Allergic Rhinitis

What is allergic rhinitis?

Rhinitis is inflammation of the nasal passages.  This inflammation may be caused by allergic or nonallergic triggers.  Allergic rhinitis is an immune reaction that occurs in the nose when you breathe in particles in the air that are commonly harmless, such as grass pollens.  When these particles cause this immune reaction, they are called allergens.

When breathed in, allergens trigger the release of inflammatory mediators like histamine, which cause itching, congestion, fluid or mucous production in the fragile linings of the nasal passages and sinuses.

What are the causes of allergic rhinitis?

• The most common causes of allergic rhinitis include the following:
• Pollens (for example:  trees, grasses, or weeds)
• Dust mites
• Molds
• Cockroach droppings
• Animal dander

What are symptoms of allergic rhinitis?

The following are the most common symptoms of allergic rhinitis.  However, each patient may experience symptoms differently.  Symptoms may include:

• Sneezing
• Congestion
• Runny nose
• Itchy nose, throat, eyes, and ears
• Nosebleeds
• Post nasal drip, clearing of the throat
• Cough
• Sore throat
• Recurrent ear or sinus infections
• Snoring
• Breathing through the mouth
• Headache or sinus pressure
• "Allergic salute."  This is when a patient rubs his or her hand upward across the bridge of the nose while sniffing.  This may cause a line or crease across the bridge of the nose.
• “Allergic shiners.” These are dark circles under the eyes from exposure to allergens.

The symptoms of allergic rhinitis may resemble other conditions or medical problems.  Always consult your health care provider for a diagnosis.

How is allergic rhinitis diagnosed?

Allergic rhinitis can be differentiated from nonallergic rhinitis with allergy testing.  The diagnosis is made by your health care provider based on a thorough medical history and physical examination.  In addition to the above symptoms, your health care provider may find, on physical examination, dark circles under the eyes, creases under the eyes, and swollen tissue inside the nose.  To determine exactly what allergens are causing your allergic rhinitis, you can be evaluated by an Allergist who is a specialist trained in performing allergy testing.  The testing can be done by skin test, blood test or combination of both depending on your history and physical exam.

Treatment for allergic rhinitis

Specific treatment for allergic rhinitis will be determined by your health care provider based on:

• Your age, overall health, and medical history
• Extent of the reaction
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the reaction
• Your opinion or preference

Treatment options may include:

Avoidance of the allergens

Based on your history, physical exam and allergy testing results, precautions can be made to avoid the allergens that are causing your symptoms.  This is the best treatment.

Medications

• Antihistamines.  Antihistamines decrease symptoms of itching, sneezing, or runny nose.  Some examples of antihistamines include diphenhydramine (Benadryl), hydroxyzine (Atarax), fexofenadine (Allegra), cetirizine (Zyrtec), and loratadine (Claritin).  Some of these medications may cause drowsiness.  Consult your health care provider to determine the proper dosage.
• Anti-inflammatory nasal sprays.  Anti-inflammatory nasal sprays can contain antihistamines, corticosteroids or a combination of antihistamines and corticosteroids.  By decreasing the release of various inflammatory mediators, they help decrease swelling in the nose and sinuses.  Consult your health care provider to determine the proper dosage.
• Anticholinergic nasal sprays. This type of nasal spray works by decreasing the release of chemicals the cause runny nose. Consult your health care provider to determine the proper dosage.
• Decongestants.  Decongestants constrict the blood vessels in the nose which reduce symptoms of nasal congestion.  Decongestants can be given by mouth or by nasal spray. They can be purchased either over-the-counter or by prescription.  They need to be taken with caution, especially in patients with elevated blood pressure(s).  Consult your health care provider to determine the proper dosage.
• Anti-leukotrienes.  Leukotrienes are released during an allergic reaction and can cause inflammation.  Anti-leukotrienes can help decrease congestion in the nose and chest. Consult your health care provider to determine the proper dosage.

Allergen immunotherapy

Allergen immunotherapy contains the specific allergens that are causing your symptoms (based on allergy testing) and are given in the form of injection (allergy shots) or by mouth (tablets under the tongue).  They have been shown to be effective in decreasing your symptoms and decreasing medication use.  This is the only option that can change your immune system to make you less allergic.

Immunotherapy can be a good option if:

1. You have a poor response to avoidance measures or are unable to avoid your allergen (like a pet).
2. You have a poor response to allergy medications and/or are unable to tolerate allergy medications.
3. You are experiencing allergy-associated health problems such as asthma, sinusitis, or headaches.
4. Consult your health care provider for more information.

Complications of allergic rhinitis

• Chronic sinus  inflammation and congestion (chronic rhinosinusitis)
• Frequent ear infections
• Ear clogging and popping (Eustachian tube dysfunction)
• Decreased sense of smell
• Headaches

The link between allergic rhinitis and asthma

Guidelines from the World Health Organization recognize the link between allergic rhinitis and asthma.   One theory asserts that the airway from the nose to the lungs is continuous so that inflammation in the nose can affect inflammation in the airways of lungs, which then can cause asthmatic symptoms. Allergy immunotherapy has been shown to alter the progression of allergic disease and prevent the development of asthma in children.