Rhinitis (Hay Fever)
Do you suffer from frequent sneezing, congestion or stuffiness and an itchy or runny nose? If so, you may have a condition called rhinitis.
There are two types of rhinitis: allergic rhinitis and non-allergic rhinitis.
Allergic rhinitis is caused by allergens like molds, pollen and animals. These are substances which are usually harmless, but can cause allergic reactions in certain people.
Allergy symptoms are the result of a chain reaction that starts in the immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to pollen, your immune system identifies pollen as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release histamine and other chemicals, causing an allergic reaction with symptoms such as sneezing, stuffiness, a runny nose, itching and post-nasal drip.
People with allergic rhinitis are also prone to itchy, watery eyes (from allergic conjunctivitis or eye allergies), and they may be more sensitive to irritants such as smoke, perfume or cold, dry air. Rhinitis can contribute to other problems such as asthma, sinus or ear conditions, or trouble sleeping.
Allergic Rhinitis Triggers
Seasonal allergic rhinitis, commonly known as hay fever, is triggered by outdoor allergens such as pollen and mold spores. Some people have symptoms year-round due to indoor allergens from pets, mold, dust mites and cockroach residue. This is called perennial allergic rhinitis. You can suffer from either seasonal or perennial allergic rhinitis, or a combination of both.
Diagnosis of Allergic Rhinitis
An allergist/immunologist, often referred to as an allergist, has specialized training and experience to determine which allergens, if any, are causing your symptoms. Your allergist will take a detailed health history, perform a physical exam and then most likely test you for allergies. Skin tests show the results within 20 minutes. These results, as well as how frequent and bad your symptoms are, will be considered when developing a treatment plan. Steps to manage your symptoms may include avoiding the allergens you are allergic to, medications or allergy immunotherapy (allergy shots or tablets).
Treatment and Management of Allergic Rhinitis
The first step to manage this condition is to avoid allergens that cause symptoms. For instance, if you are allergic to dust mites, it is important to take steps to prevent exposure to dust mites, such as frequently washing bed linens in hot water. The same is true for outdoor allergens. Limiting your exposure during times of high pollen and mold counts may help reduce symptoms.
Sometimes taking steps to avoid allergens isn’t possible or it isn’t enough to control allergic rhinitis symptoms. That is when your allergist may suggest allergy immunotherapy or recommend medications to control inflammation and prevent symptoms.
Nasal corticosteroid sprays control inflammation and reduce all symptoms of allergic rhinitis, including itching, sneezing, runny nose and stuffiness. Antihistamines in the form of liquid, pills or nasal sprays block histamine and may relieve itching, sneezing and runny nose. But they may not be as effective in reducing nasal stuffiness.
Anti-leukotrienes in pill form can decrease the symptoms of allergic rhinitis in some people.
Decongestant pills or nasal sprays can be used as needed if nasal stuffiness is not relieved with other medications. Decongestant nasal sprays should not be used for more than three days because they can cause your congestion to return and worsen. Ipratropium nasal spray can be used specifically for a runny nose.
Even though some of these medications are available over-the-counter, you should still work with your allergist to discover what medications work best for you. More importantly, an allergist can screen you for allergic asthma, which is common for rhinitis patients.
Your allergist may also recommend allergy immunotherapy, also known as allergy shots or tablets. This treatment involves receiving injections or taking tablets periodically over a period of three to five years. They have been proven effective in decreasing sensitivity to allergens, sometimes permanently.
Many people with rhinitis symptoms do not have allergies. If you have non-allergic rhinitis, avoiding allergens is unnecessary and won’t help your symptoms. This highlights the need to visit an allergist to determine what you are or are not allergic to.
Non-allergic rhinitis usually begins in adults and causes year-round symptoms, especially a runny nose and nasal stuffiness. Strong odors, pollution, weather changes, smoke and other irritants may cause symptoms of non-allergic rhinitis. Non-allergic rhinitis symptoms can also develop as side effects of medications, including some blood pressure medicines, oral contraceptives or medications used for erectile dysfunction. Another type of non-allergic rhinitis is caused by nasal decongestant sprays such as oxymetazoline, when used for long periods of time. This type of medication-induced rhinitis is called rhinitis medicamentosa.
Treatment of Non-Allergic Rhinitis
Oral antihistamines and anti-leukotriene drugs generally do not benefit non-allergic rhinitis. However, treatment options include nasal corticosteroid sprays and nasal antihistamine sprays. Ipratropium nasal spray can relieve a runny nose and decongestant pills can be used as needed to relieve nasal stuffiness.
Other forms of treatment may be considered if you have problems with the structure of your nose, such as narrow drainage passages, tumors or a shifted nasal septum (the bone and cartilage that separate the right from the left nostril). In these cases, an operation may be needed.
• There are two forms of rhinitis: allergic and non-allergic. This distinction is important in order to provide the best plan for controlling your symptoms.
• The allergic form of rhinitis can be caused by outdoor allergens such as pollen and mold spores. This is referred to as seasonal allergic rhinitis or hay fever. Allergic rhinitis can also be caused by indoor allergens such as dust mites or pets. This is called perennial allergic rhinitis, as symptoms are usually year-round.
• Steps to treat allergic rhinitis include trigger avoidance, medications for inflammation and symptom relief, and immunotherapy (allergy shots and tablets). Treating non-allergic rhinitis may include symptom relieving medication. Operations to correct your nasal structure may also be necessary.
Feel Better. Live Better.
An allergist / immunologist, often referred to as an allergist, is a pediatrician or internist with at least two additional years of specialized training in the diagnosis and treatment of allergies, asthma, immune deficiencies and other immunologic diseases.
By visiting the office of an allergist, you can expect an accurate diagnosis, a treatment plan that works and educational information to help you manage your disease and feel better.
The AAAAI's Find an Allergist / Immunologist service is a trusted resource to help you find a specialist close to home.
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This article has been reviewed by Andrew Moore, MD, FAAAAI