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what is allergic rhinitis
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  • What is Allergic Rhinitis? Symptoms, Causes, and Treatment

What is Allergic Rhinitis? Symptoms, Causes, and Treatment

Shuba Iyengar, MD, MPH
By Dr. Shuba Iyengar, MD, MPH Updated on Jun 19, 2024
Table of Contents
    Key Takeaways
    • Allergic rhinitis results from your immune system reacting to an allergen.
    • Common allergens include pollens, dust mites, and pet dander.
    • Treatments and preventive measures relieve symptoms and improve quality of life.

    Having allergic rhinitis can be bothersome, especially since symptoms can disrupt your daily life. Despite being common, unfortunately, it is often undiagnosed since people may not recognize their symptoms as allergic rhinitis and instead assume they have a cold [*].

    This article explains the nature of allergic rhinitis—including its manifestations, causes, treatment, and prevention strategies. Understanding this condition helps individuals seek proper care and avoid complications.

    What is Allergic Rhinitis?

    Allergic rhinitis, also known as hay fever, is an immune system response triggered by exposure to allergens such as pollen, dust mites, pet dander, or mold spores. As a result, your body releases histamine and other chemicals that lead to inflammation of your nasal passages, sinuses, and eyelids.

    Affecting 10-30% of the global population, its prevalence can vary based on geographical location, climate, and allergen exposure patterns.

    Allergic rhinitis can occur at any age, but often develops during childhood or adolescence since their immune systems are still maturing. Research shows that those affected by allergic rhinitis start experiencing symptoms by the age of 6 years [*].

    Related: Is It Allergies or Cold?

    What are the Common Symptoms of Allergic Rhinitis?

    Allergic rhinitis can vary widely depending on the type of allergen involved and the amount of allergen present in the air. Moreover, a person’s sensitivity level can affect the severity of their reaction.

    Common allergic rhinitis symptoms include:

    Be sure to take note of your symptoms and when and how often they occur. This information will help your healthcare provider make an accurate diagnosis.

    What are the Causes of Allergic Rhinitis?

    When a person comes into contact with certain allergens, their immune system mistakenly identifies them as harmful and reacts by releasing chemicals, such as histamine, into the bloodstream, to cause an allergic reaction.

    Common allergens in the air around you that may trigger allergic rhinitis include [*]:

    • Pollens (from trees, weeds, and grasses)
    • Dust mites
    • Pet dander
    • Mold spores
    • Allergens from insects, foods, and environment

    It's important to note that allergic rhinitis is not caused by the common cold (a viral illness) or by physical irritants (like strong odors, tobacco smoke or pollution). However, these factors can worsen symptoms in some individuals.

    What are the Types of Allergic Rhinitis?

    Allergic rhinitis can be categorized into two main types based on the timing and duration of symptoms:

    • Seasonal Allergic Rhinitis. It occurs in response to exposure to airborne allergens during specific times of the year. For example, tree pollens tend to emerge in the spring, grass pollens in the summer, and weed pollens in the fall.
    • Perennial Allergic Rhinitis. It occurs year-round and is typically caused by indoor allergens like dust mites, pet dander, and mold spores.

    Symptoms of seasonal allergic rhinitis and perennial allergic rhinitis are similar. The difference lies in their timing and triggers.

    Complications of Allergic Rhinitis

    If left untreated or inadequately managed, allergic rhinitis can lead to several complications, which may include:

    • Sinusitis
    • Ear infections (Otitis media)
    • Hearing impairment
    • Nasal polyps
    • Sleep apnea
    • Aggravation of asthma

    These complications can decrease your productivity and increase your likelihood of missed work or school days. In severe cases, patients deal with significant hospitalization costs [*].

    How is Allergic Rhinitis Diagnosed?

    Healthcare providers start by obtaining a medical history to understand a patient’s symptoms their duration, and any potential triggers. A physical examination focusing on the nose, throat, and eyes is also done to check for signs of an allergic inflammation.

    Allergy testing is often recommended. For instance, percutaneous skin testing involves pricking the skin with a small amount of an allergen, and allergen-specific IgE tests involve measuring the levels of allergy-related substances in the blood. These methods help identify specific allergens and confirm the diagnosis of allergic rhinitis [*].

    Sometimes, nasal endoscopy may be conducted to examine the nasal passages more closely. This procedure involves using a thin tube with a light and video camera at the end to visualize the inside of the nose and sinuses.

    Based on these evaluations and test results, your healthcare provider can arrive at a diagnosis and plan the right treatment.

    How is Allergic Rhinitis Treated?

    Treatment options for allergic rhinitis can include pharmacological management (such as the use of antihistamines and decongestants) and immunotherapy. Nasal saline irrigation can also be used alongside medications for symptom relief.

    We’ll explore each treatment below:

    Antihistamines

    Nasal antihistamines ( in combination with nasal steroids) are key in treating allergic rhinitis, and they work by blocking histamine receptors to relieve symptoms like sneezing, itching, and runny nose. They’re often used in combination with other medications, such as nasal corticosteroids and decongestants to provide greater relief.

    Side effects can include drowsiness (mainly with first-generation antihistamines), dry mouth, dizziness, and headache. It's important to avoid alcohol and be cautious with activities requiring alertness until you know how these medications affect you.

    Decongestants

    Decongestants help relieve nasal congestion and stuffiness. They work by constricting the blood vessels in the nasal passages, which reduces swelling and inflammation helps patients breathe more comfortably.

    Examples of decongestants are pseudoephedrine (taken orally) and oxymetazoline (nasal spray). At full strength, their side effects include increased heart rate, feeling restless, headaches, and nasal dryness.

    It’s important to use decongestants cautiously in individuals with hypertension or heart conditions, and avoid long-term use of nasal sprays to prevent dependency and worsening congestion.

    Related: Decongestants vs. Antihistamines

    Corticosteroid Nasal Sprays

    Corticosteroid nasal sprays reduce inflammation by blocking the production of chemical mediators that cause swelling and congestion. They are often used long-term to manage chronic allergic rhinitis symptoms. Regular use under medical supervision helps prevent relapse [*].

    Corticosteroid nasal sprays like triamcinolone, budesonide, and mometasone are highly effective for allergic rhinitis.

    Although they’re known for their safety and long-term use, they may cause mild side effects like nasal irritation, dryness, and nosebleeds. With proper technique (aiming away from nasal septum) and consistent use as directed, these sprays provide effective relief without systemic side effects associated with oral steroids.

    Related: Nasal Sprays for Allergies

    Leukotriene Inhibitors

    Leukotriene inhibitors like nasal olopatadine and oral montelukast are used to treat allergic rhinitis by blocking leukotrienes, inflammatory chemicals released during allergic reactions. They can relieve symptoms such as nasal congestion, sneezing, and runny nose, particularly when antihistamines or nasal sprays are insufficient.

    Regular monitoring is advised due to rare reports of serious neuropsychiatric events. Leukotriene inhibitors are typically well-tolerated and provide an alternative or adjunct to traditional allergy treatments.

    Immunotherapy

    Immunotherapy for allergic rhinitis, also known as allergy shots, is a form of long-term treatment. It works by desensitizing the immune system to allergens like pollen or dust mites.

    Patients who do not respond well to conventional medications or have severe symptoms that are difficult to manage can benefit from immunotherapy. Many medical organizations recommend it, and it’s also supported by rigorous controlled clinical trials and meta-analyses [*].

    Side effects can range from mild reactions like itching or swelling at injection sites to rare, severe allergic reactions (anaphylaxis). Regular monitoring during treatment is needed.

    How Can I Prevent Allergic Rhinitis?

    You can take several steps to help prevent allergic rhinitis or reduce its severity:

    • Identify and minimize exposure to allergens that trigger your symptoms, such as pollen, dust mites, pet dander, mold, and certain foods.
    • Use air purifiers with HEPA filters to reduce allergens indoors and regularly clean carpets, bedding, and curtains to minimize dust and pet dander.
    • Keep windows and doors closed during pollen seasons to prevent allergens from entering your home.
    • Encase mattresses, pillows, and duvets in allergen-proof covers to reduce exposure to dust mites.
    • Use a dehumidifier to reduce humidity levels, which can help prevent mold growth, a common allergen.
    • Wash your hands and change clothes regularly to remove pollen and other allergens.
    • If you're allergic to pet dander, consider keeping pets out of the bedroom and grooming them regularly.

    Even small changes in your environment and habits can make a difference in improving your quality of life.

    How Long Does Allergic Rhinitis Usually Last?

    Allergic rhinitis can last for varying durations depending on the type and severity of allergies. Seasonal allergic rhinitis typically lasts for the duration of the pollen season, which may span several weeks to months. Perennial allergic rhinitis, on the other hand, can persist continuously unless effectively managed with medications or allergen avoidance strategies.

    When to See a Doctor for Allergic Rhinitis

    You should see a doctor for allergic rhinitis if your symptoms are severe, persistent despite over-the-counter medications, or they significantly interfere with your sleep and daily activities.

    Additionally, if you experience complications such as recurrent sinus infections, worsening asthma symptoms, or suspect you may need allergy testing to identify specific triggers, it's advisable to seek medical attention.

    Early evaluation can lead to effective management strategies that help you better control allergic rhinitis.

    The Bottom Line

    Allergic rhinitis is common and it can be effectively treated with various medications. Moreover, changes in your lifestyle, such as minimizing allergen exposure, help with prevention. Nasal sprays are the mainstay for allergic rhinitis treatment.

    Remember to work closely with your healthcare provider who can create a personalized treatment plan based on your unique situation. Last but not least, actively participate in managing your health by staying educated about allergic rhinitis.

    References:

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    6. Hoang, M. P., Chitsuthipakorn, W., Seresirikachorn, K., & Snidvongs, K. (2022). As-needed intranasal corticosteroid spray for allergic rhinitis: a systematic review and meta-analysis. Rhinology, 60(4), 242–251. https://doi.org/10.4193/Rhin21.355
    7. Pavón-Romero, G. F., Parra-Vargas, M. I., Ramírez-Jiménez, F., Melgoza-Ruiz, E., Serrano-Pérez, N. H., & Teran, L. M. (2021). Allergen Immunotherapy: Current and Future Trends. Cells, 11(2). https://doi.org/10.3390/cells11020212
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