms. He or she will take a careful health history.  In most cases, skin prick testing is an important tool used to determine which proteins (allergens or “antigens”) are causing your rhinitis symptoms.  Blood testing may also be helpful if skin testing cannot be performed due to eczema or dermatitis.   Your allergist will help you to decide which kind of testing is best for you.

Treatment of allergic rhinitis
After skin prick testing has been performed, to help determine which allergens are causing your symptoms, your allergist will design a treatment plan that is best for you.  Avoiding the allergens which cause your symptoms can be an important part of your treatment.  Your physician might prescribe medication to decrease your allergic rhinitis symptoms.  These may include antihistamine tablets and nasal sprays, leukotriene receptor antagonists, nasal corticosteroids, decongestants or ipratropium.  Antihistamines block histamine, one of the mediators in allergic responses.  Antihistamines will reduce inflammation, itching, sneezing and congestion that causes difficulty breathing and runny noses.  Leukotriene agonist pills may also reduce the inflammation leading to allergic rhinitis symptoms.  Corticosteroids are among the stronger medications used to treat allergic rhinitis, but are very effective against all symptoms.  If your symptoms are persistent or severe, your allergist may choose to prescribe  nasal corticosteroids.   Decongestant sprays can be a good long acting solution for symptomatic relief.  And ipratropium nasal spray may also be effective in patients who have runny noses.

While medications may be effective in treating the symptoms of allergic rhinitis, they do not treat the underlying causes.   Allergen immunotherapy , also known as “allergy shots,” may be considered if your symptoms persist.  Allergen immunotherapy works at the level of the immune system, treating the underlying cause of allergic symptoms, decreasing the need for medications.  This form of therapy involves receipt of injections, which act to desensitize your immune system to the allergen causing your rhinitis. While treatment with immunotherapy may take several years, immunotherapy often provides long lasting relief from symptoms and in children may not only prevent new allergies from forming, but may also prevent the progression of allergic rhinitis to asthma. 

Non-allergic rhinitis

Non-allergic rhinitis usually afflicts adults and causes year-round symptoms, especially runny nose and nasal congestion. This problem differs from allergic rhinitis because the immune system does not seem to be involved. Unfortunately, we do not have good understanding of why non-allergic rhinitis occurs.   Non-allergic rhinites may be caused by polyps, or growths which block the nasal passages and keep air from flowing freely through them.  When this occurs, sufferers may also experience a loss of smell.  Other non-allergic rhinitis may be due to a sensitivity to irritants, such as smoke and pollution.  This type of rhinitis is also known as vasomotor rhinitis.  Some medicines cause nasal congestion as a side effect.  These include medications used for those who suffer from erectile dysfunction.  Finally, nasal congestion may be caused as a rebound effect from nasal decongestant sprays. This type of rhinitis is also known as rhinitis medicamentosa.

Treatment of non-allergic rhinitis

The treatment of choice for most forms of non-allergic rhinitis is nasal corticosteroid sprays.  If nasal congestion is excessive, your allergist may choose to prescribe ipratropium nasal spray or decongestant pills or sprays. Recently, an antihistamine nasal sprays have been found helpful in relieving the symptoms of non-allergic rhinitis. Your allergist can help you do determine which kind of rhinitis is causing your symptoms and create a treatment plan that is right for you.

You should consult an allergist if you or a family member have:

• Prolonged or severe symptoms of hay fever (or allergic rhinitis).
• Nasal polyps.
• Medical conditions including asthma or recurrent sinusitis.
• Itchy watery eyes, congestion, headaches, sneezing and other symptoms interfering with quality of life and/or ability to function.
• Medications have not been ineffective or you have had adverse reactions to medications.
• Your child has allergic rhinitis. This is especially important, since immunotherapy may prevent symptoms from becoming worse and progressing to the development of asthma

Copyright © 2008-2010 Dr. Beth Cowan