What is allergic rhinitis?

Allergic rhinitis, or hay fever, as it is more widely known, is a common condition that appears as the seasons change. It typically occurs in the spring or summer seasons, when allergens such as pollen, house dust mites, and cockroach droppings are breathed in through the nose or mouth. When this happens the immune system reacts by making allergic antibodies called immunoglobulin E (IgE) in people who are sensitive to these allergens. Symptoms include, a stuffy nose, itchy eyes or sneezing.

Understanding the triggers, symptoms of allergic rhinitis, and treatment and prevention options is important for sufferers.

What is allergic rhinitis?

Allergic rhinitis can be described as an allergic reaction to airborne substances such as pollen, dust mites, and animal dander. During an allergic response, the immune response releases histamine in people who are susceptible. This causes the mucous membranes of the nose, eyes and throat to become inflamed, causing allergy symptoms. The symptoms are similar to a common cold, but are triggered by allergens, not a virus. Those with asthma or eczema are more likely to develop hay fever.

What are the different types of allergic rhinitis?

Allergic rhinitis is classed into several categories:

• Seasonal

As the name suggests seasonal allergic rhinitis happens at certain times of the year, commonly during the summer months when the pollen count is high from grasses, trees and weeds

• Perennial

This type of rhinitis can happen all year round and is generally caused by pets, dust mites and mould

• Non-allergic rhinitis

Rhinitis of this type does not involve an allergy, unlike seasonal allergies. There are many causes including smoke, irritants, pollution, changes in weather, or hormonal changes

• Infectious rhinitis

The common cold falls into this category as it spreads very easily to others. The virus settles into the mucous membranes of the nose and sinus cavities, causing an infection

Symptoms of allergic rhinitis

Nasal symptoms

Individuals often experience a range of nasal symptoms due to their body’s reaction to allergens such as pollen, dust, or mould. Symptoms include:

• Nasal congestion: When the nasal passages become inflamed and swollen
• Runny nose: An increase in mucus production leads to a persistent runny nose, often alongside a postnasal drip down the throat causing irritation
• Sneezing: The sneezing reflex is triggered by an itchy nose to clear the irritants out

Eye symptoms

Symptoms can significantly affect the eyes, leading to uncomfortable and sometimes frustrating symptoms:

• Itchy eyes: Allergens cause severe itching, which with the temptation to rub the eyes can make irritation worse. Eyes can become very sore or infected with frequent rubbing, causing conjunctivitis
• Red eyes: Allergic reactions can cause blood vessels in the eyes to expand, making them appear red
• Watery eyes: The eyes may produce excess tears to flush out allergens due to irritation

Other symptoms

Symptoms that might develop later are:

• Fatigue: Poor sleep quality due to nasal congestion and other symptoms often leads to daytime tiredness
• Dark circles under the eyes: Poor sleep quality leads to puffiness under the eyes, causing darkness
• Headaches: Sinus pressure from nasal congestion can extend to sinus headaches, causing pain in the forehead, cheeks, and around the eyes

Common causes

Outdoor triggers of allergic rhinitis

Pollen is the major outdoor trigger for allergic rhinitis. The levels of pollen vary by season and geographical location. Typically tree pollen is high in early spring, while grass pollen is more common in late spring through summer. Ragweed pollen peaks in the autumn months.

Indoor triggers of allergic rhinitis

Indoor allergens such as dust mites and pet dander are present all year round. Dust mites live in warm, humid environments so bedding, carpets, and upholstered furniture are ideal homes for them. Covering mattresses and pillows with allergen-proof covers, washing bedding in hot water weekly, and maintaining low humidity can help control dust mite levels. Dusting and vacuuming the home regularly will also reduce dust mites.

Non-allergenic triggers

Smoke, strong perfumes, and various chemicals can irritate the nasal passages, making symptoms worse. Avoiding smoking areas, using unscented cleaning products, and ensuring good ventilation when using chemicals can help manage these triggers.

How to avoid allergens

To minimise outdoor allergens:

• Reduce exposure to known allergens, such as staying indoors during the pollen season, especially on dry, windy days or after thunderstorms
• Monitor pollen forecasts to prepare yourself for the days ahead
• Wearing a mask while doing outdoor activities
• Nasal allergen barrier balms may be useful, when applied around the nostrils to stop pollen from getting through
• Showering after being outside can also help remove pollen from the skin and hair

To minimise indoor allergens:

• Using allergen-proof mattress covers, washing bedding in hot water weekly, and keeping pets out of the bedroom can be effective
• Using air purifiers with HEPA filters can help keep the air clean

How do I manage my hay fever symptoms?

Medication for hay fever is available in a variety of forms, such as tablets, liquids, nasal sprays and eye drops. Side effects from treatments will vary depending on the type of medication you are using, these may include drowsiness, headaches, nasal irritation, nosebleeds and cough.

A variety of medications are available to help manage hay fever symptoms:

Antihistamines

Antihistamines such as cetirizine or loratadine can be used in two ways: they can be taken when hay fever symptoms appear or when you know the pollen count will be high to prevent symptoms. They can help reduce overall inflammation. They work by blocking the chemical histamine, which your body releases when it thinks you’re under attack from an allergen. This stops allergic reactions and clears up symptoms like itching or sneezing, but it may not help with a blocked nose.

Steroid sprays

Corticosteroid nasal sprays are effective for reducing nasal inflammation and congestion.

Decongestants

Decongestant nasal sprays are useful to use if nasal congestion and a blocked nose are particularly bothersome. Decongestant nasal sprays target the inflammation and swelling of the nasal passages, but are a short-term treatment option of 7 days. Prolonged use can cause irritation and rebound congestion.

When should I see my healthcare provider about allergic rhinitis?

When over-the-counter treatments are not effective

Over-the-counter treatments can be effective for mild hay fever symptoms. However, when symptoms persist or worsen despite these treatments, it may indicate a need for a more tailored approach. For symptoms that last more than 7 days or for severe reactions, consult with a healthcare professional to explore further treatment options.

Benefits of consulting an Allergist

Allergists specialize in diagnosing and treating hay fever and other allergic conditions. They can offer allergy testing, such as skin prick tests or blood tests to identify specific triggers and develop personalized treatment plans. Allergists can advise on how to avoid allergens, prescription medications, and long-term strategies such as immunotherapy, which may significantly improve quality of life and reduce the frequency and severity of symptoms.

Immunotherapy and prescription medications

Those with persistent or severe hay fever can use immunotherapy. This involves gradually exposing the immune system to allergens to build tolerance, potentially providing long-term relief. Both allergy shots and sublingual tablets are available. Prescription medications such as leukotriene inhibitors may also be recommended to manage acute symptoms to provide relief from chronic sinus infections, nasal congestion, and other disruptive symptoms associated with hay fever.

Conclusion

By using a combination of lifestyle modifications and medical interventions, individuals suffering from allergic rhinitis can significantly improve their quality of life. Early identification of symptoms and triggers is essential for effective management, helping those suffering from allergic rhinitis to enjoy a more comfortable quality of life.

Sources

• Rhinitis, Nasal Allergy, Hayfever
• Allergic rhinitis: MedlinePlus Medical Encyclopedia
• Allergic Rhinitis and Hay Fever – Allergy UK – National Charity
• Allergic Rhinitis (Hay Fever): Symptoms & Treatment – Cleveland Clinic
• Hay Fever – Rhinitis Symptoms, Diagnosis, Management & Treatment