Topic of the Month: March 2007: Spring & Allergic Rhinitis
In this Topic of the Month, you will learn:
- About allergic rhinitis
- Causes
- Symptoms
- Treatment
- Prevention
- The difference between allergic rhinitis and non-allergic rhinitis
- When to see a specialist
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Do you have bouts of sneezing and itching, or a runny or stuffy nose that do not seem to go away? If so, you may have rhinitis. With the peak of the spring allergy season fast approaching, millions of Americans are keeping their tissue boxes close by. The budding trees and blooming flowers associated with the early return of spring mark an increase in itchy, watery eyes, sneezing and other allergy symptoms.
Rhinitis is one of the most common illnesses in the United States, affecting more than 50 million people. Rhinitis has a significant impact on the quality of life of those who suffer from it. It can contribute to other conditions such as sinus problems, ear problems, sleep problems, and learning problems. Additionally, in patients with asthma, uncontrolled rhinitis seems to make asthma worse. It is also important to understand that there are two general types of rhinitis: allergic rhinitis and non-allergic rhinitis.
 What is allergic rhinitis?
Seasonal allergic rhinitis, or “hay fever,” affects more than 20 percent of the people living in the United States. Allergic rhinitis is caused by substances that we breathe called allergens. Allergens are usually harmless substances that can cause problems only in some people. These problems are caused because the immune system of people with allergic rhinitis mistakenly identifies these substances as intruders and generates a reaction against them. During this reaction, the immune system cells release substances such as histamine and leukotrienes that cause the symptoms of allergic rhinitis; these and other substances also cause inflammation in the nasal lining that makes the nose very sensitive to irritants such as smoke and strong odors or to changes in the temperature and humidity of the air.
What are the common causes of allergic rhinitis?
When allergic rhinitis is caused by common outdoor allergens, such as airborne tree, grass and weed pollen or mold, it is called seasonal allergic rhinitis, or “hay fever.”
Allergic rhinitis is also triggered by common indoor allergens, such as animal dander (dried skin flakes and saliva), indoor mold, droppings from dust mites and cockroach particles. This is called perennial allergic rhinitis.
What are the symptoms of allergic rhinitis?
- Sneezing
- Stuffy nose (congestion)
- Runny nose
- Itching in the nose, roof of the mouth, throat, eyes and ears
- Tearing eyes
- Dark circles under the eyes
The symptoms of rhinitis tend to flare up in the spring because many trees, grasses and weeds contain small and light pollens that are easily carried by the wind.
How is a diagnosis made?
If you have symptoms of allergic rhinitis, an allergist/immunologist can help determine which specific allergens are triggering your illness. He or she will take a thorough health history, and then use tests to determine if you have allergies. Skin tests or blood tests are the most common methods for determining your allergic rhinitis triggers.
How is allergic rhinitis treated?
Once your allergic rhinitis triggers are determined, your physician or nurse will work with you to develop a plan to avoid the allergens that trigger your symptoms. For example, if you are allergic to dust mites or indoor mold, you will want to take steps to reduce these allergens in your house as much as possible. Additionally, your physician might prescribe medication to decrease your allergic rhinitis symptoms. Some of these medications may include antihistamine pills, nasal antihistamine sprays, nasal corticosteroid sprays, or decongestant pills. Visit the Tips to Remember: Rhinitis brochure, for a complete listing of medications used to treat allergic rhinitis.
How can the symptoms of allergic rhinitis be prevented?
Make sure your exposure to irritants like pet dander, dust and mold is limited. To avoid pollen, keep windows and doors closed and use air conditioning. Stay inside when pollen counts are high, and bathe or change clothes after being outdoors. During the spring time, dry clothes in a dryer, not outdoors.
To avoid mold, do not walk through uncut fields or rake leaves. Keep windows and doors closed and use air conditioning. Clean moldy surfaces in the house, fix water leaks and use air conditioning and a dehumidifier to reduce indoor air humidity.
To avoid house dust mites, put mattresses, pillows and box springs in dust-proof casings.
Wash bedding weekly in water that is hotter than 130º F and remove stuffed toys from bedrooms.
To avoid animal dander, preferably, pets should not be kept in the house. If they are, keep them out of the bedroom and keep the bedroom door closed. Do not let pets sit on furniture.
 What is non-allergic rhinitis?
At least one out of three people with rhinitis have no allergies. Non-allergic rhinitis usually afflicts adults and causes year-round symptoms, especially runny nose and nasal congestion. This problem differs from allergic rhinitis because the immune system does not seem to be involved. Unfortunately, we do not have good understanding of why non-allergic rhinitis occurs.
What are the symptoms of non-allergic rhinitis?
Some people with non-allergic rhinitis have inflammation in their nose and sinuses. In the most severe forms of this problem, patients have polyps, which are growths on the mucus membranes of the nose that block the air from moving in and out. Patients with these problems also suffer from loss of the sense of smell. In other forms of non-allergic rhinitis there is very little if any inflammation in the nose and the symptoms are mostly triggered by strong smells, pollution, smoke and other irritants. Some doctors call this condition vasomotor rhinitis.
What are the causes of non-allergic rhinitis?
Symptoms of non-allergic rhinitis can be caused by medications as side-effects. These include some blood pressure medicines, oral contraceptives, or medications used for erectile dysfunction. The most common form of this type of non-allergic rhinitis is caused by nasal decongestant sprays, when they are used by some people for long periods of time. This type of medication-induced rhinitis is also called rhinitis medicamentosa.
How is non-allergic rhinitis treated?
If there is inflammation in the nose, the treatment of choice for this form of non-allergic rhinitis is nasal corticosteroid sprays. If there is a lot of runny nose, ipratropium nasal spray can provide relief against this symptom in non-allergic rhinitis. If nasal congestion is a major problem, decongestant pills or sprays can be used, but the sprays should not be used for more than four days.
Recently, an azelastine nasal spray has been found helpful in relieving the symptoms of non-allergic rhinitis.
By learning about the causes and symptoms of various forms of rhinitis, you will be better able to identify your symptoms and triggers. Your allergist/immunologist can assist by making an accurate diagnosis and developing an effective treatment plan for you.
When should someone see an allergist/asthma specialist for allergic rhinitis?
Allergy sufferers don't have to cope with the symptoms of allergic rhinitis every spring. An allergist/immunologist can offer relief and a plan to control the cycle of symptoms that leads to 14.1 million physician office visits and an overall cost of $6 billion each year. Patients should see an allergist/immunologist if they:
- Have prolonged or severe symptoms of rhinitis.
- Have nasal polyps.
- Have co-existing conditions such as asthma or recurrent sinusitis.
- Have symptoms interfering with quality of life and/or ability to function.
- Have found medications to be ineffective or have had adverse reactions to medications.
- For detailed explanation of how an Allergist/Immunologist can help please see the AAAAI’s How Referral to an Allergy/Immunology Physician can Help.
Additional Resources
This topic was reviewed on 3/1/2007 by Stuart Friedman, MD, FAAAAI, Patients & Consumers Web Editor
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