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Allergic Rhinitis

(Hay Fever; Seasonal Allergies)

Definition

Allergic rhinitis is irritation and inflammation in the nasal passages after exposure to allergens. Allergens are substances that cause an abnormal response of the immune system. The response can includes swelling of the nasal passage, runny or itchy nose, watery eyes, congestion and congestion pain, and sneezing. It may be:

Causes

An allergic reaction occurs when your body's immune system overreacts to an allergen. When you breathe in an allergen, cells in your nasal passages release a chemical called histamine. Histamine causes your nose to feel itchy and creates swelling and mucus production in the nasal passages.
Site of Histamine Production
Nasal passage
This area has swelling and increased mucus production after contact with an allergen.
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Risk Factors

Factors that increase your chance of having allergic rhinitis include:

Symptoms

Exposure to the allergen can cause:

Diagnosis

You will be asked about your symptoms and medical history. Allergic rhinitis is most often diagnosed based on description of symptoms. A referral to an allergy specialist may also be made.
The following tests may be done:

Treatment

Minimizing exposure to the allergen is the most effective way to treat allergies. Specific steps will depend on allergen such as:
Dust mite reduction:
Mold exposure reduction:
Animal allergen reduction:
Pollen reduction:
General reduction techniques:
Though reducing allergens can help, it is not possible to completely eliminate all allergens. Other treatments may help reduce the body's reaction to the allergen:

Medications

Medications can help to minimize the reaction of the immune system to reduce symptoms like swelling and mucous production. They may be given alone or in combination. Options include:
  • Nasal corticosteroid (glucocorticoid)—often considered most effective for allergic rhinitis
  • Antihistamine—may be pills taken by mouth or as nasal spray
These medications are most effective when delivered before exposure to allergen and through time of exposure.
Other medications that may be added include:
  • Nasal mast cell stabilizers
  • Leukotriene receptor antagonists
  • Anticholinergics
Decongestants may be recommended for severe congestion. Decongestants are not appropriate for everyone and do not stop symptoms, only temporarily relieve some pressure. Overuse of nasal decongestant sprays can actually make symptoms worse.

Immunotherapy

Immunotherapy gradually introduces your body to an allergen through injections or pills placed under the tongue. The goal is to make your body's immune system less sensitive to those allergens and reduce or eliminate allergic rhinitis. This therapy requires several treatments over an extended period of time. It may only be recommended for people who have poor management with medication alone.
The therapy is delivered in small amounts over weeks, months, or even years. Immunotherapy is only available for specific allergens but more may become available after appropriate testing.

Prevention

The reason that allergic rhinitis develops is not clear, so there are no clear steps to prevent it. Exclusive breastfeeding in the first few months of life may help decrease the risk of allergies later in life.

RESOURCES

American Academy of Allergy, Asthma, and Immunology http://www.aaaai.org

Asthma and Allergy Foundation of America http://www.aafa.org

CANADIAN RESOURCES

Allergy Asthma Information Association http://aaia.ca

Health Canada http://www.hc-sc.gc.ca

References

Allergic rhinitis. American College of Allergy, Asthma, & Immunology website. Available at: http://www.acaai.org/allergist/allergies/types/rhinitis/Pages/default.aspx. Accessed September 23, 2015.

Allergic rhinitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 8, 2015. Accessed September 23, 2015.

Managing Indoor Allergen Culprits. American Academy of Allergy Asthma and Immunology website. Available at: http://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Libraries/EL-indoor-allergies-managing-patient.pdf. Updated February 2011. Accessed September 23, 2015.

Rhinitis. American Academy of Allergy Asthma & Immunology website. Available at: http://www.aaaai.org/conditions-and-treatments/allergies/rhinitis.aspx. Accessed September 23, 2015.

Wheatley L, Togias A. Allergic Rhinitis. N Engl J Med 2015; 372:456-463. Accessed at: http://www.nejm.org/doi/full/10.1056/NEJMcp1412282. Accessed September 23, 2015.

8/11/2006 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Durham SR, Yang WH, Pedersen MR, et al. Sublingual immunotherapy with once-daily grass allergen tablets: a randomized controlled trial in seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2006;117:802-809.

8/27/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Kim JM, Lin SY, Suarez-Cuervo C, et al. Allergen-specific immunotherapy for pediatric asthma and rhinoconjunctivitis: a systematic review. Pediatrics. 2013 Jun;131(6):1155-67.

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