Allergic Rhinitis

The reason almost half of US dreads summer!

Jul 25, 2009 Jitesh Iyer

Come summers and one is reminded of grassy plains and warm sunshine. But these very conditions are ripe for plants to produce pollen, the main allergen causing hay fever.

The word ‘rhin-‘, ‘rhine-‘ or ‘rhino-‘, is derived from Greek and refers to the nose. ‘-itis’, in medical terminology, refers to an inflammation or swelling. This follows that ‘Allergic Rhinitis’ is an inflammation/swelling of your nose caused due to an allergy, or a hyper-reaction. It is usually caused when the air you breathe contains something you’re allergic to, resulting in swelling and inflammation of the insides of your nostrils. The most common culprit is pollen, which is why its also known as ‘Hay Fever’. Allergic rhinitis affects 60 million people in the United States each year.

What Causes Allergic Rhinitis?

The cause of allergic rhinitis, as the name suggests, is allergy. The allergy is most often to common items like mould, plant pollen, dust, animal hair, even cockroach droppings! Depending on the season, you can get a hint as to what you’re probably allergic to. If you’re prone to rhinitis in the spring, its mostly tree pollen. If its summer, the culprit could be grass or weed pollen. But if its non-specific and occurs throughout the year, it may be animal dander, dust mites or moulds.

There is a strong genetic contribution to allergic rhinitis, with the chance of your having it being 30% if one of your parents have it, and 50% if both do. Though onset may occur at anyage, it usually shows up before the age of 30.

Symptoms

The symptoms are quite similar to common cold, except that its more severe and may last for upto 10 days.

1. Stuffy/runny nose
2. Sneezing and coughing. Cough is often clear mucus running down the back of the throat.
3. Headache
4. Itching nose/eyes. Usually there’s watering in the eyes too.
5. Sore throat.

Available Medicines

Though the best treatment is to get away from the allergen, it may not always be possible to do so. In such cases, your doctor may prescribe you one of the following available medications :

1. Anti-histamines: Histamine is a body component responsible for causing inflammation. Antihistamines are molecules that suppress the action of histamine and provide relief. Antihistamines are available over-the-counter (fexofenadine (Allegra), loratidine (Claritin) and cetirizine (Zyrtec)) or on prescription (desloratidine (Clarinex), levocetirizine (Xyzal)). Antihistamines are mild and some, though not all, may cause drowsiness.
2. Intranasal Steroids : These are molecules generally known as ‘corticosteroids’, and are one of the most effective treatments for prolonged or severe attacks, and provide quick and long-lasting relief. They include fluticasone (Flonase), mometasone(Nasonex). Though belonging to the class ‘steroids’, they should not be confused with ‘anabolic steroids’ and are quite safe for children and adults.
3. Nasal Decongestants : These are only a symptomatic treatment for the stuffy nose that occurs with rhinitis and is not a sure per se. Should not used for periods extending 3 days.
4. Other treatments : In cases where asthma co-exists in a patient of rhinitis, either montelukast (Singulair) alone or in combination with loratidine is prescribed. Nasal washes with saline is also said to provide relief.
5. Allergy Shots : If the anigen causing rhinitis cannot be avoided and the symptoms are quite hard to manage, the only option is to condition the body to ‘tolerate’ the antigen and not produce allergic reactions. To do this, increasing doses of the same allergen (each dose is slightly larger than the previous dose) are given periodically by injection, so that an immunity to the allergen develops in the body. Such a treatment should be decided and carried out only by your doctor, and helps to provide an almost permanent relief from rhinitis caused by the particular allergen.

Prevention Is Better Than Cure

Though it may not be possible to completely avoid allergic rhinitis, a few precautions would go a long way in preventing it

1. If you have pets in the house, keep them away from furniture and regularly wash their fur. Its best to avoid contact with furry pets if its possible.
2. Put your unused pillows, bedspreads, cushions, etc. in plastic bags to prevent dust accumulation. Regularly vacuum the house and keep it dust-free.
3. Keep away from strong odours. Use an air-conditioner or dehumidifier to keep away odours, pollen moulds and the like.

Further Reading

1. Allergic Rhinitis, New England Journal of Medicine, Nov 2005, 353(18):1934-1944.
2. Diagnosis and management of allergic rhinitis in adults, Medicine Today, Jun 2007;5(2):45-48.

The copyright of the article Allergic Rhinitis in General Medicine is owned by Jitesh Iyer. Permission to republish Allergic Rhinitis in print or online must be granted by the author in writing.