Allergic Rhinitis

Seasonal Allergies and Perennial Allergies

When allergies affect the nasal passages and sinuses, the result is symptoms of allergic rhinitis. Most people are more familiar with the term “hay fever” which implies seasonal symptoms of sneezing, running and itching nose, nasal and sinus congestion, and post-nasal drip. The term “Allergic rhinitis” includes both seasonal and year-round (perennial) forms of an allergy affecting the mucous membrane of the nose

People with allergic rhinitis often think they have “sinus trouble.” When no specific allergy can be found, but nose symptoms are present, the condition is called vasomotor rhinitis. Most people develop allergic rhinitis before age 30. An estimated 13 million Americans suffer from hay fever—primarily due to ragweed pollen allergy.

Common symptoms of allergic rhinitis are:

  • Nasal congestion
  • Sneezing
  • Watery eyes
  • Itching

Symptoms also associated with allergic rhinitis but not so common are:

  • Sore throat
  • Cough
  • Headache
  • Lose senses of smell, taste, and hearing
  • Fatigue

Many times, allergic rhinitis is diagnosed as a common cold because the symptoms are similar. When symptoms are worse at only certain times of the year (seasonal allergic rhinitis) they are most likely due to pollens or outdoor molds. As a broad generalization, weeds are a problem in the fall, grasses in the spring and summer, molds during late summer, and trees during late winter and spring. These facts do not always apply to South Florida because of our unique weather conditions.
When symptoms occur year-round (perennial allergic rhinitis) they are usually due to dust mites, indoor molds or animal dander. If they occur while the person is in bed or while sitting on a fluffy couch, dust mites are the likely cause (upholstered furniture, beds and carpets are dust mite havens).

Persons with allergic rhinitis often have dark circles under their eyes. To relieve an itching nose, children especially may develop the habit of pushing the nose up with the palm of the hand. After a few years, this can cause a crease (called an “allergic crease”) to appear across the nose. Also, the mid part of the nose may broaden from the pressure of swollen tissue underneath. The mouth may be open continually so the person can breathe better. Children may develop a variety of other mannerisms which parents find annoying but which are caused by the allergy.

What Causes Allergic Rhinitis?

The allergens that cause allergic rhinitis include dust mites, pollens (weeds, grasses, trees), animal dander (mostly cats and dogs), and molds. Sometimes the patient’s history and pattern of symptoms can help determine what is causing the allergic rhinitis. The nose is especially reactive because it contains many cells filled with histamine, which become sensitized and release the histamine upon contact with an allergen.

Diagnosing Allergic Rhinitis

An allergist is a pediatric physician and/or internal medicine physician who is specifically trained to diagnose and treat patients who have allergies and asthma. Once an allergist has taken a medical history and then an allergy skin test is completed, they can determine if patients have seasonal allergies or if the symptoms are non-allergic.

Treatment for Allergic Rhinitis

Once an allergy is determined, an allergist will develop a treatment plan for each patient. Allergies are often treated with a three-tier approach, avoidance, medication, and immunotherapy.

Treatment for allergic rhinitis starts with avoidance strategies. This can be a very simple task if only one allergen is predominant, such as giving away the family cat (allergists recognize that this may be very difficult for those emotionally attached to their animal). Avoidance of dust mites is possible if one follows certain environmental control measures. Pollen and outdoor mold exposure can be limited by keeping car or windows closed, but it is difficult to totally avoid these allergens (unless you never go outside!). In most cases different types of allergens are involved in the same individual, making complete avoidance a difficult task.

Also, part of treatment for allergic rhinitis is medications. There are current prescription medications that are very effective and have minimal side effects. The newer antihistamines (Claritin™, Allegra™ , Zyrtec™, Xyzal™, Clarinex™) cause very little sleepiness and are quite useful. Prescription nasal cortisone/steroid sprays are also very effective and safe medications – usually more effective than allergy pills. These steroid-type nasal sprays should not be confused with “systemic” steroids (pills, syrup, injection), which do have significant side effects. Also, the newer antihistamine sprays can be very effective (e.g. Astepro™, Patanase™).

Some patients don’t respond well to medications, and some simply don’t want to be taking daily medications. For those people, allergy shots are a great option. Allergy injections (see Immunotherapy), when given to appropriate patients at the proper dose are also very effective. They can be an alternative or an addition to the above medications. Although they may take 3-6 months to start working, these injections provide long-lasting relief of symptoms and less reliance on drugs. While the shots are starting to work, patients are usually maintained on allergy medications.

Don’t suffer from untreated allergies. Schedule an appointment today with one of our board-certified allergists, and move towards a clearer tomorrow.