Allergic Rhinitis

Allergic RhinitisAllergic rhinitis describes the itching, sneezing and nasal congestion that is triggered by allergens, the substances that trigger allergic reactions.

Seasonal allergic rhinitis, also referred to as "Hay Fever", is triggered by allergens that come and go with the seasons. Despite its name, hay fever is rarely triggered by hay and it doesn't cause a fever. Seasonal allergic rhinitis triggers include:

  • Tree pollen, common in the spring
  • Grass pollen, common in the late spring and summer
  • Weed pollen, common in the fall
  • Mold spores, present year-round but worse during warm-weather months

Perennial allergic rhinitis is a reaction to allergens that are present all year. It is persistent, chronic and generally less severe than seasonal allergic rhinitis. Year-round (perennial) allergic rhinitis triggers include:

  • Dust mites or cockroaches
  • Pet dander (dried skin flakes and saliva) from pets such as cats, dogs or birds
  • Spores from indoor and outdoor fungi and molds

Some people can suffer from both seasonal and perennial allergic rhinitis.

What are the symptoms of allergic rhinitis?

Symptoms of allergic rhinitis usually develop immediately after exposure to an allergen and can include:

  • Runny nose and nasal congestion
  • Watery or itchy eyes
  • Sneezing
  • Itchy nose, or throat
  • Sinus pressure
  • Swollen and darkened skin under the eyes (called "allergic shiners")

Although symptoms of allergic rhinitis may first appear at any age, they most commonly arise during childhood or early adulthood. The severity of symptoms usually changes year to year and most people find that symptoms tend to diminish slowly, often over decades.

How can I tell the difference between allergic rhinitis and a cold?

Allergies and colds can cause similar symptoms with significant nasal congestion, but there are ways to distinguish the symptoms.

  • The "common cold" usually produces a thicker discharge with a low-grade fever. Allergic rhinitis produces a clear watery discharge without a fever.
  • Cold symptoms last for 5-7 days. Allergic rhinitis symptoms will last as long as you're exposed to the allergen, which may be for weeks or months.
  • Cold symptoms appear 1-3 days after exposure to the cold virus. Allergic rhinitis symptoms arise immediately after exposure to allergens.

How is allergic rhinitis diagnosed?

A medical history of your symptoms will taken to understand the severity of symptoms, the time of year that they occur, and the possible causes.

Skin tests or blood tests (RAST) may be recommended for determining the specific allergens that trigger your allergies.

What causes allergic rhinitis?

The immune system mistakenly identifies a harmless allergen, such as tree pollen, as something that harmful. It then produces antibodies that are designed to attack this allergen.  The next time the body is exposed to the allergen, these antibodies are produced in large quantities. The antibodies release histamine and other chemicals that result in an allergic reaction.

How is allergic rhinitis treated?

There are several allergy medications available for the treatment of allergic rhinitis.They can be categorized as follows:

1) Antihistamines can be used to treat the symptoms of allergic rhinitis. Antihistamines are best started BEFORE peak allergy season or at the earliest signs of symptoms. Drowsiness is a common side effect of common over-the-counter anthistamines, such as diphenhydramine (Benadryl®) or chlorpheneramine.

Non-sedating antihistamines (Allegra®, Claritin®, Clarinex®, Xyzal®, Zyrtec®) are available, but they are more expensive and some insurers may not reimburse the cost for these medications if other less expensive medicines have not been attempted first.

2) Nasal corticosteroid sprays are an effective alternative to antihistamines. Examples include budesonide (Rhinocort®) and beclomethasone (Vancenase®, Beconase®). When they are used regularly and have been given enough time to have their full effect, nasal corticosteroid sprays control allergy symptoms in the nose better than antihistamines do. If the sprays irritate the nasal passages, it may be helpful to use a nasal saline spray afterwards, or to use a variety of nasal spray that is packaged in a water-based (aqueous, or AQ) spray.

3) Cromolyn nose spray (Nasalcrom®), which does not require a prescription, may also be used. It causes the least amount of irritation and other side effects. However, it work only when taken before exposure to an allergen, so they must be used before very predictable allergy exposures (staying at a friends with a pet) or used on a regular schedule (several times a day).

4) Antihistamine nasal spray, such as Astelin® (azelastine), is available by prescription only. Nasal antihistamine sprays may be recommended if you have significant side effects from oral antihistamines.

5) Decongestants may be used for immediate relief of symptoms of congestion. They are include phenylephrine (Sudafed® PE) and pseudoephedrine (Sudafed®). Decongestant medicine can also be purchased in the form of a nasal spray (oxymetazoline, or Afrin®). Nasal sprays are intended for short-term relief only. They can cause an increase in rhinitis symptoms if used for more than three days without a break.

Side effects from oral decongestants can include insomnia, high blood pressure, and a racing heart rate. Consult your health-care provider before using these medications if you have high blood pressure, a history of stroke, or heart disease.

Allergic rhinitis prevention

The most important step for preventing allergic rhinitis or decreasing the severity of symptoms is to minimize your exposure to allergens.

It's not possible to completely avoid allergens, but you can reduce its symptoms by limiting your exposure. It helps to know what you are allergic to so that you can take steps to avoid your specific allergic triggers.

Pollen or molds

  • Close doors and windows during pollen season.
  • Don't hang laundry outside — pollen can stick to sheets and towels.
  • Use air conditioning in your house and car.
  • Use an allergy-grade filter in the ventilation system.
  • Avoid outdoor activity in the early morning when pollen counts are highest.
  • Stay indoors on dry, windy days.
  • Use a dehumidifier to reduce indoor humidity.
  • Use a high-efficiency particulate air (HEPA) filter in your bedroom.
  • Avoid mowing the lawn or raking leaves, which stirs up pollen and molds.
  • Wear a dust mask when doing outdoor activities such as gardening.

Dust mites

  • Use allergy-proof covers on mattresses, box springs and pillows.
  • Wash sheets and blankets in water heated to at least 130 F (54 C).
  • Use a dehumidifier or air conditioner to reduce indoor humidity.
  • Vacuum carpets weekly with a vacuum cleaner equipped with a small-particle or HEPA filter.
  • Consider removing carpeting, especially where you sleep, if you're highly sensitive to dust mites.

Cockroaches

  • Block cracks and crevices where roaches can enter.
  • Fix leaky faucets and pipes.
  • Wash dishes and empty garbage daily.
  • Sweep food crumbs from counters and floors.
  • Store food, including pet food, in sealed containers.
  • Consider professional pest extermination.

Pet dander

  • Remove pets from the house, if possible.
  • Bathe pets weekly. Using wipes designed to reduce dander also may help.
  • Keep your pet out of the bedroom.

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© 2010 Vivacare. Last updated August 22, 2012.

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Additional Resources

Overview
Allergic Rhinitis (link to ACAAI)
Allergic Rhinitis (link to NIH)
Treatment Summary
Related Conditions
Multimedia
En Espanol
Rinitis alergica (link to NIH)
More Information
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