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Allergic Rhinitis

Allergic rhinitis describes the itching, sneezing and nasal congestion that is triggered by allergens, the substances that trigger allergic reactions.

Seasonal vs. Perennial Symptoms

Seasonal allergic rhinitis, also referred to as "Hay Fever", is triggered by allergens that come and go with the seasons. Despite its name, hay fever is rarely triggered by hay and it doesn't cause a fever. Seasonal allergic rhinitis triggers include:

Perennial allergic rhinitis is a reaction to allergens that are present all year. It is persistent, chronic and generally less severe than seasonal allergic rhinitis. Year-round (perennial) allergic rhinitis triggers include:

Some people can suffer from both seasonal and perennial allergic rhinitis.

What are the symptoms of allergic rhinitis?

Symptoms of allergic rhinitis usually develop immediately after exposure to an allergen and can include:

Although symptoms of allergic rhinitis may first appear at any age, they most commonly arise during childhood or early adulthood. The severity of symptoms usually changes year to year and most people find that symptoms tend to diminish slowly, often over decades.

How can I tell the difference between allergic rhinitis and a cold?

Allergies and colds can cause similar symptoms with significant nasal congestion, but there are ways to distinguish the symptoms.

How is allergic rhinitis diagnosed?

A medical history of your symptoms will taken to understand the severity of symptoms, the time of year that they occur, and the possible causes.

Skin tests or blood tests (RAST) may be recommended for determining the specific allergens that trigger your allergies.

What causes allergic rhinitis?

The immune system mistakenly identifies a harmless allergen, such as tree pollen, as something that harmful. It then produces antibodies that are designed to attack this allergen. The next time the body is exposed to the allergen, these antibodies are produced in large quantities. The antibodies release histamine and other chemicals that result in an allergic reaction.

How is allergic rhinitis treated?

There are several allergy medications available for the treatment of allergic rhinitis.They can be categorized as follows:

1) Antihistamines can be used to treat the symptoms of allergic rhinitis. Antihistamines are best started BEFORE peak allergy season or at the earliest signs of symptoms. Drowsiness is a common side effect of common over-the-counter anthistamines, such as diphenhydramine (Benadryl®) or chlorpheneramine.

Non-sedating antihistamines (Allegra®, Claritin®, Clarinex®, Xyzal®, Zyrtec®) are available, but they are more expensive and some insurers may not reimburse the cost for these medications if other less expensive medicines have not been attempted first.

2) Nasal corticosteroid sprays are an effective alternative to antihistamines. Examples include budesonide (Rhinocort®) and beclomethasone (Vancenase®, Beconase®). When they are used regularly and have been given enough time to have their full effect, nasal corticosteroid sprays control allergy symptoms in the nose better than antihistamines do. If the sprays irritate the nasal passages, it may be helpful to use a nasal saline spray afterwards, or to use a variety of nasal spray that is packaged in a water-based (aqueous, or AQ) spray.

3) Cromolyn nose spray (Nasalcrom®), which does not require a prescription, may also be used. It causes the least amount of irritation and other side effects. However, it work only when taken before exposure to an allergen, so they must be used before very predictable allergy exposures (staying at a friends with a pet) or used on a regular schedule (several times a day).

4) Antihistamine nasal spray, such as Astelin® (azelastine), is available by prescription only. Nasal antihistamine sprays may be recommended if you have significant side effects from oral antihistamines.

5) Decongestants may be used for immediate relief of symptoms of congestion. They are include phenylephrine (Sudafed® PE) and pseudoephedrine (Sudafed®). Decongestant medicine can also be purchased in the form of a nasal spray (oxymetazoline, or Afrin®). Nasal sprays are intended for short-term relief only. They can cause an increase in rhinitis symptoms if used for more than three days without a break.

Side effects from oral decongestants can include insomnia, high blood pressure, and a racing heart rate. Consult your health-care provider before using these medications if you have high blood pressure, a history of stroke, or heart disease.

Allergic rhinitis prevention

The most important step for preventing allergic rhinitis or decreasing the severity of symptoms is to minimize your exposure to allergens.

It's not possible to completely avoid allergens, but you can reduce its symptoms by limiting your exposure. It helps to know what you are allergic to so that you can take steps to avoid your specific allergic triggers.

Pollen or molds

Dust mites

Cockroaches

Pet dander