Allergic Rhinitis

What is Allergic Rhinitis? (Uncommon Cold)

Have you found yourself sneezing repeatedly when you’re around dust or smoke? If yes, then it’s highly possible that you’re allergic.

Your body’s immune system helps you fight harmful things such as viruses and bacteria and protects you. When you are allergic to something, it means that your immune system is trying to protect you from something that is completely harmless – such as dust or pollen from plants and trees and sometimes, even certain food items. An allergy can affect any part of the body, such as the skin, eyes, and nose.

Allergies are very common and can affect anyone. However, if any of your family members have a history of allergies, then you may be more likely to develop an allergy. Allergic rhinitis refers to an allergy that specifically affects the nose. Allergic rhinitis, unlike a common cold, is not caused by any virus. The symptoms start to show when you breathe in something you’re allergic to. These are known as allergens. The most common allergens are:

  • Outdoor allergens such as pollen and smoke
  • Indoor allergens such as dust mites, pet hair or dander and mold (fungus)
  • Other irritants such as cigarette smoke, perfumes, chemicals and exhaust fumes

Broadly, there are two types of allergic rhinitis – seasonal and perennial.

Seasonal allergic rhinitis is when your symptoms show or get worse only during certain periods of the year. This is more common when your allergen is something like pollen, which is found in abundance during certain periods of the year.

Perennial allergic rhinitis, on the other hand, is when you have the symptoms throughout the year. This is more common when you are allergic to things that are present throughout the year, such as dust, smoke etc.

Uncommon Cold (Allergic Rhinitis) v/s Common Cold

Allergic rhinitis (AR) is a condition affecting the nose. It is often mistaken for the common cold—because of some common symptoms such as sneezing and runny or blocked nose. However, it is not just another viral infection, and it does not go away quickly. Unlike the common cold, allergic rhinitis is not caused by a virus.

AR is caused by allergens, which are usually harmless substances; however, when breathed in, they could trigger an allergic reaction in some people. An allergic reaction occurs when the person’s immune system overreacts to an allergen. People with AR are prone to symptoms such as runny nose, sneezing, congestion and sinus pressure. AR can also contribute to other problems such as asthma, sinus or ear conditions, or having trouble sleeping.

Seasonal AR, often referred to as hay fever, is typically caused by outdoor allergens such as pollen from trees, grasses and weeds. Perennial AR occurs year-round. It is usually triggered by allergens such as pet dander (tiny bits of dead skin shed by animals or birds), house dust mites or mold.

There are certain differences in the symptoms that can help you distinguish between the two.

Allergic Rhinitis

Common Cold

It is an allergic reaction caused by allergens

It is a viral infection

Symptoms are seen immediately after
exposure to allergens

Symptoms are seen one to two
days after exposure to a cold virus

You generally do not have fever or
body ache

You have fever and body ache

The mucus in your nose is clear
and watery

The mucus in your nose is yellow or green and thick

You sneeze many times

Sneezes are infrequent, and usually restricted to a few at one time

Extremely watery eyes

No watery eyes

Symptoms stay longer than a
few days

Symptoms go away in a few days

Some people with rhinitis symptoms don’t suffer from allergies. The symptoms may be similar, but the causes are different, this is called Nonallergic rhinitis (NAR or vasomotor rhinitis). It is a condition that causes chronic sneezing, congestion, or runny nose. People with NAR may have symptoms similar to AR but don’t suffer from allergies (because the immune system is not involved), and the triggers are also different.

Triggers for NAR (Nonallergic Rhinitis)

Triggers include cold air and other weather changes, irritants such as strong odors, chemical fumes, air pollution and second-hand tobacco smoke, changes in sexual hormone levels, exercise, and alcohol ingestion. Medications and other chronic health conditions can also contribute to NAR symptoms.

Who can get AR (Allergic Rhinitis)

AR affects approximately 20% of people of all ages. The risk of developing AR is much higher in people with asthma or eczema, and in people who have a family history of asthma or AR. It can begin at any age, although most people first develop symptoms in childhood or early adulthood. The symptoms are often most severe in children and in people in their 30s and 40s. However, the severity of symptoms tends to vary throughout a person's life. Some people go through periods during which they have no symptoms at all.

Classification of AR

Traditionally, AR is categorized into two types:

  • Seasonal (occurring during a specific season)
  • Perennial (occurring throughout the year)

However, not all patients fit in the above categories because, in some individuals, the attack of some allergic triggers such as pollen (allergen) occurs during cold weather (seasonal) and continues during warm weather, and patients with multiple “seasonal” allergies may have persistent symptoms throughout the year (perennial).

Based on these observations, AR is now classified according to the symptom duration;

  • intermittent (<4 days per week or <4 consecutive weeks)
  • persistent (>4 days/week or >4 consecutive weeks)
  • mild (normal sleep and normal daily routine, no troublesome symptoms)
  • moderate/severe (significantly affects sleep and daily activities or is considered troublesome)

It is important to classify the severity and duration of symptoms to help guide the management approach for individual patients.

Symptoms of Allergic Rhinitis

Allergic rhinitis is associated with various symptoms affecting the nose. Symptoms of allergic rhinitis appear when you come in contact with allergens such as dust mites, molds, pollen, animal dander, strong fumes, etc. For most people, the symptoms of allergic rhinitis occur after breathing any of these allergen substances. Tree and grass pollen are the most common causes in the summers, while ragweed, mold, and weed pollen are common in the winter season. Few people are allergic to certain foods and consuming the same will put them at risk of experiencing allergic symptoms.

A person might be suffering from chronic nasal congestion, excess production of mucus, itching in the nose and more similar symptoms to allergic rhinitis. In these cases, allergy might be the cause for a person to develop allergic rhinitis.

For people suffering from seasonal allergic rhinitis, the symptoms will occur only during a specific time of the year while for someone having perennial allergic rhinitis, they may experience symptoms over around the year.

Some of the early allergic rhinitis symptoms include:

  • Repeated sneezing, especially in the early hours of the morning
  • Runny nose and a thin, clear post-nasal drip that may cause a sore throat
  • Watery and itchy eyes
  • Coughing
  • Itchy ears, nose, mouth, eyes and throat

Symptoms of allergic rhinitis that may develop later include:

  • Stuffy nose
  • Headache
  • Fatigue and irritability
  • Blocked ears
  • Decreased sense of smell
  • Swollen or puffy eyelids
  • Dark circles under the eyes
  • Itching in nose, eyes, or throat
  • Hives (swollen, pale, red bumps on the skin)
  • Sore throat
  • Pressure in the nose and cheeks
  • Ear fullness and popping

A person will experience one or more of these above symptoms after coming in contact with an allergen. For a few people, symptoms occur only when they are exposed to a large number of allergens in the environment. For most people with allergic rhinitis, the symptoms are mild and can be easily managed or treated.

However, for a few people, the symptoms of allergic rhinitis can be severe or persistent and it may affect their daily activities, sleep or even their performance at work. The symptoms will gradually fade with time but it can take many years and it is unlikely that this condition disappears completely.

Complications of Allergic Rhinitis

There can be some complications that may arise due to allergic rhinitis. It includes:

  • Inability to sleep due to symptoms
  • Frequent infection of the ears
  • Frequent sinus infection
  • Irritability
  • Impaired hand-eye coordination
  • Frequent headaches
  • Development or worsening of symptoms
  • Limited activities/reduced productivity

If these symptoms are hindering your daily life or activities, immediately visit a doctor to know the cause of your symptoms with the help of a proper diagnosis.

You should keep a record of your symptoms over time as this will help the doctor to diagnose your condition appropriately and provide the required allergic rhinitis treatment.

The treatment for allergic rhinitis aims to manage your symptoms. You can consult the doctor to know a suitable treatment for your particular symptoms. You can draft a management plan with the help of your doctor to deal with the symptoms of allergic rhinitis.

Allergic Rhinitis Treatment

This condition has no cure but the aim of the treatment is to bring the symptoms under control. The medication can help to lessen the effects and, in a few cases, it can also reduce the sensitivity of allergens.

The causes of allergic rhinitis are allergens such as pollen, dust, mites, mold, pet dander, chemical fumes, etc. These allergens lead to a reaction that causes allergic rhinitis symptoms that include coughing, sneezing, headache, runny or stuffy nose, sore throat, throat, nose and eyes.

It is important that you treat your allergic rhinitis because if it is not treated on time, it can lead to complications such as ear infections, sinusitis and nasal polyps. Various medications are available for the treatment of allergic rhinitis. The allergic rhinitis medicine and treatment will depend on the severity and type of symptoms that a person is experiencing.

Here are the different allergic rhinitis medications and treatments that your doctor might recommend:

  • Antihistamines - Antihistamines help block the action of the chemical called histamine. This chemical is released after an allergic reaction that provokes uncomfortable symptoms. Antihistamine can limit the release of histamine or help to lessen its effects once the body has released it. This allergic rhinitis medicine is available in various forms such as liquid, tablet, nasal spray, creams, and injections (used in extreme cases). It may usually take around 30 minutes for an antihistamine medicine to start working. There are antihistamines that cause sedation and antihistamines that do not cause sedation.
  • Nasal Sprays - Nasal sprays are one of the most effective allergic rhinitis treatments. Nasal sprays will help to deliver the medicine directly to the nose. The dose of medicine is less and nasal sprays have minimal side effects. There are corticosteroid nasal sprays available that help with immune response and inflammation in the nose. They are a long-term treatment option and a useful way to manage allergic rhinitis symptoms. The doctor may recommend you start using this spray before the seasonal symptoms start showing up. The daily use of nasal corticosteroids will help to reduce symptoms like coughing, wheezing, nasal congestion, etc.
  • Eye Drops - Eye drops can help to reduce the itchiness in your eyes and relieve you from watery eyes. It can also help reduce other symptoms related to allergies for a short term. However, overusing certain nose and eye drops may cause side effects, thus consult your doctor and make sure to get the best medicines for allergic rhinitis. The doctor will determine which medication is for long-term management and which one is for short-term use.
  • Decongestants - Decongestants come in the form of nasal sprays, nose drops, and even oral pills. These are best used for a short period of time. It helps to relieve symptoms of allergic rhinitis such as stuffy nose and sinus pressure. It also helps to shrink the blood vessels in the nose and reduce inflammation. After using it many times, the dose has to be higher for effective results. However, after the medication has worn off, it causes rebound congestion. This means once you have stopped taking medicines the symptoms will get worse. Therefore, such Nasal sprays or drops must not be used for more than 3 days as you can become dependent on them.
  • Nasal Saline Washout - Allergens can stay in the nose and it is important to wash them out. You can rinse your nose with a mixture of salt and water (saline) to reduce the effects of the symptoms. This is known as nasal sinus washout. A nasal washout with saline can be performed once per day or twice if your symptoms are severe. This saline solution must be taken in through the nostril while breathing in but do not let it reach the throat. This can be done using nasal irrigation kits, please consult your doctor.
  • Mast Cell Stabilizers - Mast cells stabilizers are medicines that will help to block a type of white blood cell called the mast cell from releasing histamine. For allergic rhinitis treatment, these stabilizers are available in the form of nasal sprays and eye drops that work effectively to lessen the symptoms.
  • Leukotriene receptor antagonists (LTRAs) - Leukotriene is another chemical that our body releases when it comes in contact with allergens. Leukotriene inhibitors are prescribed by the doctor because it helps to block the release of these chemicals in the body and thus lessen the risk of allergic rhinitis symptoms.
  • Immunotherapy - Immunotherapy or allergy shots can be recommended by the doctor in severe cases when nasal corticosteroids and antihistamines are not effective in controlling the symptoms of allergic rhinitis. This is a long-term treatment that will help to alter the body’s immune system in response to certain allergens or causes of allergic rhinitis. This medication requires a long-term commitment plan. These allergy shots include a small amount of allergens that you are allergic to and taking these gradually will help your body get used to these allergens.

A course of allergy shots begins with a buildup stage wherein you visit the doctor one to three times a week for the shots. After 3-6 months, you can get allergy shots for three to five days a week, and this is called the maintenance stage. At this stage, your allergy symptoms will fade away. Immunotherapy must be carried out only under the close supervision of a specially trained doctor.

How to Manage Allergic Rhinitis

The best way to prevent allergic rhinitis is to avoid the allergen that causes it. But this is not always easy. Allergens, such as dust mites, are not always easy to spot and can breed in even the cleanest house. It can also be difficult to avoid coming into contact with pets, particularly if they belong to friends and family. It is often possible to identify the allergens and other triggers that provoke allergic rhinitis by the following ways:

  • Recalling where you were and what you were doing before your symptoms started (for example, spending time outside or around animals)
  • Nothing the time of year during which you have noticed symptoms
  • Looking closely at the home, work and school environments for potential allergens

Your doctor may suggest skin testing if your symptoms are not well-controlled with medications or if it is not clear what is causing your symptoms. This involves an allergist putting tiny drops of different allergens on your skin, then quickly pricking the skin at those areas so that they enter the skin, and observing which causes a reaction. Blood tests are also available, although these are not needed in all situations.

In addition to treatment, there are a few steps that you can take to manage your allergic rhinitis.

  • Do not smoke and avoid being a passive smoker. In case you need help to quit smoking, consult your doctor for a management plan.
  • Rinse your sinuses and nose with a saltwater nasal spray or with a saltwater solution. This will help to thin the thick mucus and get rid of the dirt or allergens after a rinse. It will also contribute to reducing inflammation in your nose and improving your breathing.
  • Most importantly, you can prevent the worsening of symptoms by avoiding the allergens that trigger them.

How To Avoid Allergens

Data suggest that children less than 15 years of age are more sensitized to food, animal dander/Insects and dust as compared to adults whereas adults are more sensitized to mold/fungi and pollen. To avoid exposure to outdoor allergens, you can, take the following precautions:

  • During the pollen season, stay indoors during mid-morning and early evenings or when it is windy outside, as the pollen count in the air is usually higher during these times.
  • Wear a mask while gardening or visiting a dusty place.
  • Try not to hang clothes and towels to dry outside, as pollen and dust tend to stick to them.
  • When you are outside, always wear glasses/sunglasses to protect your eyes and prevent rubbing of eyes; doing so will irritate them and could make your symptoms worse.

Nearly all allergens thrive in moist, damp, or dirty places. One of the best ways to lower your chances of allergic rhinitis is to keep these places clean and dry. To avoid exposure to indoor allergens, you can, for instance, take the following precautions:

  • Try and keep your windows closed. Keep windows closed and use air conditioning in your car and home. Make sure to keep your air conditioning unit clean.
  • Clean floors with a damp rag or mop, rather than dry-dusting or sweeping.
  • Clean the walls regularly to get rid of patches of molds (fungus), if any.
  • Wash your blankets, pillow covers and bed sheets in hot water, frequently.
  • Get the carpet and curtains cleaned from time to time.
  • Use mite-proof covers for all your bedding – pillows, mattress, comforters etc. to reduce your exposure to dust mites.
  • Keep the humidity levels in your house as low as possible (you can use a dehumidifier), so that molds cannot thrive.
  • To limit exposure to mold, keep the humidity in your home low (between 30 and 50%) and clean your bathrooms, kitchen, and basement regularly. If mold is visible, clean it with mild detergent and a 5% bleach solution as directed by an allergist.
  • Exposure to pets - the proteins found in a pet's dander, skin flakes, saliva and urine can cause an allergic reaction in some people. Also, pet hair or fur can collect pollen, mold spores and other outdoor allergens.
    • Wash your hands immediately after petting any animals; wash your clothes after visiting friends with pets.
    • If you are allergic to a household pet, keep your pet out of your home as much as possible. If the pet must be inside, keep it out of your bedroom so you are not exposed to pet allergens while you sleep.
    • Close the air ducts to your bedroom if you have forced-air or central heating or cooling. Replace carpeting with hardwood, tile, or linoleum, all of which are easier to keep dander-free.
  • Cockroaches and mice cause allergies and asthma. Have a professional come to clear them out. Steps that may help to prevent pests include:
    • Close all open gaps in windows, floorboards, doors, and around drains.
    • Fix and seal leaky water faucets and pipes because roaches need water and humidity to survive.
    • Keep food in airtight containers.
    • Remove pet food dishes after they've eaten.
    • Keep stove and kitchen surfaces free of food and dirt.
  • Complementary health approaches - Yoga is a complementary alternative that has a great impact on the human body. Yoga is an inexpensive and safe methodology for the prevention of many systemic diseases.
  • The practice of yoga, including some breathing techniques like pranayama and Jalaneti can be helpful for the overall respiratory function. Jalaneti cleanses the nasal passage and Pranayama a breathing technique helps in improving the functions of the respiratory system.

AR can often be a debilitating condition, which, if untreated, can result in considerable health-related and economic consequences. Despite the fact that the symptoms of nasal congestion, sneezing, rhinorrhea, and nasal itch can be very troublesome to the patient, many people with AR do not to seek medical advice regarding treatment, choosing instead to self-treat with home remedies and over-the-counter medications. This may be because AR is perceived by both patients and the health care community as less important than other airway diseases such as asthma.

The presence of AR may also be directly linked to exacerbations of other inflammatory airway diseases, such as asthma, chronic otitis media, and rhinosinusitis and thus has additional important health implications.

Nasal allergies are usually responsible for substantially more disability than is generally realized. Thus, it is evident that the general population lacks an understanding of the symptom burden of AR, its associated risks for other respiratory complications, and its ability to compromise all aspects of an individual’s health.

For many people, allergic rhinitis is a lifelong condition. Fortunately, symptoms can usually be controlled with a combination of personal and environmental measures and medications. If your allergy symptoms seem to get worse, work with your doctor to identify potential triggers and develop a treatment plan.

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