Allergic Rhinitis

Allergic rhinitis, or hay fever, is a collection of symptoms, predominantly in the nose and eyes, to allergens such as dust, dander and pollen. The sensitized immune system produces antibodies to these allergens, which cause chemicals called histamines to be released into the bloodstream, causing itching, swelling of affected tissues, mucus production, hives, rashes, and other symptoms. Symptoms vary in severity from person to person.

 Description of Allergic Rhinitis

Allergic rhinitis affects about 20 percent of the American population and ranks as one of the most common illnesses in the U.S. The symptoms occur in the nose and eyes and usually occur after exposure to dust, danders, or certain seasonal pollens in people that are allergic to these substances.

Click for Larger ImageTwo-thirds of all patients have symptoms of allergic rhinitis before the age of 30, but onset can occur at any age. Allergic rhinitis has no sexual predilection, although boys up to the age of 10 are twice as likely to have symptoms as girls.

There is strong genetic predisposition to allergic rhinitis. One parent with a history of allergic rhinitis has about a 30 percent chance of producing offspring with the disorder; the risk increases to 50 percent if both parents have a history of allergies.

Patients can be severely restricted in their daily activities, resulting in excessive time away from school or work. Millions of dollars are spent each year on physician services and medication for treatment of this chronic illness.

Seasonal Allergic Rhinitis or hayfever occurs in late summer or spring. Hypersensitivity to ragweed, not hay, is the primary cause of seasonal allergic rhinitis in 75 percent of all Americans who suffer from this seasonal disorder. People with sensitivity to tree pollen have symptoms in late March or early April; an allergic reaction to mold spores occurs in October and November as a consequence of falling leaves.

Click for Larger ImagePerennial Allergic Rhinitis: This condition occurs year-round and can result from sensitivity to pet hair, mold on wallpaper, houseplants, carpeting, and upholstery. Some studies suggest that air pollution such as automobile engine emissions can aggravate allergic rhinitis. Although bacteria is not the cause of allergic rhinitis, one medical study found a significant number of the bacteria Staphylococcus aureus in the nasal passages of patients with year-round allergic rhinitis, concluding that the allergic condition may lead to higher bacterial levels, thereby creating a condition that worsens the allergies.

Non-Allergic Rhinitis: This form of rhinitis does not depend on the presence of IgE and is not due to an allergic reaction. The symptoms can be triggered by cigarette smoke and other pollutants as well as strong odors, alcoholic beverages, and cold. Other causes may include blockages in the nose, a deviated septum, infections, and over-use of medications such as decongestants.

Click for Larger ImageSymptoms of Allergic Rhinitis

Characteristic symptoms include repetitive sneezing; rhinorrhea (runny nose); post-nasal drip; nasal congestion; pruritic (itchy) eyes, ears, nose or throat; and generalized fatigue. Symptoms can also include wheezing, eye tearing, sore throat, and impaired smell. A chronic cough may be secondary to postnasal drip, but should not be mistaken for asthma. Sinus headaches and ear plugging are also common.

Patients who suffer from recurring bouts of allergic rhinitis should observe their symptoms on a continuous basis. If facial pain or a greenish-yellow nasal discharge occurs, a qualified ear, nose, and throat specialist can provide appropriate sinusitis treatment.

 Diagnosis of Allergic Rhinitis

After a medical history, your physician will perform a physical exam. Often, the nasal mucosa (lining of the nose) is pale or violaceous because of the engorged veins. Nasal polyps may be seen. Classic signs of allergic rhinitis may include swelling of the eyelids, injected sclerae (the whites of the eyes may be red), allergic shiners (darkened areas under the lower eyelids thought to result from venous pooling of blood), and extra skin folds in the lower eyelids.

Skin testing may confirm the diagnosis of allergic rhinitis. Initial skin testing is performed by the prick method. Intradermal testing is performed if results of prick testing are negative.

 Self Care and Avoidance Measures

  • Seasonal allergens (such as tree, grass and ragweed pollens) are difficult to avoid outdoors, but can be controlled by closing windows and running air conditioners.
  • Excessive exposure to allergens, such as outdoor molds, can be prevented by avoiding lawn mowing and other activities likely to stir these up.
  • Maintaining an allergen-free environment also includes covering pillows and mattresses with plastic covers, substituting synthetic materials (such as foam mattresses or acrylics) for animal products (such as wool or horsehair) and removing dust-collecting household fixtures (like carpets, drapes and bedspreads).
  • Air purifiers and dust filters may help. Keep the house dry, clean and adequately ventilated.

Medical treatments include antihistamines which reduce nasal discharge, itchiness and sneezing. Decongestants which can cause shrinkage of the nasal mucosa by constricting the blood vessel inside and thus relief obstruction. Corticosteroids which are more effective than antihistamines in reducing symptoms.

 Associations with Other Disorders

Depression: Some evidence has linked depression with allergies. A 2002 study, for example, found that people with depression reported a higher rate of allergic disorders (71%) compared to nondepressed individuals (43%). During allergy season, patients with allergies were more likely to experience mood changes, including sadness, lethargy, and mental fatigue, than at other times. Some evidence suggests that specific immune factors in the allergic response can cause depressive symptoms. Other research indicates that both may have a common cause.

Parkinson’s Disease: A 2006 study suggested that allergic rhinitis may be associated with the later development of the neurological disorder Parkinson’s disease. The researchers think that the inflammatory response may be the link between the two conditions. However, there is not yet any evidence that treating allergic rhinitis can prevent Parkinson’s disease.

Chronic Fatigue Syndrome (CFS): Some, although not all, studies have reported that a majority of patients with CFS also have allergies to foods, pollen, metals (such as nickel or mercury), or other substances. One theory is that allergens, like viral infections, may trigger a harmful overreaction of the immune system that can cause fatigue, joint aches, and fever as well as hormone and brain chemical disturbances. (However, most people with allergies do not have CFS.)
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