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Allergic Rhinitis

Definition

Allergic rhinitis is irritation and inflammation in the nose after it comes in touch with allergens. An allergens is anything that causes an abnormal response of the immune system. In allergic rhinitis, the immune system may cause swelling of the inside of the nose, runny or itchy nose, watery eyes, stuffiness, and sneezing. It may be:

  • Seasonal allergic rhinitis (sometimes called hay fever or rose fever)—This occurs during specific times of the year when allergens are in the air. The most common allergens are tree, grass, or weed pollens.
  • Persistent allergic rhinitis—Caused by allergens that may be around throughout the year. Common allergens may include chemicals, dust, dust mites, cockroaches, animal dander, or mold spores.

Causes

An allergic reaction happens when the immune system overreacts to an allergen. When the allergen makes contact with the inside of the nose, it starts a chain of events. Immune cells in the nose release a chemical called histamine. Histamine causes itchiness, swelling, and increases the amount of mucus in the nose.

Site of Histamine Production
Nasal passage
This area has swelling and increased mucus production after contact with an allergen.
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Risk Factors

Factors that increase your chance of having allergic rhinitis include:

Symptoms

The reaction to the allergen can lead to:

  • Sneezing
  • Itching in the nose, eyes, throat, and ears
  • Red, watery eyes
  • Runny nose, nasal congestion
  • Congestion with sinus pressure
  • Postnasal drip and cough
  • Headache
  • Dark circles under your eyes

Diagnosis

You will be asked about your symptoms and medical history. Allergic rhinitis is most often diagnosed based on description of symptoms. A referral to an allergy specialist may also be made.

The following tests may also be done:

  • Skin prick test—A tiny bit of an allergen is placed under the skin with a needle. The doctor watches to see if the skin in that area becomes red, raised, and itchy. This can be done for multiple allergens at the same time. It can help find what you have the strongest reaction to.
  • RAST testing—A small sample of blood is taken and tested for different allergens.

Treatment

Avoiding the allergen as much as possible is the best way to treat allergies. Specific steps will depend on the type of allergen, for example:

Reducing dust mite allergens:

  • Wash pillows and bed sheets regularly in hot water.
  • Remove carpeting, feather pillows, and upholstered furniture, especially in bedroom.
  • Keep clothes off bedroom floor.
  • Use acaricides solutions to kill dust mites.
  • Keep humidity levels < 50%.
  • Use double-bag vacuum bags and HEPA filters.

Reducing mold contact:

  • Wear facemasks when working with soil, leaves, or compost.
  • Try to avoid moist, damp areas within the home.
  • Use a dehumidifier in places like your basement that may encourage mold growth.
  • Repair leaky roofs or pipes.

Reducing animal allergens:

  • Removal of a pet from home is the most efficient option. It may take 4-6 months to clear the home of pet allergens.
  • If you wish to keep pets, keep your pet out of bedroom and off of furniture.
  • Frequent vacuuming or removal of rugs

Reducing pollen contact: Use news reports or online resources to track pollen levels in you area. If your allergen is high:

  • Stay indoors and keep windows closed.
  • Consider using an air purifier inside.
  • Do not dry clothes outside.
  • Shower when you get home. Keep clothes contaminated with pollen out of the bedroom.

General steps that may reduce contact with allergen:

  • Use petroleum jelly on the nostrils. The jelly may catch some of the allergens before they pass into the nose.
  • Nasal filters—Device inserted into the nostrils that can filter allergens before they reach the nose.
  • A Neti Pot, nasal sinus rinse, or saline nasal spray may help clear irritants from the nasal passage after exposure. It may also help loosen congestion.

Though reducing allergens can help, it is not possible to completely eliminate all allergens. Other treatments may help reduce the body's reaction to the allergen:

Medications

Medications can help to decrease the reaction of the immune system. This will lead to fewer and less severe symptoms like swelling and mucous. These medications may be given alone or in combination. Options include:

  • Nasal corticosteroid (glucocorticoid)—often considered most effective for allergic rhinitis
  • Antihistamine—may be pills taken by mouth or as nasal spray

These medications are most effective when taken before contact with the allergen. It will also need to be continued as long as the allergen is present.

Other medications that may be added include:

  • Nasal mast cell stabilizers
  • Leukotriene receptor antagonists
  • Anticholinergics

Decongestants may be recommended for severe congestion. Decongestants are not appropriate for everyone and only temporarily relieve some pressure. Overuse of nasal decongestant sprays can actually make symptoms worse.

Immunotherapy

Immunotherapy uses injections or pills to gradually introduce your body to an allergen. The goal is to make your body's immune system less sensitive to those allergens. For some it may stop allergic rhinitis for others it may help decrease symptoms. It is most often used for those who have a poor response to allergy medications.

The therapy is delivered in small amounts over weeks, months, or even years. Immunotherapy is only available for specific allergens but more may become available after appropriate testing.

Prevention

The reason that allergic rhinitis develops is not clear, so there are no clear steps to prevent it. Exclusive breastfeeding in the first few months of life may help decrease the risk of allergies later in life.

Revision Information

  • American Academy of Allergy, Asthma, and Immunology

    http://www.aaaai.org

  • Asthma and Allergy Foundation of America

    http://www.aafa.org

  • Allergy Asthma Information Association

    http://aaia.ca

  • Health Canada

    http://www.hc-sc.gc.ca

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  • Allergic rhinitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116217/Allergic-rhinitis. Updated September 29, 2016. Accessed September 30, 2016.

  • Managing Indoor Allergen Culprits. American Academy of Allergy Asthma and Immunology website. Available at: http://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Libraries/EL-indoor-allergies-managing-patient.pdf. Updated February 2011. Accessed September 23, 2015.

  • Rhinitis. American Academy of Allergy, Asthma & Immunology website. Available at: http://www.aaaai.org/conditions-and-treatments/allergies/rhinitis.aspx. Accessed September 23, 2015.

  • Wheatley L, Togias A. Allergic Rhinitis. N Engl J Med 2015; 372:456-463. Accessed at: http://www.nejm.org/doi/full/10.1056/NEJMcp1412282. Accessed September 23, 2015.

  • 8/11/2006 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116217/Allergic-rhinitis: Durham SR, Yang WH, Pedersen MR, et al. Sublingual immunotherapy with once-daily grass allergen tablets: a randomized controlled trial in seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2006;117:802-809.

  • 8/27/2013 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116217/Allergic-rhinitis: Kim JM, Lin SY, Suarez-Cuervo C, et al. Allergen-specific immunotherapy for pediatric asthma and rhinoconjunctivitis: a systematic review. Pediatrics. 2013 Jun;131(6):1155-67.