Allergic Rhinitis (Hay Fever)

By Roland Larrabee, M.D.

Allergic rhinitis is a reaction of the lining of the nose to particles in the air. Allergic rhinitis occurs when the nose and usually also the ears, eyes, sinuses, and throat come into contact with allergy-causing substances. The allergy-causing substances are called allergens. The most common allergens are pollens, molds, dust, and animal dander. Some allergens are present only during certain seasons, for example, ragweed in the fall. The allergic reaction they cause is called seasonal allergic rhinitis or hay fever. Other allergens are present year-round, such as the mites in house dust. These allergens cause a type of rhinitis called perennial allergic rhinitis.

When the lining tissues of the nose and sinuses come into contact with allergens, a chemical called histamine is released from cells in these tissues. Histamine causes the nose lining to swell, itch, and produce excess mucus.

Common symptoms of allergic rhinitis are itchy, runny nose, sneezing, and nasal and head congestion. Other common symptoms include fatigue and lethargy, itchy throat, postnasal drainage, and itchy watery eyes.

It may take some detective work to figure out exactly what you are allergic to. You may have tests for specific allergies. For most people the best tests are skin scratch or prick tests. For these tests your health care provider or an allergy specialist places tiny amounts of suspected allergens under your skin and looks for reactions. These allergy tests will identify which of many possible allergens are causing your symptoms. In some cases you may have blood tests to look for antibodies to suspected allergens. Allergy tests are expensive. Your health care provider will probably recommend that you first try treating your symptoms with medicine. If medicines do not control your symptoms, then you may need allergy tests.

The first step is to try to avoid contact with the things you are allergic to. For example, using an air conditioner rather than having your windows open during ragweed season can help. Special HEPA air filters can lessen the amount of pollen that circulates in your home. Putting plastic covers on mattresses may help you avoid dust and mold. You may also cover pillows with plastic. Limiting the amount of carpeting can reduce dust-mites.

The second step is treatment with medicine. Decongestants (for itchy, watery symptoms) or decongestants (for congestion) can be used for mild symptoms. You may have some side effects from decongestants, such as a rapid heart rate or trouble sleeping. A commonly used decongestant is pseudoephredrine (Sudafed®).

There are different types of antihistamines. Drowsiness is a common side effect of many of them (diphenhydramine [Benadryl®], chlorpheniramine [Chlor-Trimeton®]). This may not be a problem if a dose at bedtime is all you need. Or you might try the medicine for several days despite the drowsiness. Often the drowsiness goes away after you have taken the drug for 3 to 5 days. Some "nonsedating" antihistamines are available that usually don't cause drowsiness (Claritin® [available over-the-counter], Zyrtec®, Allegra®). They work well for most people, but they tend to cost more than other antihistamines. Some people take antihistamines only on the days they are having symptoms. Others start the medicine at the beginning of their usual allergy season and continue taking it until the season is over. It is safe to take antihistamines and decongestants together if you do not have a medical reason for not taking either type of medicine.

Your health care provider may prescribe a steroid nose spray. A nonprescription nose spray containing a medicine called cromolyn is also available. Depending on your other allergy symptoms, the nose spray may be the first and only medicine you need. Additionally, a drug such as Singulair® (originally approved for asthma) can be used.

If your symptoms are severe in spite of medicines, allergy shots may be suggested. A mixture is prepared that contains the allergens identified in your allergy tests. The mixture is injected into your skin in tiny but increasing amounts over the course of many months. Over time, the shots make you less sensitive to the allergens. Usually after 4 to 6 months of allergy shots you will begin to have relief from your allergies. However, you will probably need to continue the shots for 2 to 3 years or longer.

Dr. Larrabee is Associate Director of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.