What is Allergic Rhinitis?

Do you ever notice yourself sneezing a lot around dust or smoke? If so, you might have allergies. When you're allergic to something, it means your immune system thinks it's harmful, even though it's not. This can happen with things like dust, pollen from plants and trees, or certain foods.

Allergies can affect different body parts, like skin, eyes, and nose.

Allergies can happen to anyone. If your family has a history of allergies, you might be more likely to have them too.

Allergic rhinitis is when allergies specifically affect your nose. It's not like a regular cold caused by a virus. Allergic rhinitis symptoms happen when you breathe in triggers you're allergic to, like dust or pollen.1

Types of Allergic Rhinitis

Seasonal allergic rhinitis

Seasonal allergic rhinitis (hay fever) is having allergic symptoms that pop up or worsen only at certain times of the year. It's common if you're allergic to triggers like pollen, which tends to be everywhere during specific seasons.

Perennial allergic rhinitis

Perennial allergic rhinitis means you deal with the symptoms all year long. This happens more often if you're allergic to things that stick around no matter the season, dust or smoke.2

The Pattern of Asthma Symptoms

Allergic rhinitis (AR) mostly affects the nose and is often confused with a common cold as it shares similar symptoms like sneezing and a stuffy or runny nose.

AR isn't caused by a virus; it is triggered by allergens like pollen or pet dander.

When a person breathes in allergens, their immune system overreacts, causing symptoms like runny nose, sneezing, nasal congestion, and sinus pressure.

AR can also lead to other issues like asthma, sinus infections, or trouble sleeping.

Some people experience symptoms like sneezing, congestion, or a runny nose similar to allergies, but they don't actually have allergies. This condition is called nonallergic rhinitis (NAR). Unlike allergies, where the immune system is involved, NAR doesn't involve the immune system. It's a condition that causes chronic nasal symptoms but not because of allergens.

Triggers for Nonallergic Rhinitis

Certain things can make your nose act up, like cold weather or strong smells. Other triggers include chemicals in the air, pollution, and even second-hand smoke. Changes in hormones, like during your period or when you exercise or drink alcohol, can also play a part. Some medications and health problems can add to these symptoms too.

Who can get Allergic Rhinitis?

Allergic rhinitis (AR) affects around 20% of people, regardless of age. People with asthma or eczema, or those with a family history of asthma or AR, have a higher risk of developing it. AR can start at any age, but most people notice symptoms in childhood or early adulthood. Symptoms can be worse in children and people in their 30s and 40s, but they can vary over time. Some people have times when they have no symptoms at all.

Asthma in Children

Allergic rhinitis (AR) is divided into two types:
  • Seasonal AR (happens at certain times of the year)
  • Perennial AR (happens throughout the year)

It is important to classify the severity and duration of symptoms to help guide the management approach for individual patients.3

Symptoms of Allergic Rhinitis

When someone encounters triggers they're allergic to, they might experience one or more of the symptoms. Some people only get symptoms when they're around a lot of allergens. For most people with allergies, the symptoms aren't too bad and can be dealt with easily.4

Complications of Allergic Rhinitis

Some complications may arise due to allergic rhinitis. It includes:

If you're experiencing symptoms that are making it hard for you to do your usual activities, it's important to see a doctor right away. They can figure out what's causing your symptoms by giving you a proper diagnosis.

It's helpful to keep track of your symptoms over time because it can help the doctor understand what's going on and give you the right treatment.5

Diagnosis and Tests

 
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Your doctor can often figure out if you have allergic rhinitis by asking about your symptoms and medical background. They'll ask if you've noticed anything specific that triggers your reactions, like certain places or times.

Your doctor might also look inside your nose to see if there are any abnormal growths called nasal polyps. These polyps can develop due to the inflammation caused by allergic rhinitis.

If your symptoms improve with medications like antihistamines, it's likely you have allergic rhinitis.

If your doctor isn't sure what's causing your allergic rhinitis, they might send you to a special clinic for allergy testing. There are two main types of tests:

  • Skin prick test: They'll put a tiny amount of the suspected allergen on your arm and then prick your skin with a needle. If you're allergic to it, you might get a small, itchy bump where the needle touched.
  • Blood test (RAST): This test checks for a specific antibody called immunoglobulin E (IgE) in your blood. Your body makes this antibody when it's reacting to an allergen.

It's really important that these test results are interpreted by a qualified healthcare professional who knows your symptoms and medical history well.6

Prevention

  • Refrain from touching your face, especially avoid rubbing your eyes or nose.
  • When pollen levels are high in the spring, summer, and early fall, keep windows closed at home and in the car.
  • Cover pillows, mattresses, and box springs to shield against dust mites.
  • Keep pets off furniture and out of certain rooms by closing doors.
  • Reduce allergens in the air by using filters in your vacuum cleaner and air conditioner.
  • Wash your hands frequently, especially after interacting with pets.
  • Wear a hat and sunglasses when outdoors to shield your eyes from pollen. Change your clothes promptly upon returning indoors.7

Treatment

Allergic rhinitis doesn't have a cure, but we can manage its symptoms. Medicines can help reduce the effects of pollen, dust, pet dander, and mold that trigger allergic reactions. These reactions cause symptoms like sneezing, runny or stuffy nose, headache, and itchy eyes, nose, and throat.

It's crucial to treat allergic rhinitis because, if left untreated, it can lead to complications. Treatment options vary depending on the severity and type of symptoms you experience.

Here are some common treatments your doctor might suggest:

  1. Antihistamines: Antihistamines work by blocking histamine, a chemical released during allergic reactions and can provide relief within about 30 minutes.
  2. Nasal Sprays: Nasal Sprays are effective in delivering medicine directly to your nose with minimal side effects. Corticosteroid nasal sprays are particularly helpful for reducing inflammation and symptoms like congestion. They're often used daily, especially before allergy season starts.
  3. Eye Drops: Eye Drops can relieve itchiness and watering in your eyes caused by allergies.
  4. Decongestants: Decongestants are available as nasal sprays, drops, or oral pills; these can provide short-term relief from stuffiness and sinus pressure by shrinking blood vessels in the nose. However, prolonged use can lead to rebound congestion, so they're best used for short periods.
  5. Nasal Saline Washout: Rinsing your nose with a saltwater solution can help flush out allergens and reduce symptoms.
  6. Mast Cell Stabilizers: Mast Cell Stabilizers prevent mast cells from releasing histamine, offering relief from allergy symptoms. They're available as nasal sprays and eye drops.
  7. Leukotriene Receptor Antagonists: Leukotriene receptor antagonists are medicines that block the release of leukotrienes, another type of chemical involved in allergic reactions, reducing symptoms of allergic rhinitis.
  8. Immunotherapy (Allergy Shots): In severe cases where other treatments aren't effective, allergy shots may be recommended. These involve receiving small amounts of allergens over time to habituate your immune system, providing long-term relief from allergies.8

Allergy shots work in two stages. First, you go to the doctor 1-3 times a week to get the shots and build up your tolerance. After 3-6 months, you go 3-5 days a week often, but still regularly, to maintain the effects. During this time, your allergy symptoms should get better.

Prognosis

Many symptoms of allergic rhinitis can be managed effectively. In severe cases, allergy shots may be necessary.

Some individuals, particularly children, may eventually outgrow their allergies as their immune systems become less reactive to the triggers. However, once an allergen like pollen triggers allergies, it often has a lasting impact on the individual.9

Reference

  1. Allergies - Symptoms and causes [Internet]. Mayo Clinic. [cited 2024 Feb 28]. Available from: Click here
  2. Allergic Rhinitis [Internet]. MSD MANUAL Professional Version. 2022. Available from: Click here
  3. Small P, Keith PK, Kim H. Allergic rhinitis. Allergy, Asthma & Clinical Immunology [Internet]. 2018 Sep;14(S2). Available from: Click here
  4. Allergic Rhinitis (Hay Fever): Symptoms, Diagnosis & Treatment [Internet]. Cleveland Clinic. Available from: Click here
  5. Allergic Rhinitis: Symptoms, Treatment, and Home Remedies [Internet]. Healthline. 2015. Available from: Click here
  6. Allergic rhinitis [Internet]. NHS inform. [cited 2024 Feb 28]. Available from: Click here
  7. Allergic Rhinitis (Hay Fever): Symptoms, Diagnosis & Treatment [Internet]. Cleveland Clinic. Available from: Click here
  8. Hay fever - Diagnosis and treatment - Mayo Clinic [Internet]. www.mayoclinic.org. Available from: Click here
  9. Pennmedicine.org. 2024 [cited 2024 Feb 28]. Available from: Click here