Patient Education – Allergic Rhinitis

Allergic Rhinitis (“Hay Fever”) and Its Treatment

When allergies (see What is an Allergy?) affect the nasal passages and sinuses, the result is symptoms of allergic rhinitis. Most people are more familiar with the term “hay fever” which implies seasonal symptoms of sneezing, running and itching nose, nasal and sinus congestion, and post-nasal drip. The term “Allergic rhinitis” includes both seasonal and year-round (perennial) forms of the disease.

The allergens that cause allergic rhinitis include dust mites, pollens (weeds, grasses, trees), animal dander (mostly cats and dogs), and molds. Sometimes the patient’s history and pattern of symptoms can help determine what is causing the allergic rhinitis.

When symptoms are worse at only certain times of the year (seasonal allergic rhinitis) they are most likely due to pollens or outdoor molds. As a broad generalization, weeds are a problem in the fall, grasses in the spring and summer, molds during late summer, and trees during late winter and spring. These facts do not always apply to South Florida because of our unique weather conditions.
When symptoms occur year-round (perennial allergic rhinitis) they are usually due to dust mites, indoor molds or animal dander. If they occur while the person is in bed or while sitting on a fluffy couch, dust mites are the likely cause (upholstered furniture, beds and carpets are dust mite havens).

The diagnosis of allergic rhinitis can be made by combining the patient history and physical exam. On the physical exam the doctor will look for typical signs of allergic rhinitis including “allergic shiners” (dark circles under the eyes), nasal tissue swelling, red eyes, and evidence of post-nasal drip. Skin testing confirms the diagnosis and helps to narrow down the causes.

Treatment for allergic rhinitis starts with avoidance strategies. This can be a very simple task if only one allergen is predominant, such as giving away the family cat (allergists recognize that this may be very difficult for those emotionally attached to their animal). Avoidance of dust mites is possible if one follows certain environmental control measures. Pollen and outdoor mold exposure can be limited by keeping car or windows closed, but it is difficult to totally avoid these allergens (unless you never go outside!). In most cases different types of allergens are involved in the same individual, making complete avoidance a difficult task.

Also, part of treatment for allergic rhinitis is medications. There are current prescription medications that are very effective and have minimal side effects. The newer antihistamines (Claritin™, Allegra™ , Zyrtec™, Xyzal™, Clarinex™) cause very little sleepiness and are quite useful. Prescription nasal cortisone/steroid sprays are also very effective and safe medications – usually more effective than allergy pills. These steroid-type nasal sprays should not be confused with “systemic” steroids (pills, syrup, injection), which do have significant side effects. Also, the newer antihistamine sprays can be very effective (e.g. Astepro™, Patanase™).

Some patients don’t respond well to medications, and some simply don’t want to be taking daily medications. For those people, allergy shots are a great option. Allergy injections (see Immunotherapy), when given to appropriate patients at the proper dose are also very effective. They can be an alternative or an addition to the above medications. Although they may take 3-6 months to start working, these injections provide long-lasting relief of symptoms and less reliance on drugs. While the shots are starting to work, patients are usually maintained on allergy medications.