(Updated at Mar 24 / 2023)
What is allergic rhinitis and how is it treated?
Allergic rhinitis, also known as “hay fever,” is an inflammatory disease of the nasal mucosa characterized by episodic nasal breathing, mucous discharge from the nose, and sneezing, which are based on immediate allergic reactions. It is a quite common disease that according to various estimates affects around 40% of the world population.
Short information about allergic rhinitis
Allergic rhinitis is caused by various allergens. The clinical manifestations of allergic rhinitis are characterized by swelling and nasal congestion, discharge, itching, and repeated sneezing. Allergic rhinitis, according to the ARIA classification (international initiative on allergic rhinitis and its effect on the development of bronchial asthma), can be intermittent (lasts 4 or fewer days a week and 4 or fewer weeks a year) and persistent (lasts more than 4 days a week and more than 4 weeks a year). In addition, in some cases, for example, by the FDA classification, allergic rhinitis is divided into seasonal (with a seasonal increase in allergens in the environment, for example during the flowering period of plants) and year-round (with year-round allergens in the environment, for example, with allergies to animal hair, house dust, etc.)
Differences between types of allergic rhinitis:
Occurs during blossoming season in spring and summer.
The main cause of seasonal rhinitis is the pollen of trees, herbs, and flowers. Sometimes this form is caused by spores of moldy fungi that can enter the nasal passages, for example, from poorly cleaned air conditioners, cooker hoods or humidifiers.
Many patients mistakenly believe that the cause of the disease is poplar fluff. But practice shows that much more often unpleasant symptoms are a consequence of individual intolerance to pollen of plants, which bloom just when there is a lot of poplar fluff around.
The year-round form of the disease develops due to the person’s constant contact with the allergens that surround them at home and at work. Most often it is dust, animal hair, household chemicals and cosmetics, but even unexpected irritants like fabrics or finishing materials can cause an unpleasant reaction.
This form has stable symptoms - during the year the patient does not notice an exacerbation, and his nose is constantly blocked. Well-being can be worsened, for example, by infection with SARS (Severe acute respiratory syndrome), inhalation of cold air or cigarette smoke.
Occurs at any time of the year regardless of season.
In some cases, a patient can have allergy both to pollen and also substances they contact year-round. In this case, allergy has a year-round character with episodes of seasonal flare-ups. This means that troubled breathing is present all year-round but in spring during the blossoming of a plant that causes exacerbations, the symptoms intensify, i.e. nasal discharges, itching of the nose, eyes, sneezing, also occur. In this case, it is difficult to diagnose the disease because it requires the identification of not one but several allergens
Allergic rhinitis is also classified by the severity of symptoms:
- Mild – the symptoms can be absent at all;
- Moderate – nasal discharges and other symptoms are long-lasting and reoccur;
- Severe – if a patient doesn’t receive treatment, the condition worsens so that a person can no longer sleep, work, exercise, and so on as the symptoms are very intense.
What causes allergic rhinitis?
The basis for the disease is the immediate response of the body to contact with allergens, for instance, pollen, dust, smoke, spores, etc. the flare-ups can be triggered by intense smells, cold air, and so on.
What are the symptoms of allergic rhinitis?
- Itchy nose;
- Frequent sneezing;
- Abundant transparent nasal discharges;
- Difficulty breathing (most patients breath by mouth);
-Impaired sense of smell;
- Increased lacrimation and associated burning sensation in the eyes.
How is allergic rhinitis diagnosed?
First, a doctor listens to a patient’s complaints and makes a physical examination. In an examination, a doctor sees a friable and pale nasal mucosa. Around the nostrils, the skin is red, with severe peeling, often with inflammation. In a year-round form, the symptoms are usually not so intense. Usually, a patient complains of constant nasal congestion and runny nose. Rhinoscopy, an examination of the inside of the nose with a special tool, is made to assess the amount and consistency of mucus discharged from the nose, to study the severity of edema and the color of the mucous membranes.
In order to find out what causes the problem, a doctor finds out how the disease manifests, what signs of allergic rhinitis are observed, and when they become most pronounced. A swab from the nasal cavity and a general blood test are made.
Diagnostics may also include:
- X-ray of the sinuses;
- Skin allergy tests;
- Blood test for antibodies to allergens, etc.
Determining what causes year-round allergic rhinitis is difficult. Regular contact with allergens makes the symptoms of the disease pronounced and permanent, so the doctor sometimes fails to understand the real causes of the problem.
What medicines are used for allergic rhinitis treatment?
Symptoms and treatment directly depend on the form of the disease and the severity of its course. Most often, antihistamines and intranasal glucocorticoids are prescribed to patients.
The doctor decides which drug will help faster, since an individual approach is needed to treat allergic rhinitis in adults. It is advisable to choose antihistamines of the second generation such as Allegra (Fexofenadine) because unlike previous generation medications they do not cause drowsiness, inhibit psychomotor reactions and are characterized by a minimum number of side effects. With severe swelling of the nose, it is advisable to use vasoconstrictor drops and sprays.
The following medicines can be used:
- Antihistamines (Alerzin, Fexofenadine, Suprastin) reduce the amount of discharge from the nose and nasal congestion by inhibiting the response of the body to the allergens.
- Cromoglycate sodium in the form of a nasal spray prevents the appearance of new attacks. It is effective for allergic rhinitis of mild and moderate severity.
- Intranasal glucocorticoids (beclomethasone dipropionate, Budesonide, fluticasone, and others) are prescribed when the therapy with antihistamines and cromolines doe not provide expected results, as well as for severe allergic rhinitis.
- Ipratropium bromide in the form of a nasal spray, prescribed in each nostril 3-4 times a day, can reduce nasal congestion.
- Topically applied vasoconstrictors (nasol, tizin, farmazolin, vibrocil, naphthyzin, galazolin, menthol), which can reduce swelling of the nasal mucosa, nasal discharge, but do not affect the pathogenetic mechanisms of allergic inflammation. Therefore, when you stop taking them, the clinical manifestations of allergic rhinitis can resume.
- Hyposensitizing therapy is widely used in case of establishing an allergen that causes clinical manifestations of allergic rhinitis in this patient.
Minimizing risks of allergic rhinitis manifestations
Elimination of risk factors can significantly improve the course of the disease.
Allergens include dust, pollen, cigarettes smoke, rubber crumb from car tires in apartments located near roads, and others.
Methods for eliminating risk factors:
- Do not open the without gauze or fine mesh to avoid pollen getting indoors.
- Do not dry laundry outdoors or on an open balcony.
- Wear sunglasses, hats so that as little pollen as possible gets on the mucous membranes.
- Do wet cleaning daily.
- Buy a floor air filter, preferably with a carbon filter, and regularly change the filter element.
- Install a window filter, preferably with a charcoal filter. It will allow airing the apartment without dust, pollen, crumb rubber and harmful emissions.
Post by: Rachel Lewis, Senior Medical Advisor at Medibank, Sydney, New South Wales, Australia
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