Allergic rhinitis

Allergic rhinitis is a group of symptoms affecting the nose. These symptoms occur when you breathe in something you are allergic to, such as dust, animal dander, or pollen. Symptoms can also occur when you eat a food that you are allergic to. This article focuses on allergic rhinitis due to plant pollens. This type of allergic rhinitis is commonly called hay fever or seasonal allergy. Causes An allergen is something that triggers an allergy. When a person with allergic rhinitis breathes in an allergensuch as pollen, mold, animal dander, or dust, the body releases chemicals that cause allergy symptoms. Hay fever involves an allergic reaction to pollen. Plants that cause hay fever are trees, grasses, and weeds. Their pollen is carried by the wind. (Flower pollen is carried by insects and does not cause hay fever.) Types of plants that cause hay fever vary from person to person and from area to area. The amount of pollen in the air can affect whether hay fever symptoms develop. Hot, dry, windy days are more likely to have a lot of pollen in the air. On cool, damp, rainy days, most pollen is washed to the ground.

Hay fever and allergies often run in families. If both of your parents have hay fever or other allergies, you are likely to have hay fever and allergies, too. The chance is higher if your mother has allergies. Symptoms Symptoms that occur shortly after you come into contact with the substance you are allergic to may include: Itchy nose, mouth, eyes, throat, skin, or any area Problems with smell Runny nose Sneezing Watery eyes

Symptoms that may develop later include: Stuffy nose (nasal congestion) Coughing Clogged ears and decreased sense of smell Sore throat Dark circles under the eyes

Puffiness under the eyes Fatigue and irritability Headache

Exams and Tests The health care provider will perform a physical exam and ask about your symptoms. You will be asked whether your symptoms vary by time of day or season, and exposure to pets or other allergens. Allergy testing may reveal the pollen or other substances that trigger your symptoms. Skin testing is the most common method of allergy testing. If your doctor determines you cannot have skin testing, special blood tests may help with the diagnosis. These tests, known as IgE RAST tests, can measure the levels of allergy-related substances. A complete blood count (CBC) test called the eosinophil count may also help diagnose allergies. Treatment LIFESTYLE AND AVOIDING ALLERGENS The best treatment is to avoid the pollens that cause your symptoms. It may be impossible to avoid all pollen. But you can often take steps to reduce your exposure. You may be prescribed medicine to treat allergic rhinitis. The medicine your doctor prescribes depends on your symptoms and how severe they are. Your age and whether you have other medical conditions, such as asthma, will also be considered. For mild allergic rhinitis, a nasal wash can help remove mucus from the nose. You can buy a saline solution at a drug store or make one at home using one cup of warm water, half a teaspoon of salt, and pinch of baking soda. Treatments for allergic rhinitis include: ANTIHISTAMINES Antihistamines work well for treating allergy symptoms. They may be used when symptoms do not happen often or do not last long. Be aware of the following: Many antihistamines taken by mouth can be bought without a prescription. Some can cause sleepiness. You should not drive or operate machines after taking this medicine. Others cause little or no sleepiness. Antihistamine nasal sprays work well for treating allergic rhinitis. Ask your doctor if you should try these medicines first.

CORTICOSTEROIDS

Nasal corticosteroid sprays are the most effective treatment for allergic rhinitis. They work best when used nonstop, but they can also be helpful when used for shorter periods of time. Many brands are available. You will need a prescription from your doctor. Corticosteroid sprays are generally safe for children and adults.

DECONGESTANTS Decongestants may also be helpful for reducing symptoms such as nasal stuffiness. Do not use nasal spray decongestants for more than 3 days.

OTHER MEDICINES Leukotriene inhibitors are prescription medicines that block leukotrienes. These are the chemicals that the body releases in response to an allergen that also trigger symptoms.

ALLERGY SHOTS Allergy shots (immunotherapy) are sometimes recommended if you cannot avoid the pollen and your symptoms are hard to control. This includes regular shots of the pollen you are allergic to. Each dose is slightly larger than the dose before it, until you reach the dose that helps control your symptoms. Allergy shots may help your body adjust to the pollen that is causing the reaction. Outlook (Prognosis) Most symptoms of allergic rhinitis can be treated. More severe cases need allergy shots. Some people, especially children, may outgrow an allergy as the immune system becomes less sensitive to the trigger. But once a substance, such as pollen, causes allergies, it often continues to have a longterm effect on the person. When to Contact a Medical Professional Call for an appointment with your health care provider if: You have severe hay fever symptoms Treatment that once worked for you no longer works Your symptoms do not respond to treatment

Prevention You can sometimes prevent symptoms by avoiding the pollen you are allergic to. During pollen season, you should stay indoors where it is air-conditioned, if possible. Alternative Names Hay fever; Nasal allergies; Seasonal allergy; Seasonal allergic rhinitis

References Frew AJ. Allergen immunotherapy. J Allergy Clin Immunol. 2010 Feb;125(2 Suppl 2):S306-13. Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet. 2011;378(9809):2112-2122. Orban NT, Saleh H, Durham SR. Allergic and non-allergic rhinitis. In: Adkinson NF Jr., Bochner BS, Busse WW, et al., eds. In: Middletons Allergy Principles and Practice . 7th ed. Philadelphia, Pa.: Elsevier Mosby; 2008:chap 55.

Taken from: http://www.nlm.nih.gov/medlineplus/ency/article/000813.htm

Hay fever facts.

Hay fever (Allergic rhinitis) is common. Allergy symptoms mimic chronic colds. Allergic rhinitis can lead to other diseases. The best way to treat an allergy condition is to identify the allergic substance and avoid it. Effective treatment is available in many forms.

What is hay fever? What are the symptoms and signs?

Hay fever affects up to 30% of all people worldwide, including up to 10% of U.S. children under 17 and 7.8% of U.S. adults. The medical cost of allergic rhinitis is approximately $3.4 billion, mostly because of the cost of prescription medications. These figures are probably an underestimate because many of those affected may attribute their discomfort to a chronic cold. Although childhood hay fever tends to be more common, this condition can occur at any age and usually occurs after years of repeated inhalation of allergic substances. The incidence of allergic disease has dramatically increased in the U.S. and other developed countries over recent decades. "Hay fever" is a misnomer. Hay is not a usual cause of this problem, and it does not cause fever. Early descriptions of sneezing, nasal congestion, and eye irritation while harvesting field hay promoted this popular term. Allergic rhinitis is the correct term used to describe this allergic reaction, and many different substances cause the allergic symptoms noted in hay fever. Rhinitis means "irritation of the nose" and is a derivative of rhino, meaning nose. Allergic rhinitis which occurs during a specific season is called "seasonal allergic rhinitis." When it occurs throughout the year, it is called "perennial allergic rhinitis." Rhinosinusitis is the medical term that refers to inflammation of the nasal lining as well as the lining tissues of the sinuses. This term is sometime used because the two conditions frequently occur together. Symptoms of allergic rhinitis, or hay fever, frequently include nasal congestion, a clear runny nose, sneezing, nose and eye itching, and excess tear production in the eyes. Postnasal dripping of clear mucus frequently causes a cough. Loss of the sense of smell is common, and loss of taste sense

occurs occasionally. Nose bleeding may occur if the condition is severe. Eye itching, redness, and excess tears in the eyes frequently accompany the nasal symptoms. The eye symptoms are referred to as "allergic conjunctivitis" (inflammation of the whites of the eyes). These allergic symptoms often interfere with one's quality of life and overall health. Allergic rhinitis can lead to other diseases such as sinusitis and asthma. Many people with allergies have difficulty with social and physical activities. For example, concentration is often difficult while experiencing allergic rhinitis.
Medically Reviewed by a Doctor on 12/17/2013

Why does an allergic reaction occur?

An allergic reaction occurs when the immune system attacks a usually harmless substance called an allergen that gains access to the body. To more simply describe this complex immune process, we will make an analogy to a war within the body. The immune system calls upon a protective substance called immunoglobulin E (IgE) antibodies ("E" for "erythema" or redness) to fight these invading allergic substances or allergens. Even though everyone has some IgE, an allergic person has an unusually large army of these IgEdefenders -- in fact, too many for his/her own good. This army of IgE antibodies attacks and engages the invading army of allergic substances of allergens. As is often the case in war, innocent bystanders are affected in battle. These innocent bystanders are special cells called mast cells. These cells are frequently injured during the warring of the IgE antibodies and the allergic substances. When a mast cell is injured, it releases a variety of chemicals into the tissues and blood, one of which is known as histamine. These chemicals frequently cause allergic reactions. These chemicals are very irritating and cause itching, swelling, and fluid leaking from cells. Through various mechanisms, these allergic chemicals can cause muscle spasm and can lead to lung and throat tightening as is found in asthma and loss of voice.

What causes allergic rhinitis?

Any substance can cause an allergy if exposed to a person in the right way. But for all practical purposes and with few exceptions, allergic rhinitis is caused by proteins. Commonly, allergic rhinitis is a result of an allergic person coming in contact several times with protein from plants. Many trees, grasses, and weeds produce extremely small, light, dry protein particles called pollen. This pollen is spread by the wind and is inhaled. These pollen particles are usually the male sex cells of the plant and are smaller than the tip of a pin or less than 40 microns in diameter. Even though pollen is usually invisible in the air, pollen is a potent stimulator of allergy. Pollen lodges in the nasal lining tissues (mucus membranes) and other parts of the respiratory tract where it initiates the allergic response. Up to 7.8% of American adults suffer from allergic rhinitis. A person is programmed to be allergic by his/her genetic makeup and is destined to be allergic from birth. Approximately one in four people with allergic rhinitis also has asthma.

Medically Reviewed by a Doctor on 12/17/2013

When and where does allergic rhinitis occur?

Since allergic rhinitis is frequently caused by pollen, symptoms occur when pollen is in the air. Trees primarily pollinate in the spring, while grasses pollinate in the spring and summer. Weeds usually pollinate in the late summer and fall. Of allergy sufferers in the United States, many are allergic to ragweed, about half are allergic to grasses, and fewer are allergic to trees. Of course, many people are allergic to other substances such as mold spores, animal protein, and mites, to name a few. Food is an uncommon cause of allergic rhinitis. If you wish to know the pollen count in your area, this information can often be found in the newspaper in the weather section or you can access the National Allergy Bureau's pollen count information at their web site (http://www.aaaai.org/nab/index.cfm).

How is allergic rhinitis diagnosed, and how are allergies identified?

Typically, allergies are initially diagnosed by a combination of characteristic symptoms coupled with exam findings that correspond with allergies. If a person is experiencing the typical symptoms of hay fever, a consultation with an allergy specialist can help identify the offending substances. Since the ideal way to manage an allergy is to avoid the substances that cause allergic reaction, it is therefore very important to first identify these substances (allergens). Many allergens can be suspected from information obtained in a patient's particular history. For example, if symptoms usually worsen with exposure to cats, then cat dander protein is a probable allergen causing the symptoms. If cutting grass is associated with the onset of symptoms, then grass allergy is probable. A patient's history of reactions is very important in determining his/her unique allergies. Allergy testing is only done when allergies are debilitating enough that patients desire allergy immunotherapy. Because the identification of allergens is important and often difficult to pinpoint, skin testing is often needed to identify exactly the specific substance causing the allergy. Skin testing is now done with minimal discomfort and is performed as follows:

A small amount of the suspected allergy substance is placed on the skin. The skin is then gently scratched through the small drop with a special sterile needle. This is known as the prick-puncture method and is typically used for initial evaluations. A second method, known as the intradermal method, involves injection of a small amount of the test substance into the skin. Intradermal testing is more sensitive but also tends to lead to more false-positive results. If the skin reddens and, more importantly, swells, then an individual is said to be "sensitized" to the particular allergen. If typical symptoms occur when a sensitized individual is exposed to the suspected substance, then allergy to that substance is probable.

The skin testing described is tolerated by the youngest of patients and should be the standard of testing. Skin testing is not indicated for people who are at risk of a severe (anaphylactic) allergic reaction, who have certain skin conditions, or who are taking certain medications.

A number of blood tests are also available to aid in the diagnosis of allergy. These blood tests may be useful in people who cannot be skin tested due to skin diseases, who are taking medications that interfere with skin testing, or who are at a high risk of having an anaphylactic reaction to skin testing. These blood tests typically use various techniques to look for IgE antibodies in the blood and by inference suggest allergy in the tissues. If the allergy testing agrees with the history of symptoms upon exposure to the substance, then a diagnosis of allergic rhinitis is likely.
Medically Reviewed by a Doctor on 12/17/2013

How are allergies treated?

Avoidance of identified allergens is the most helpful factor in controlling allergy symptoms. Attempts to control the environment and avoidance measures often significantly aid in resolving symptoms. However, allergy avoidance is often not easy. A thorough discussion with your physician is needed, and control measures may be required daily. If avoidance is not possible or does not relieve symptoms, additional treatment is needed. Many patients respond to medications that combat the effects of histamine, known as antihistamines. Antihistamines do not stop the formation of histamine, nor do they stop the conflict between the IgE and antigen. Therefore, antihistamines do not stop the allergic reaction but rather protect tissues from the effects of the allergic response. The first-generation antihistamines, such as diphenhydramine (Benadryl), chlorpheniramine (Chlortrimaton), dimenhydrinate (Dramamine), brompheniramine (Dimetapp and others), clemastine fumarate (Tavist, Allerhist), and dexbrompheniramine (Drixoral) frequently cause mouth dryness and sleepiness as side effects. Newer, so-called "non-sedating" or second-generation antihistamines are also available. These includeloratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec), fexofenidine (Allegra), and azelastine (Astelin Nasal Spray). In general, this group of antihistamines is slightly more expensive, has a slower onset of action, is longer acting, and induces less sleepiness. Discuss with your physician other antihistamine side effects that very occasionally occur (for example, urine retention in males, fast heart rate, and others). You should always discuss the potential side effects of any medication with your physician and/or pharmacist. A thorough review of specific antihistamines can be found under the Medications Center and more in the Nasal Allergy Medications article. Decongestants help control allergy symptoms but not their causes. Decongestants shrink the swollen membranes in the nose and make it easier to breathe. Decongestants can be taken orally or by nasal spray. Decongestant nasal sprays should not be used for more than five days without a doctor's advice, and if so, usually only when accompanied by a nasal steroid. Decongestant nasal

sprays often cause a so-called "rebound effect" if taken for too long. A rebound effect is the worsening of symptoms when a drug is discontinued. This is a result of a tissue dependence on the medication. Some people with allergies need specialized prescription medications such as corticosteroids, cromolyn, and ipratropium (Atropine-like) nasal sprays. These nasal sprays do not cause the rebound effect noticed with decongestant nasal sprays. Cortisone nasal sprays are very effective in reducing the inflammation which causes swelling, sneezing, and a runny nose. Cortisone can also stop the allergy "war" by halting the formation of the many allergy chemicals described above. Many cortisone nasal sprays are on the market through prescription only. Fluticasone (Flonase) is one example, but many preparations are available. Intranasal steroids are typically the first-line medications for patients suffering from persistent allergies. Cromolyn is also an antiinflammatory medication. Although cromolyn is not as potent as cortisone, it has a very safe profile. Cromolyn must be used well in advance of anticipated allergy symptoms to be useful. Ipratropium nasal spray is available for drying a wet runny nose. It will not prevent allergic reactions. This is an atropine derivative and although usually very safe, a person sensitive to atropine should be cautious when taking this drug. Montelukast (Singulair) is an inhibitor of leukotriene action, another chemical involved in the allergic reaction. This medication is used for therapy of asthma and has also been approved for treatment of allergic rhinitis. It has been shown to be most effective in those for whom significant congestion is a primary complaint. It may also be used in some cases together with antihistamines. If antihistamines and nasal sprays are not effective or not tolerated by the patient, other modalities of therapy are available. Allergy desensitization or immunotherapy may be needed. Allergy immunotherapy stimulates the immune system with gradually increasing doses of the substances to which a person is allergic. Because the patient is being exposed to the allergy-inducing substance, an allergic reaction can occur, and this treatment should be supervised by a physician. Although the exact way allergy desensitization works is not completely known, allergy injections appear to modify or stop the allergy "war" by reducing the strength of the IgE and its effect on the mast cells. This form of treatment is very effective for allergies to pollen, mites, cats, and especially stinging insects (for example, bees). Allergy immunotherapy usually requires a series of injections and takes three months to one year to become effective. The required length of treatment may vary, but three years is a typical course. Frequent office visits are necessary. The duration of the effect of allergy immunotherapy should last many years, if not a lifetime. Although rare, serious allergy reactions can occur while receiving allergy injections. One cannot predict who will have a severe reaction. Even after years of receiving allergy shots, a patient can experience a reaction. Medically reviewed by Rambod Rouhbakhsh, MD, MBA, FAAFP; American Board of Family Medicine REFERENCES:

Becker, Jack M. "Allergic Rhinitis: Treatment & Medication." eMedicine.com. July 13, 2009. <http://emedicine.medscape.com/article/889259-treatment>. Plaut, Marshall, and Martin D. Valentine. "Allergic Rhinitis." New England Journal of Medicine 353.18 Nov. 2005: 1934-1944. Previous contributing author: Alan Szeftel, MD

Medically Reviewed by a Doctor on 12/17/2013

Taken from: http://www.medicinenet.com/hay_fever/article.htm