Allergic Rhinitis

Allergic Rhinitis, also called hay fever, occurs when the body responds to allergens with a robust immunological response. The triggers for allergic rhinitis could be domestic allergens like mites, domestic animals, insects, pollen grains or certain plants, occupation triggers such as latex, tobacco, smoke, exhausts like sulphur dioxide, and oxides of nitrogen or non-steroidal anti-inflammatory drugs.

The body's reaction to these allergens is a buildup of significant inflammation in the delicate nasal tissues.

Classification of Allergic Rhinitis

1. Duration of Allergic response - Intermittent or Persistent
2.  Severity of the symptoms - Mild, Moderate or Severe

 

What Causes Allergic Rhinitis?

Allergic rhinitis is caused when the human body reacts to certain irritants or allergens.For the majority of people, allergens are safe. However, in some people, the body responds to these allergies as though they were unwanted invaders. Their immune system responds by injecting the bloodstream with the natural chemical histamine to defend the body. This substance is what triggers allergic responses. Of an effort to expel the allergen, the mucous membranes in the nose, eyes, and throat become irritated. . 

 

Symptoms of allergic rhinitis vary at different times of the year. Allergies that occur due to pollen are more during the spring months. The reactions to indoor allergens will be more severe when people spend more time indoors, like during the rainy season or winter. 

Below are the common symptoms that people with allergic rhinitis experience.

1. Congestion and stuffy nose
2. Sneezing
3. Runny nose
4. Itchy and watery eyes
5. Headache and sinus pains
6. Dark circles under the eyes
7. Frequent headaches
8. Fatigue
9. Wheezing, coughing and troubled breathing
10. Increased mucus in the nose and throat
11. Sore throat due to postnasal drip (mucus dripping down the throat)
12. Rhinorrhea

People feel one or more of these symptoms as soon as they come into contact with an allergen. However, symptoms like recurrent headache and fatigue occur after long-term exposure to allergens. 

 

How Do Doctors Diagnose Allergic Rhinitis?

Doctors enquire with patients about the symptoms and their severity.

The patient will be asked about other conditions like asthma and cold.

Specialists will discuss with patients to find out possible triggers.

Skin Prick Test - This test is painless and accurate. In this test, the doctors place small amounts of various possible allergens on the patient's forearm or back. Doctors scratch or prick the skin to allow the allergen to get into the blood. If the patient is allergic to a particular substance, the area will become itchy, red and irritated within 15-30 minutes. The patient may develop raised, hive-like welts called wheals. Both these indicated that the person is allergic to the substance. 

Radioallergosorbent Test (RAST) - It is a blood test that allows doctors to find out the immune system's response to a specific allergen. It can measure the amount of allergy-causing antibodies in the bloodstream. These antibodies are called immunoglobulin E antibodies. 

CT Scan test is done to exclude the condition of acute rhinosinusitis tumours. 

 

Asthma and Allergic Rhinitis - How are they different or similar?

Allergic Rhinitis And Asthma

 

For many people, allergies and asthma occur together. Allergens like pollen, pet dander and dust mites that cause allergic rhinitis, can also cause symptoms of asthma. For some, even skin or food allergies could result in asthma. Allergic reactions occur when antibodies bind to the allergens to protect the body. The same reactions can also affect the lungs and airways for a few people. This leads to asthma. 

Most people with asthma suffer from rhinitis. A small percentage of those suffering from allergic rhinitis also have asthma. In both asthma and allergic rhinitis, a similar type of inflammation is seen. The difference between the two conditions is location of the inflammation onset that is lungs or  nose.

 

1. Family members who have had allergies.
2. Being exposed to cigarette smoke.
3. Presence of asthma.
4. Having eczema which makes the skin itchy and dry.
5. Constant exposure to allergens.
6. Living in an area with high air pollution.
7. Exposure to strong smells.
8. Having mothers who smoked during the first year of life.

There is no way to prevent allergic rhinitis if a person is prone to allergies. However, it is possible to reduce the occurrences by taking a few simple steps and a lifestyle change. 

 

One should avoid touching the face and rubbing the nose or eyes as much as possible.

It is ideal to keep the windows closed during the seasons when the pollen count is high in the air.

Pillows and mattresses must be kept in dust mite covers. 

One must not allow pets to sit on couches and beds.

Pets must not be allowed to enter the bedroom.

Those suffering from allergic rhinitis must wash the pets at least once in two weeks and groom them outside the house. 

Vacuum cleaners and air conditioners must have filters to reduce the number of allergens in the air. The filters must be regularly cleaned. 

Hats and sunglasses when going out help protect the eyes from allergens.

It is advisable to change clothes as soon as people get back home. 

Dampness and condensation at home must be dealt with air dehumidifiers . 

 

Though allergic rhinitis is not a very serious illness, there are occasions when the symptoms might prevent a person from carrying on with their normal lives. At these times, it is better to seek the help of a healthcare provider. One must consult the doctor if the following occurs.

There is no relief from the symptoms.

Anti-Allergic medicines don't give relief.

The person suffers from other conditions like nasal polyps, asthma or sinus infection that can worsen allergic rhinitis. 

Symptoms interfere with the normal functioning of the person. 

Allergic rhinitis can reduce people's quality of life and prevent them from enjoying regular activities in life. They can miss work or school. It can cause people to be less productive.

People can suffer symptoms that will prevent them from sleeping well at night. This will cause fatigue and a general feeling of illness. 

This condition can worsen symptoms of asthma-like coughing and wheezing. 

Prolonged sinus congestion can lead to sinusitis.

Children with allergic rhinitis often suffer from a middle ear infection.

 

There are several medicines that help to reduce allergies and symptoms that doctors recommend to treat allergic rhinitis. 

 

Antihistamines

 

Nasal sprays with nasal corticosteroids work wonders for stuffy, runny, and itchy noses. They are typically the first drugs given to people with allergic rhinitis. They are safe and effective for long-term usage. Some people may also feel nasal pain in addition to an unpleasant taste or odour. Nasal spray use seldom causes negative effects from steroids.

 

Decongestants

 

These medicines remove congestions in the nose and sinuses. As they don't take care of other symptoms, it is common to prescribe these drugs and antihistamines. Decongestants are available both as oral medicines and nasal sprays. Oral decongestants are likely to cause many unpleasant side effects like high blood pressure, insomnia, headache and irritability. They are also known to create problems while urinating in people with an enlarged prostate. Patients must not use the nasal spray for more than three days at a time as it can cause rebound swelling (a condition where the blood vessels swell).

Nasal Corticosteroids

Sprays containing nasal corticosteroids are an excellent treatment for stuffy, runny, and itchy noses. These are frequently the first medications prescribed for allergic rhinitis patients. Long-term use is both safe and productive with them. Some people may experience a bad taste or smell as well as nasal discomfort. The use of nasal sprays seldom results in steroid side effects.

Leukotriene Inhibitors

 

Leukotriene is a chemical released during allergic reactions. They cause symptoms like an itchy nose and excessive production of mucus. These drugs are also known to cause inflammation. Leukotriene inhibitors block the chemical and give relief from the above symptoms. These drugs are likely to cause side effects like mood changes, seeing dreams, involuntary muscle movements and skin rash. Patients must consult the doctor in case they feel such side effects. 

Immunotherapy 

When medicines are not effective, doctors recommend this therapy. Several injections of allergens are given over a 3 - 5 years period. Each time the dose of allergens is increased. This creates immunity in the patient's body to such allergens. The aim is to make the body get used to allergens and stop reacting to them. The medication is also administered as pills that are kept under the tongue and dissolve. These pills are usually prescribed as a daily dose. 

Surgery

 

It can be done in the case of deviated nasal septum deviation causing obstruction in air passage, drug resistant turbinate hypertrophy or the presence of polyps in the nose.

 

Preparing For Consultation With The Doctor

 

It is better to go prepared when visiting the doctor so that patients can tell exactly what reactions are felt and when they occur. 

 

Patients must fix a time to meet their healthcare provider when they feel symptoms of allergic rhinitis.

If they are consulting a general physician, they may be directed to an allergy specialist. 

It is advisable for patients to take a close family member with them so that they don't forget or miss any of the symptoms. 

Patients must make a note of when the allergic reactions occur and what seems to be triggering them. 

If they have moved to a new house or a new region, patients must tell the doctor about it. 

Patients must inform the specialist about all the medicines they regularly take. 

As this condition is likely to be inherited, patients must inform if any close family members also suffer from allergic rhinitis. 

Conclusion

Allergic rhinitis is not a fatal disease. If the condition is seasonal, it is easy to manage it with medications. But if the disease occurs perennially and is chronic in nature, then it is better to approach a specialist for some long-term treatment. Allergic rhinitis can worsen conditions like asthma. The disease can also disrupt regular life because of the inability to sleep and fatigue. The availability of a variety of medicines makes it easy to manage the disease by consulting a specialist.