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ALLERGIC RHINITIS - a patient's guide

Dr Vincent Crump

- Allergy Specialist

Overview:

Allergic rhinitis is inflammation of the nasal lining


It causes chronic sneezing, runny nose or a blocked nose
Seasonal allergic rhinitis is also known as hay fever
It is caused by allergies to various types of pollen
Perennial allergic rhinitis is caused by allergies to things like dust mites,
chemicals and cats
Skin prick tests can help identify what substance a sufferer is allergic to
The rate of allergic rhinitis varies from 1.4 percent to 40 percent around the
world
There is evidence the prevalence of the condition is increasing

What is allergic rhinitis?

Rhinitis means inflammation of the nasal lining or mucosa. It is characterised by


chronic or recurrent sneezing, rhinorrhea (runny nose), itchy and blocked nose,
which may be labeled as allergic when an allergen is identified. The most well
known form of rhinitis is the common cold, which is infectious rhinitis due to a
virus.
The hallmark of allergic rhinitis is the relationship of symptoms on exposure to an
allergen. Your nose is not the only organ that may be affected in allergic rhinitis.
You may have itching of your eyes (allergic conjunctivitis), throat and ears.
There are two types of allergic rhinitis:
Seasonal allergic rhinitis or hay fever - when symptoms are experienced only during
spring and/or summer. It is usually due to various types of pollen, which are carried
by the wind and easily breathed into the nose. When most people talk about hay
fever it usually means seasonal allergic rhinitis.
Perennial allergic rhinitis - when symptoms are experienced all year round. It is
usually caused by allergens such as house dust mite, particles from the family pets
known as animal dander, or mould spores which are carried in the air.
Other causes of perennial rhinitis:
Occupational: vets working with furred animals, bakers allergic to flour, health
workers allergic to latex, etc.
Drugs: Oral contraceptives, hormone replacement therapy, aspirin & other
nonsteroidal anti-inflammatory drugs and anti-hypertensives can all cause rhinitis.

How common is allergic rhinitis?

Allergic rhinitis is estimated to have a prevalence of up to 40% in the New Zealand


and Australian populations.

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How is allergic rhinitis diagnosed?

The history
It should be ascertained whether the allergic symptoms are seasonal or perennial.
The exact month of the year that symptoms start could give a clue as to the
specific type of pollen involved.
The tree pollen season starts in late winter and usually ends before the grass pollen
season in spring. The weed pollen season overlaps with the grass season, usually
starting in late spring and extending through to end of summer.
Patients who are allergic to their pets will often deny obvious symptoms related to
contact with their own pets. This is due to some sort of tolerance developed due to
continuous exposure to the allergen. If they were to go away for a two week
vacation, they might notice immediate symptoms upon their return.
The predominance of nasal symptoms on waking may suggest the diagnosis of
house dust mite allergic rhinitis.

How is allergic rhinitis treated?

Broadly speaking there are three main options in the treatment of allergic rhinitis.
1. Avoiding allergens
Total eradication of the allergen is usually not possible, but measures to reduce the
allergen in the local environment should be encouraged. The measures to be used
will differ depending on the nature of the allergen.
Pollen
Pollen particles are part of the reproductive mechanism of plants and are an
environmental contaminant, which are difficult or impossible to eliminate.
Measures, which can help to reduce the exposure, include:
Keep windows in cars and buildings shut
Wear glasses or sunglasses
Avoid open grassy places, particularly in the evening and at night
Use a car with a pollen filter
Check the pollen count in the media
During the peak season take your holidays by the sea or abroad
House dust mite
House dust mites are found in mattresses, pillows, bedcovers, carpets and soft
furnishings throughout the home. Optimal conditions for mite growth is achieved
through well-insulated, centrally heated homes!
Mattress/bedding barrier intervention has been shown to reduce mite allergen
levels and improve clinical symptoms of both rhinitis and asthma.
Animal allergens
The major cat allergen is a salivary protein, which is preened on to the fur where it
dries into flakes, which become airborne for many hours and are easily breathed in.
Families with atopic (allergic) members should be advised against furred animals in
the home. Psychological factors may render dogmatic statements about removal of
a family pet unwise.
Where removal of a pet is not possible, advice can be given to confine the animal
outside the house.

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Recent studies have suggested that washing the cat (once weekly) when combined
with other cleaning measures may effectively reduce airborne cat allergen levels in
the home.
2. Drug treatment

Patients need drugs for allergic rhinitis if avoiding the allergen is impossible or fails
to control the symptoms.
In recent years, the mainstay of treatment for allergic rhinitis has been the use of
topical corticosteroid nasal sprays, and the newer non-sedating antihistamines.
These may be highly effective when used either alone or in combination.
Topical sodium cromoglycate represents an alternative anti-inflammatory agent to
corticosteroids, particularly in young children.
Topical anticholinergic drugs (e.g. atrovent) and decongestants may have a part to
play in defined circumstances.
Corticosteroids and sodium cromoglycate affect the underlying allergic process and
should be used as first-line treatment for most patients. Compliance may be a
problem with cromoglycates, as they need to be used 3-6 times per day.
Antihistamines and decongestants simply relieve symptoms.
Topical decongestants should not be used for more than 5 days because of rebound
congestion.
3. Immunotherapy
Immunotherapy is the injection of increasing doses of the identified allergen(s), in
order for the body to build up a resistance to it.
There remains a small group of subjects who, despite regular use of medication,
continue to have marked symptoms or unacceptable side-effects from their
medication. These patients should be offered immunotherapy.

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