What is allergic rhinitis?
Rhinitis means inflammation of the lining of the nose. If the inflammation is due to allergy, this is called allergic rhinitis. The 4 classical symptoms of allergic rhinitis are-
SNEEZING,
ITCHY NOSE/EYES/THROAT,
CLEAR MUCOID DISCHARGE, and
NASAL CONGESTION
Every time we breathe in, we inhale countless numbers of small particles of dust, pollen and animal fluff etc. Most of us do not suffer any bad effects from this, but for many people, some of these particles can set off an allergic reaction.
The result can be an itchy nose, eyes and palate, a runny nose and eyes, and sneezing. Inflammation from the allergy will cause swelling of the lining of the nose- this causes nasal congestion and obstruction
Who gets allergic rhinitis?
More females than males develop allergic rhinitis, but overall about 1 out of every 5 people has significant symptoms. There are several factors involved, including the environment, occupation, stress and diet. It does run in families to a certain extent. Usually the symptoms improve as the person gets older, and it is uncommon for allergic rhinitis to develop for the first time in someone over 40 years of age.
Is allergic rhinitis the same as hay fever?
Some people have their symptoms at a particular time of the year, usually in spring and early summer when pollen is plentiful. This type of seasonal allergic rhinitis is often termed hay fever.
What sorts of things trigger allergic rhinitis?
Substances which trigger an allergic reaction are called allergens. Most allergens are inhaled but it may be possible that an allergen taken in by eating, for instance, can also set off allergic rhinitis.
Pollen usually triggers seasonal allergic rhinitis. Other substances can set off symptoms all year round e.g. house dust mites, animal dander (especially cats and dogs), cockroach, and fungal spores
Poorly controlled allergic rhinitis leaves the lining of the nasal passages irritable. Non-allergic irritants may then react with the oversensitive lining, causing allergy-like symptoms. This is one reason why cigarette smoke, perfumes, petrol fumes and air conditioning cause symptoms for some people.
Is it possible to identify what the trigger factor is?
Skin testing may help to identify some allergens. Blood testing (RAST) may also be used in selected patients.
Treatment of allergic rhinitis
The treatment of allergic rhinitis has 4 components:
1.Avoidance of allergen/s
Avoid the allergen trigger as much as possible. If you have hay fever, avoid grassy areas when pollen concentrations are high. There will be less pollen inside a house than outside. Keep your environment as dust free as possible and avoid any other possible irritants such as cigarette smoke, perfumes, rapid changes in temperature, etc.
If dust mite is a trigger, concentrate on keeping dust levels down e.g. by dusting with a damp cloth every few days. The highest concentrations of dust mite are found in the bedroom and particularly in the bed itself. The mattress is a particular problem because even regular vacuuming removes only a small percentage of the mite allergens inside.
Plastic (polyurethane) covers provide a barrier to dust mites and their allergens. Choose synthetic fabrics in preference to wool or cotton fabrics. Feather and cotton stuffed toys should be removed from the bedroom. Indispensable favourite toys can be brushed and then frozen in the deep freeze for 24 hours every other day to keep allergen levels to a minimum. However, all these avoidance measures have recently been shown to be of limited benefit with regards to symptom control.
Mould can collect anywhere. A dehumidifier for damp areas in the house may help to reduce the mould levels and can be useful for people allergic to fungal agents. Discuss with your doctor whether your pet is a possible cause of your problems.
2.Medications
These can help and your doctor will choose from the following
Corticosteroid nasal sprays reduce inflammation in the nasal lining, and are the mainstay of the treatment of allergic rhinitis. If used continuously, they can improve symptoms for several months. However, for best results, you must take them all the time, not just when you have the symptoms.
These sprays affect the nose only – they do not have any other effect on the rest of the body and are safe for pregnant women at normal dose levels. The aqueous, rather than the aerosol spray, is kinder on the nose.
Antihistamines help block part of the allergic process, but not all of it. They can be very useful, but in some patients they have the side effect of making them feel quite sleepy. This is less of a problem with the newer antihistamines such as Deselex, and Xyzal.. Antihistamine nasal sprays may also be helpful.
Saline sprays/douches are useful in clearing nasal secretions, but do not directly affect the allergic inflammation. They are however free of side effects
3.Surgery
Surgery is of limited benefit in the treatment of allergic rhinitis. It is used only to relieve nasal obstruction- this helps to improve the delivery of corticosteroid nasal sprays or to treat the complications of allergic rhinitis, in particular chronic sinusitis.
Cautery or surgical reduction of the turbinates and/or correction of a deviated nasal septum can help reduce the obstruction and secondarily improve the effect from nasal sprays. If there are nasal polyps, or underlying sinus disease, then surgical treatment of these conditions can help improve the effect of anti-allergy treatments.
4.Immunotherapy
Immunotherapy (desensitisation) can be useful for some patients who are sensitive to grass pollen and/or dust mites. The treatment programme involves 3 years of injections, or the use of sublingual (under the tongue) drops and is only suitable for selected patients where nothing else has been helpful. Patients need to be prepared to undergo the entire programme.
YOUR CONSULTATION
If you think you suffer from allergic rhinitis, and would like help, please book an appointment by calling 031 201 3118.
At your consultation, best ENT practice guidelines will be followed.
A detailed history of your problem will be taken.
This will be followed by a complete examination of the nasal passages, including nasal endoscopy, to exclude significant nasal septum deviations, bulky inferior turbinates (the structures on the side wall of your nose, that warm and moisten the air), polyps, and sinusitis.
An allergy test may be requested, and the appropriate treatment prescribed according to best ENT specialist practice guidelines.
A follow-up visit will be scheduled to assess the efficacy of the treatment, and to advise on long-term treatment.