Rhinitis

Rhinitis, commonly referred to as hay fever or allergic rhinitis, is an allergic reaction characterized by inflammation that leads to symptoms similar to a cold. These symptoms include nasal congestion, runny nose, sneezing, and itching. Despite its name, hay fever does not indicate an allergy to hay nor does it involve fever. Unlike the common cold, rhinitis is not contagious, as it is not triggered by a virus.

Rhinitis is an allergic response

Rhinitis is often a seasonal allergy, triggered by indoor and outdoor allergens such as pollen, dander, and dust mites, among others.

Rhinitis can persist for weeks to months, depending on the specific allergen causing the reaction. Rhinitis ranks as the 5th most common disease in the United States.

Avoiding allergy triggers

Managing allergic rhinitis without resorting to procedures or medications involves minimizing exposure to allergens. Avoiding contact with substances that trigger your allergies can help alleviate symptoms. However, complete avoidance may not always be feasible. In such cases, over-the-counter (OTC) medications can provide relief.

Causes of rhinitis

Rhinitis develops when your immune system misidentifies harmless airborne substances as threats, prompting the production of antibodies. The next time you encounter the substances, the antibodies signal a histamine release that causes allergy symptoms.

Common causes

The primary triggers for allergic rhinitis include:

• Specific foods or spices, potentially due to a food allergy

• Certain medications and excessive use of nasal sprays

• Changes in the environment

• Extreme temperatures or sudden temperature changes

• Strong smells and airborne irritants

• Hormonal fluctuations

• Exposure to irritants like tobacco smoke

Other allergy triggers

• Grass pollen, prevalent in late spring and summer

• Tree pollen, abundant in early spring

• Weed pollen, common in the fall

• Seasonal pollen allergies from flowers

• Year-round triggers like pet dander, dust mites, and cockroach waste may exacerbate symptoms, particularly in winter when homes are sealed up

• Spores from fungi and mold, which can occur seasonally or persist year-round

Rhinitis symptoms

Allergic rhinitis symptoms include:

• Fatigue

• Feeling like you have a cold

• General discomfort

• Headaches, if hay fever is severe

• Nasal allergy symptoms:

• Clear nasal discharge

• Itchy nose

• Nosebleeds

• Persistent nasal congestion

• Runny nose

• Sinus discomfort

• Frequent sneezing, often triggered by pollen or dander

• Nasal congestion

• Eye allergy symptoms:

• Watery, red or itchy eyes (allergic conjunctivitis)

• Throat allergy symptoms:

• Mouth breathing

• Coughing

• Itchy throat or itchiness in the roof of the mouth

• Snoring

• Sore throat from post nasal drip

• Ear symptoms:

• Recurrent ear infections

• Swollen, darkened skin beneath the eyes (allergic shiners), which are more prevalent in children

When to consult your healthcare provider

• If allergy medications fail to provide relief or produce undesirable side effects.

• When symptoms persist despite attempts to alleviate them.

• If you have concurrent conditions that exacerbate allergic rhinitis, such as asthma, recurrent sinus infections, or nasal polyps.

Diagnosing Rhinitis

Most often, the diagnosis is made by your healthcare provider based on a full health history and physical exam. In addition to the aforementioned symptoms, your healthcare provider may identify:

• Indentations beneath the eyes

• Inflamed nasal tissues

• Resorting to breathing through the mouth

Your healthcare provider may also suggest the following diagnostic tests:

Skin prick test: Small quantities of allergenic substances are introduced into the skin on your arm or upper back. If necessary, your doctor may refer you to an allergist who will monitor any allergic reactions, manifested by localized bumps (hives) at the site of the allergen exposure.

Allergy blood test (RAST, or radioallergosorbent test): A blood sample is taken and sent to a laboratory to gauge your immune system's response to specific allergens. This examination determines the levels of allergy-triggering antibodies present in your bloodstream.

Treating rhinitis

The best way to treat allergic rhinitis without any procedures or medications is to limit exposure. By preventing yourself from coming into contact with your allergy triggers, you can alleviate your symptoms.

In some instances, if this is not a possible solution, over-the-counter medications will be recommended to help. For severe symptoms, prescription medications may be necessary. Allergy medications have also proven to be beneficial, especially in combination with other allergy meds.

Medications

• Antihistamines: These medications can be taken orally, applied as nasal sprays, or used as eye drops to counteract the histamine response triggered by allergens. They are effective in preventing itching in the eyes and symptoms like sneezing and a runny nose. However, antihistamines are not very effective in relieving congestion. Common antihistamines include Claritin, Zyrtec, and Allegra.

• Decongestants: Available over the counter in liquid, pill, or nasal spray form, decongestants provide relief from allergy symptoms. Popular brands include Afrin and Sudafed. It's important to note that decongestants can have several side effects and should not be used continuously for more than two to three days.

• Nasal corticosteroids: These prescription nasal sprays, such as Nasonex, Rhinocort, and Flonase, are corticosteroids that effectively treat allergic rhinitis by reducing nasal inflammation, itching, and a runny nose. They are considered safe for long-term use and rarely cause side effects.

• Oral corticosteroids: Similar to nasal corticosteroids but taken orally, medications like prednisone are prescribed to alleviate severe allergy symptoms. However, oral corticosteroids can lead to significant side effects and are typically recommended for short-term use only.

Other treatments

• Allergy tablets: Sublingual immunotherapy, or allergy tablets, offer an alternative to allergy shots. They involve tiny amounts of allergens formulated into a pill, which is dissolved under the tongue daily.

• Allergy shots: Also known as immunotherapy, allergy shots are recommended when medications fail to alleviate rhinitis symptoms. Administered regularly over several years, these shots contain minute amounts of allergens to desensitize the body, reducing the need for medication. They are particularly effective for allergens like cat dander, dust mites, or pollen, and can aid in preventing the development of asthma in children.

• Nasal saline rinses (nasal irrigation): Using devices like the Neti Pot, nasal saline rinses help clear nasal passages by flushing them with a sterile saline solution. This process removes mucus and allergens, providing relief from nasal congestion and itching.

Who is at risk for rhinitis?

Individuals with asthma face an elevated risk of rhinitis. While there's a suspected association between allergic rhinitis and asthma, the precise connection remains unclear. Experts think that since rhinitis makes it hard to breathe through the nose, it’s harder for the nose to work normally. Breathing through the mouth does not warm, filter or humidify the air before it enters the lungs, which can make asthma symptoms worse.

Asthma and allergies share common chemical triggers in the body. Effectively managing allergic rhinitis may assist in controlling asthma symptoms for some individuals.

Several factors can heighten the likelihood of developing rhinitis, including:

• Atopic dermatitis (eczema). Although rash is not a main symptom of hay fever, people with eczema can notice flare ups.

• Living in a high-allergen environment, such as one with lots of pollen or dander.

• Having a mother who smoked during the first year of your life.

Frequently asked questions (FAQs) about Rhinitis

How can you tell the difference between rhinitis and a cold?

Distinguishing between rhinitis and a cold can pose a challenge due to their similar symptoms, but they differ in onset and duration.

Common cold: Cold symptoms typically include a runny nose with thick, sometimes yellowish discharge. These symptoms usually manifest three to five days after contracting a cold virus and persist for three to seven days.

Rhinitis: Rhinitis symptoms present as a clear runny nose with no fever, following immediate exposure to an allergen like pollen, with a duration for about as long as you are exposed to the allergen.

How can you relieve rhinitis without medication, or prevent it?

Rhinitis can't be entirely prevented, but certain lifestyle adjustments can help alleviate symptoms or provide relief based on their triggers, which may include:

Pollen or molds

• During pollen season, keep home entrances like doors and windows closed

• Utilize air conditioning or a humidifier indoors and in your vehicle

• Install a high-efficiency particulate air (HEPA) filter in rooms where you spend most of your time

• Regularly clean and replace filters in your home ventilation system

• Stay indoors on dry or windy days

• Avoid hanging laundry outside

• Steer clear of yard work such as mowing or raking leaves

• Limit outdoor activities in the early morning when pollen counts are highest

• Consider wearing a dust mask when engaging in cleaning or gardening tasks

Pet dander

• Keep pets out of your bedroom and off furniture

• Bathe dogs twice weekly, if feasible

Dust mites

• Wash bedding frequently using hot water

• Employ allergy covers on mattresses, pillows, or box springs

• Reduce humidity in rooms by using an air conditioner or dehumidifier.

• Use insecticide to eliminate dust mites on bedding, carpets, and furniture

• If highly sensitive to dust mites, consider removing carpeting from sleeping areas

• Regularly vacuum or use a vacuum with a HEPA filter

Cockroaches

• Seal crevices and cracks to prevent pest entry

• Maintain cleanliness by frequently cleaning your home, including daily garbage disposal and dishwashing

• Clear surfaces, counters, and floors of crumbs

• Store food in sealed containers

• Consult a professional exterminator if dealing with an infestation

Can rhinitis cause any complications?

Allergic rhinitis can lead to the following complications if left untreated:

• Ear infection: Children with rhinitis often experience middle ear infections

• Sinusitis: Prolonged sinus congestion due to rhinitis increases the likelihood of developing sinusitis, an infection or inflammation in the sinus membranes

• Aggravated asthma: Rhinitis can exacerbate asthma symptoms, including increased coughing and wheezing

• Sleep disturbances: Symptoms of rhinitis can disrupt sleep patterns, resulting in difficulty falling and staying asleep, leading to fatigue and a sense of unwellness

• Diminished quality of life: Whether due to disrupted sleep or general rhinitis symptoms, the condition can impact daily activities, enjoyment, and productivity, potentially leading to missed work or school days