Allergic Rhinitis

What is allergic rhinitis?

Allergic rhinitis (commonly referred to as Hay Fever) is a disorder characterized with sneezing, itching, rhinorrhea +/- nasal congestion. The symptoms are generated due to the increased bodily reaction to environmental agents such as grass, trees, dust mites, mold and animal dander. Once the nasal lining is exposed to the triggering agent, it will lead to increased inflammation and consequently itchiness, congestion and drainage.

Allergic rhinitis may be classified as seasonal (if the allergens occur during specific seasons), perennial (if the allergens occur throughout the entire year), or mixed (if both seasonal and perennial allergens are involved).

Many people with allergic rhinitis may also have asthma, atopic dermatitis, eczema or other allergic conditions.

What are common symptoms?

  • Nasal congestion
  • Itchy/watery eyes
  • Itchy nose
  • Itchy ears
  • Sneezing
  • Runny nose

How is it diagnosed?

Diagnosis of allergic rhinitis is based upon clinical history, physical examination, and allergy testing. First a detailed history (seasonal variations, living/working conditions, pet, and food sensitivities) can determine if there are seasonal variations or pinpoint the cause of your allergies. Once an adequate history is performed, a good physical examination can also identify other pathologies that can accentuate your nasal symptoms such as nasal polyps, deviated nasal septum, and other anatomic abnormalities.

Your doctor may order a skin or blood test to determine if you are sensitive to specific allergens. You may be offered one type of test over another depending on the type of medications or skin conditions you may have.

How is allergic rhinitis treated?

Treatment options include avoidance of relevant allergens, topical nasal steroids, systemic antihistamines, topical antihistamines, decongestants, immunotherapy and surgery:

  • Avoidance of allergen: This can prevent the onset of your symptoms. In your home, you can purchase an air purifier with a HEPA filter and vacuum on a more frequent basis. These filters can remove over 99% of the particles in your home. If there is sensitivity to dust mites, wash the bedding materials in hot water that is above 130°F.
  • Antihistamines: There are oral and topical versions of these medications. Examples include loratadine, fexofenadine, cetirizine, and azelastine. The goal of this class of medication is to reduce the histamine release; therefore, it is best to take these medications prior to any allergen exposure. Some oral antihistamine may cause drowsiness as well.
  • Steroids: Topical and oral versions of these medications exist. The steroid function by decreasing the body’s response to the allergens in the environment. The topical versions of these medication can take several weeks before you will notice its effect. Oral steroids, on the other hand will work much quicker; however, there are several systemic side effects that one can experience.
    Decongestants: For a short period of time topical or oral decongestants may be beneficial. You should be aware that if topical decongestants (ex/oxymetazoline) is used continuously for over 3 days, you can develop rhinitis medicamentosa, and become dependent on the medication.
  • Immunotherapy: There are two types of immunotherapy (intradermal and sublingual). The therapy is provided by an allergist and consists of a series of diluted extracts of the allergens. The amount of exposure (shot or tablet) is gradually increased over a period of time. This therapy will allow the body to become resistant to the allergens and therefore, when exposed, your body will have a reduced intensity of symptoms. At times, the treatment can make your allergic reactions disappear.
  • Surgery: If medical therapy An inferior turbinate reduction or partial resection can help with the nasal congestion symptoms of your allergic rhinitis. At TSI, our surgeons perform a submucous resection of the inferior turbinate. The procedure will reduce the size of thee inferior turbinate. Moreover, it will remove some of the erectile tissue while keeping the external structure. The reduction will lead to your turbinates not being as congested or runny compared to before.

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