Allergic Rhinitis (hayfever)

Stella Lee, MD

Introduction
Do you experience runny nose, sneezing and nasal congestion in the same season year after year? Do you seem to get "colds" often? If so, you may be suffering from a common condition known as hay fever, or allergic rhinitis. An understanding of the causes, symptoms and treatments can help make your symptoms more bearable.

Causes
Allergic rhinitis is a condition in which the body reacts to the environment in a hyperactive way. Even normal substances in the environment can become symptom-producing allergens in certain individuals. Although hay and weeds are common culprits, pollens from grasses and trees, mold, dust mite, and animal danders can also cause symptoms. The various pollens produce seasonal symptoms, whereas mold, dust mite and animal dander may result in perennial, or year-round symptoms. Since pollen and mold counts can vary widely, a variety of resources are available to determine which allergens are found in your region, and when they tend to be highest in quantity (www.aaoaf.org, www.pollen.com). Regardless of the allergen, the result of exposure is the same. Histamine and other inflammatory chemicals are released in the body, and the symptoms of allergies ensue.

Symptoms
Nasal symptoms such as runny nose, sneezing, and congestion are the most common complaints. Many other areas of the body can also be affected by allergies. Itching of the eyes with redness and watering, headache, intermittent ear plugging, chronic cough, wheezing, intermittent hoarseness, sore throat, and fatigue can also be experienced. Chronic sinus and ear infections, and even asthma may result from allergic rhinitis.

Diagnosis
Your doctor may recommend further evaluation to determine if you have sensitivity to particular environmental allergens. Two types of tests are commonly performed: skin testing or a blood test called a (radioallergosorbent) RAST test. During skin testing a small amount of allergen is pricked or injected into the skin and then checked for a reaction after waiting several minutes. You may develop a bump at the site of testing if you are allergic. In RAST testing a sample of your blood is drawn and sent to the lab. In this test levels of an antibody to specific allergens are measured and may be elevated in allergic rhinitis.   

Treatment
There are several ways to manage the symptoms of allergic rhinitis:

• Avoidance/Environmental Control
• Medications
• Immunotherapy
• Avoidance/Environmental Control

For pollen

• Stay indoors during peak allergy season.
• Keep windows closed and use air conditioning if possible.
• Use HEPA air filters/vacuum cleaners.
• Wear a dust mask if working outdoors.

For mold

• Thoroughly clean all damp areas of the home with fungicidal cleaner.
• Avoid having indoor plants, which can harbor mold in the soil.
• Discard any moldy food.

For dust mites

• Wash bed sheets at least weekly in hot water > 140o F.
• Cover pillows, mattress and box springs with hypoallergenic dust mite barriers.
• Keep humidity low (<50%).
• Remove dust catchers i.e. drapes, excess pillows, etc.
• Use HEPA air filters.
• Vacuum carpets with a HEPA filter.

For animal dander

• Keep pets out of the bedroom.
• Wash pet at least once per week.
• Wash hands after handling.
• Use HEPA air filters.
• Vacuum carpets HEPA filter.

For cockroach

• Dispose of food debris.
• Use insecticides or exterminator.
• Caulk cracks and crevices in house.

Medications
In addition to avoidance measures, a wide array of safe and effective medications can be used to control allergy symptoms. If over-the-counter medications are not effective, your doctor may recommend prescription medications. The mainstays of allergy medication therapy are nasal steroid sprays and oral/nasal antihistamines. New evidence shows that a combination of topical medications may provide increased efficacy. Nasal steroid sprays work by decreasing inflammation in the nose but the effect is not apparent immediately. It may take several days to weeks before you notice improvement. Other medications include leukotriene inhibitors and anticholinergic nasal sprays. Your doctor will seek to tailor your medical therapy to your specific symptoms. .

Immunotherapy
Allergy shots, or immunotherapy, can be useful in controlling allergy symptoms when avoidance measures and medications provide incomplete relief. Immunotherapy is a prophylactic and therapeutic treatment, and may decrease the need for allergy medications. Another method of immunotherapy which is gaining increased interest is called sublingual immunotherapy (SLIT). In SLIT, drops of the allergen are placed under the tongue. A consultation with an otolaryngic allergist will determine if you are a candidate for immunotherapy.