Allergic Rhinitis (Hay Fever)

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 dander 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 but 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 accompany 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 also known as a (radioallergosorbent) RAST test or an in vitro 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 in vitro 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 measures
For pollen
  • Stay indoors when pollen emission is high (early morning hours, windy days).
  • Keep windows closed and use air conditioning if possible.
  • Use HEPA air filters/vacuum cleaners.
  • Wear a dust mask if working outdoors, change clothing and shower once indoors.

For mold
  • Address areas of water damage in the home by repairing leaks and cleaning damp areas.
  • Avoid having indoor plants, which can harbor mold in the soil.
  • Discard any moldy food.
  • Keep humidity low (<50%).

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 hands after handling.
  • Use HEPA air filters.
  • Vacuum carpets HEPA filter.
For cockroach
  • Dispose of food debris.
  • Consider consulting an 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. Nasal saline irrigations can be helpful to maintain the health of your nose by improving clearance of mucous and allergens. Your doctor will seek to tailor your medical therapy to your specific symptoms.

Immunotherapy
Allergy shots, or immunotherapy, is a potential cure for allergic rhinitis and 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 or a tablet containing the allergen(s) are placed under the tongue. A consultation with an otolaryngic allergist will determine if you are a candidate for immunotherapy.


Revised 01/20/2015
©American Rhinologic Society