Many of you have experienced these symptoms: Itchy, runny nose. Sneezing and watery eyes. Are you suffering from Allergic Rhinitis? How is Allergic Rhinitis diagnosed? And how is it treated? I have created a handout, available to my patients, entitled, “Understanding Allergic Rhinitis”. It has been published in its entirety below for your reference.
Allergic Rhinitis refers to a group of symptoms that affect the nose. Allergy signs and symptoms include: itchy nose, eyes or throat, runny nose, sneezing, watery eyes, cough, clogged ears, headache, dark circles and/or puffiness under the eyes and fatigue. Other symptoms associated with Allergic Rhinitis include impaired sleep, increased irritability and recurrent sore throat. It is estimated that Allergic Rhinitis affects 40-50 million people a year. Allergic Rhinitis can be a trigger for asthma and predisposes patients to chronic sinus infections or ear infections. Allergic Rhinitis is the fifth most costly condition in the United States, trailing only hypertension, heart disease, mental illness and arthritis.
Symptoms of Allergic Rhinitis are caused when an allergen you are allergic to is inhaled. This causes an inflammatory response, the release of histamine, and the symptoms outlined above. Allergic Rhinitis can be seasonal due to spring and fall pollens, or year-long due to dust mites, animal dander, cockroaches or mold. Non-Allergic Rhinitis can mimic Allergic Rhinitis, but it is caused by irritants such as smoke, air pollution, exhaust fumes, fragrances, paint fumes, and the like. A diagnosis is made on the basis of patient history, a physical exam and testing. Skin testing is the most common method of allergy testing. If for some reason the patient cannot get skin testing, a blood test known as IgE Rast can also be done. Other tests that can be helpful include a Complete Blood Count (CBC) with differential, to assess the serum-eosinophil cationic protein level (S-ECP). The serum-eosinophil cationic protein level (S-ECP) has been promoted as a biomarker of asthma that reflects the degree of bronchial eosinophilic inflammation.
Lifestyle and environmental controls are the cornerstones of treatment. Identifying the proper triggers is helpful in outlining the proper treatment strategy.
Pollens: Keep windows closed and use air conditioning in the summer. Don’t hang clothing outdoors. Pollen may cling to towels and sheets, worsening symptoms. Usually allergy symptoms are worse between 5 a.m. and 10 a.m. You may want to consider wearing a pollen mask (NIOSH 95 filter rating) while working outdoors.
Mold: Keep water away from the house; use a dehumidifier to keep household humidity around 40%.
Dust Mites: Use dust mite covers, minimize exposure to carpets and heavy drapes, and minimize exposure to stuffed animals. Keep household humidity low, as outlined above.
Irritants: Avoid exposure.
Saline Irrigation: Saline irrigation can be helpful in combination with medications, or alone, if symptoms are mild. We recommend using a ceramic Neti Pot, as plastic containers are a wonderful surface for growing layers of bacteria and biofilms. We suggest combining 1/4 teaspoon of salt and 1/4 teaspoon of baking soda with 4-8 ounces of distilled water. Gentle irrigation improves mucociliary clearance which helps prevent infection.
Nasal Steroids: Nasal corticosteroids are the most effective treatment for Allergic Rhinitis. They work best when used continuously, as directed by your physician. When the patient is asymptomatic, dosages can be reduced. Nasal steroids are considered very safe. If symptoms are strictly seasonal, using nasal steroids on an intermittent basis may be recommended.
Antihistamines: Antihistamines can be taken by mouth, and are generally supplied without a prescription. Some antihistamines can cause drowsiness and impair one’s ability to operate machinery or drive a motor vehicle. Antihistamine nasal sprays can also be effective in the treatment of allergies.
Decongestants: Occasionally, decongestants may be helpful in reducing symptoms such as nasal stuffiness. However, decongestants can also exacerbate hypertension or cause heart palpitations. Nasal decongestants should not be used for more than 3 consecutive days.
Leukotriene Inhibitors: These medications are generally recommended for patients with nasal polyps. Examples are Singulair and Zyflo.
Allergic Rhinitis can cause symptoms independently, or can be a precipitating cause for other diseases such as asthma or vocal cord dysfunction. Most symptoms of Allergic Rhinitis can be treated effectively. Depending on the severity of symptoms, a variety of treatment strategies can be recommended to effectively treat allergies, as well as concomitant illness. If you are experiencing symptoms similar to those of Allergic Rhinitis, I encourage you to make an appointment with our office, Annapolis Allergy & Health Enhancement Center, to obtain a proper diagnosis and treatment plan.