Hay Fever, Seasonal Rhinitis, Paroxysmal Rhinorrhea, Spasmodic Rhinorrhea
What is Allergic rhinitis?
Allergic rhinitis is inflammation of the mucous membrane lining the nose and throat due to an allergic reaction. Inhaling dust, fumes, pollen or any other airborne substance to which an individual is allergic provokes an exaggerated response from the immune system. These otherwise harmless substances (allergens) trigger the release of histamine and other chemicals, causing inflammation and fluid production in the lining of the nose and air cavities around the nose (sinuses). This results in the characteristic symptoms of allergic rhinitis: runny nose, sneezing, congestion, watering eyes, and itching of the eyes, nose and throat. The most common allergens causing allergic rhinitis include: tree, grass, and weed pollens, molds, animal hair, feathers, skin scales, house dust, and house dust mites.
Seasonal allergic rhinitis occurs in people who are allergic to pollens and molds present during certain seasons of the year. Also referred to as hay fever, seasonal allergic rhinitis is worse during hot, windy weather, when the pollen count is high.
Perennial allergic rhinitis results from the constant presence of allergens such as mold or dust mites. This type of allergic rhinitis occurs throughout the whole year, but the symptoms may be less severe than with seasonal rhinitis.
Occupational allergic rhinitis occurs when an individual is allergic to specific allergens present only in his work place.
Allergic rhinitis is common and affects between ten and twenty percent of Americans. It is more common in people who have other allergies, such as asthma or eczema, and tends to run in families. Although it can occur at any age, allergic rhinitis has its peak occurrence in the years of early adulthood, and affects women more than men.
How is it diagnosed?
History: Symptoms may include sneezing, itchy throat, watering and itching eyes, runny nose, nasal congestion, post-nasal drip, cough, irritability, or fatigue. The individual may report an exposure to a specific substance such as cat dander, ragweed, or dust, or may be unaware of what precipitated the episode.
Physical exam usually reveals reddened nose, swollen and either pale or red nasal membranes, watery and reddened eyes (occasionally with dark circles underneath). Examination of the throat may reveal redness with post-nasal drip. The lungs will be clear on examination.
Tests are not necessary to diagnose hay fever. However, allergy testing is advised if the individual develops rhinitis on a frequent or chronic basis. Allergy skin tests help identify the specific allergens responsible so that exposure can be avoided or kept to a minimum.
How is hay fever treated?
Treatment of allergic rhinitis begins with the identification of the agent(s) that caused the allergic reaction. Symptom relief and decreasing the number and severity of further episodes is also addressed. Immediate symptom relief can often be obtained by removing the offending allergen from the environment. If this is not possible, symptom relief can usually be obtained with decongestants and antihistamines. While antihistamines reduce the symptoms of itching, runny nose, and nasal congestion, many have the disadvantage of causing drowsiness.
In cases of chronic allergic rhinitis against multiple allergic agents, nasal anti-inflammatories (corticosteroid drugs) have proven successful in decreasing the number and severity of rhinitis episodes. Allergy shots (immunotherapy) can provide long-term symptom relief by desensitizing an individual to a particular allergen. This is accomplished by the injection of gradually increased amounts of the allergen into the skin or subcutaneous over a period of years. The immune system gradually becomes less sensitive to that allergen, reducing allergic symptoms when the substance is encountered in the future.
Periactin (Cyproheptadine), Phenergan (Promethazine), Zyrtec (Cetirizine), Claritin (Loratadine), Atarax (Hydroxyzine), Clarinex (Desloratadine), Flonase (Fluticasone), Medrol (Methylprednisolone), Atrovent (Ipratropium bromide)
What might complicate it?
Complications associated with hay fever are few and generally minor. Most involve a superimposed viral or bacterial infection in the region of the nose and throat. Prolonged nasal congestion can precede a case of nasopharyngitis (common cold) or can lead to obstruction of sinus drainage resulting in sinusitis. Continuous post-nasal drip can cause inflammation of the throat (pharyngitis), tonsils (tonsillitis), or voice box (laryngitis) although temporary use of a decongestant spray or drops may reduce symptoms, continued use can eventually worsen the symptoms. In immunotherapy, there is always the danger of a severe allergic reaction (anaphylactic shock) shortly after an allergy injection is given.
Treatment can effectively reduce most symptoms of allergic rhinitis. Allergy identification through testing, with attempts to avoid allergen exposure, can reduce the number of future occurrences.
Allergic rhinitis often mimics the common cold.
Internist, otolaryngologist, and allergist.
Notify your physician if
- You have severe symptoms of hay fever that are interfering with your normal activities.
- Signs of infection, such as fever, headache, muscle aches, or thick, discolored nasal discharge, appear. A sinus infection may be complicating the allergy.
Last updated 21 December 2011