Your Guide to Allergies.
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Spring is in full bloom, and many areas of the country are experiencing high pollen levels, leading to misery in allergy sufferers. Will this be a bad year for allergies? It sure seems like it's starting out that way. So, if you're one of the 40 million Americans with allergic rhinitis (hayfever), it's time to be prepared to treat your symptoms.
The spring season typically brings tree pollen, the summer brings grass pollen and the fall brings weed pollen. Molds can be present all year long, although may be the highest in the late summer months. These are only general rules, and many areas of the country can have any type of pollen present throughout the year, especially after rains. Learn more about seasonal allergies.
If you have allergies, be prepared and read the following:
- Find out the pollen counts in your area
- Learn about allergic rhinitis symptoms
- Discover the best treatments for hayfever
What is Hay Fever?
From Daniel More, MD,
Your Guide to Allergies.
Stay up to date!
What is Allergic Rhinitis?
What is hay fever?
Hay fever, or allergic rhinitis, is the most common chronic disease, affecting up to 30% of the population. It is the most common reason for chronic sinus and nose problems. Children and young adults are the most common age groups affected by this disease, although many older adults and elderly people also experience symptoms.
Allergic rhinitis is defined as inflammation and irritation of the nasal passages due to seasonal and year-round allergens. Symptoms include sneezing, runny nose, nasal congestion, itching of the nose, and post nasal drip. Half of all people with allergic rhinitis also have a component of non-allergic rhinitis to their symptoms.
What puts someone at risk for developing hay fever?
Those at risk for the development of allergic rhinitis include people with a family history of atopy, those with atopic dermatitis, a mother who smoked during pregnancy, and living a modernized lifestyle (urban setting, higher socioeconomic status, small family size).
The presence of pets, especially multiple dogs, in the home at the time of birth appears to protect against the development of allergic diseases such as hay fever.
The above phenomenon is explained by the “hygiene hypothesis,” which suggests that since we live in a cleaner environment, our immune systems do not need to fight as many infections as in the past. We don't grow up on farms around animals, we don't play in the dirt, we receive vaccines to protect against infections, and we receive antibiotics when we do have infections. As a result, the immune system is less stimulated from an infection-fighting mode, and switches to allergy mode. Early pet exposure, especially to dogs, may help prevent this.
What’s the big deal, it’s just a runny nose, right?
Wrong. Allergic rhinitis affects nearly 39 million Americans, leading to millions of missed work days, school days, and days of reduced productivity each year as a result. The costs of this disease process are measured in the multiple billions of dollars annually (doctor visits, missed work/school days, and medication costs). The effect of allergic rhinitis on a person’s quality of life is comparable to that of a severe asthmatic.
Allergic rhinitis also influences other diseases. Uncontrolled hay fever symptoms can lead to sinus infections, ear infections and worsening of asthma. And people with allergic rhinitis are more prone to illnesses, since the inflammation in the nose makes them more susceptible to the virus that causes the common cold.
How is allergic rhinitis diagnosed?
History. Diagnosis is made by a person’s symptoms that are consistent with allergies, a physical exam by a medical professional showing signs suggestive of allergies, as well as positive allergy testing. It may be difficult to tell the in some people; clues which suggest allergies include:
- Presence of other atopic diseases (such as atopic dermatitis)
- Family history of allergic diseases
- Symptoms associated with a season or trigger (such as a cat)
- Improvement of the allergy symptoms with medications
- The presence of itching (of the nose, eyes, ears, roof of mouth) is highly suggestive of allergies
Physical exam. A physician will also perform a physical exam, looking for clues for allergies. The exam includes looking in the ears (fluid behind the ear drum can suggest allergies), in the nose (pale, swollen mucus membranes in the nasal passages suggest allergies), and in the mouth (evidence of post nasal drip may also suggest allergies). Dark circles under the eyes are called “allergic shiners,” and are due to nasal congestion. A horizontal crease on the nasal bridge is from upward rubbing of the nose with the palm of the hand, called an “allergic salute”.
Allergy testing. Positive allergy tests are required to diagnose allergic rhinitis; negative allergy testing suggests non-allergic rhinitis. Allergy testing is accomplished with skin testing or blood tests (called a RAST). Skin testing is considered the standard, and is performed in a variety of ways, the most common being prick (or scratch) tests. Find out more about allergy testing.
Find out about the treatment of allergic rhinitis.
Sources:
1. Bousquet J, van Cauwenberge P, Khaltaev N. Allergic Rhinitis and Its Impact on Asthma. J Clin Allergy Immunol. 2001;108:S147-344.
2. Buttram J, More D, Quinn J. Allergy and Immunology. The Complete History and Physical Exam Guide. 2003:53-69.
DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.
Updated: March 10, 2007
Treatment of Allergic Rhinitis, Part 2: Medications
From Daniel More, MD,
Your Guide to Allergies.
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Use of Medications
When avoidance measures fail or are not possible, many people will require medications to treat their allergic rhinitis symptoms. The choice of medication depends on numerous questions to be answered by the person or person’s physician:
1. How severe are the symptoms?
2. What are the symptoms?
3. What medication can the person get (over the counter, prescription)?
4. What medication will the person take?
5. Is the medication needed daily or intermittently?
6. What side effects might the person experience from the medications?
Oral anti-histamines. This is the most common class of medications used for allergic rhinitis.
The first generation anti-histamines, which includes Benadryl®, are generally considered too sedating for routine use. These medications have been shown to affect work performance and alter a person's ability to operate an automobile.
Newer, second-generation anti-histamines have now become first-line therapy for people with allergic rhinitis. These prescription medication include cetirizine (Zyrtec®), fexofenadine (Allegra®), and desloratadine (Clarinex®). Loratadine (Claritin®, Alavert® and generic forms) is now available over the counter.
These medications have the advantage of being relatively inexpensive, easy for people to take, start working within a few hours, and therefore can be given on as “as needed” basis. The medications are particularly good at treating sneezing, runny nose, and itching of the nose as a result of allergic rhinitis. Side effects are rare, and include a low-rate of sedation or sleepiness, but much less than the first-generation anti-histamines.
Topical nasal steroids. This class of allergy medications is probably the most effective at treating nasal allergies, as well as non-allergic rhinitis. There are numerous topical nasal steroids on the market, and are all available by prescription. Some people note that one smells or tastes better than another, but they all work about the same.
This group of medications includes fluticasone (Flonase®), mometasone (Nasonex®), budesonide (Rhinocort Aqua®), flunisolide (Nasarel®), triamcinolone (Nasacort AQ®) and beclomethasone (Beconase AQ®).
Nasal steroids are excellent at controlling allergic rhinitis symptoms. However, the sprays need to be used daily for best effect and therefore don’t work well as needed. Side effects are mild and limited to nasal irritation and nose bleeds. The use of these nasal sprays should be stopped if irritation or bleeding is persistent or severe.
Other prescription nasal sprays. There are two other prescription nasal sprays available, a nasal anti-histamine and a nasal anti-cholinergic. The anti-histamine, azelastine (Astelin®), is effective at treating allergic and non-allergic rhinitis. It treats all nasal symptoms similar to nasal steroids, and should be used routinely for best effect. Side effects are generally mild and include local nasal irritation and some reports of sleepiness, as it is a first-generation anti-histamine.
Nasal ipratropium (Atrovent nasal®) works to dry up nasal secretions, and is indicated at treating allergic rhinitis, non-allergic rhinitis and symptoms of the common cold. It works great at treating a “drippy nose”, but will not treat nasal itching or nasal congestion symptoms. Side effects are mild and typically include local nasal irritation and dryness.
Over-the-counter nasal sprays. This group includes cromolyn nasal spray (NasalCrom®) and topical decongestants such as oxymetazoline (Afrin®) and phenylephrine (Neo-Synephrine®). Cromolyn works by preventing allergic rhinitis symptoms only if used before exposure to allergic triggers. This medication therefore does not work on an as-needed basis.
Topical decongestants are helpful in treating nasal congestion. These medications should be used for limited periods of 3 days every 2-4 weeks; otherwise there can be a rebound/worsening of nasal congestion called rhinitis medicamentosa.
The side effects of the above are both generally mild and include local nasal irritation and bleeding, but topical decongestants should be used with caution in patients with heart or blood pressure problems.
Oral decongestants. Oral decongestants, with or without oral anti-histamines, are useful medications in the treatment of nasal congestion in people with allergic rhinitis. This class of medications includes pseudoephrine (Sudafed®), phenylephrine, and numerous combination products. Decongestant/anti-histamine combination products (such as Allegra-D®, Zyrtec-D®, Clarinex-D® and Claritin-D® are indicated for treating allergic rhinitis in people 12 years of age and older.
This class of medication works well for occasional and as-needed use, but side effects with long-term use can include insomnia, headaches, elevated blood pressure, rapid heart rate and nervousness.
Leukotriene blockers. Montelukast (Singulair®), was originally developed for asthma approximately 10 years ago, and is now approved for the treatment of allergic rhinitis as well.
Studies show that this medication is not as good at treating allergies as the oral anti-histamines, but may be better at treating nasal congestion. In addition, the combination of montelukast and an oral anti-histamine may be better at treating allergies than either medication alone.
Montelukast may be of particular benefit for people with mild asthma and allergic rhinitis, since it is indicated for both medical conditions. The medication must be taken daily for best effects, and usually takes a few days before it starts working. Side effects are usually mild and include headaches, abdominal pains and fatigue.
Want to keep learning? Discover the only potential cure for allergies: allergy shots.
Sources:
1. Dykewicz MS, Fineman S, editors. Diagnosis and Management of Rhinitis: Complete Guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology.
DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.
Hayfever Symptoms Caused by More Than Just Pollen
Spring is the major time of the year for hayfever, or allergic rhinitis, to occur. Classically, people who suffer from this type of allergy are allergic to pollens in the air. However, a recent study shows that people with hayfever are also more likely to suffer from non-allergic rhinitis.Non-allergic rhinitis is due to irritants, rather than allergens, and can mimic symptoms of hayfever. Triggers for non-allergic rhinitis include cigarette smoke, perfumes, cold air, weather changes and exercise. These triggers caused symptoms in 42% of people with hayfever, compared with only 3% of people without hayfever.
Seasonal Allergies
From Daniel More, MD,
Your Guide to Allergies.
Stay up to date!
Hay Fever
What is a Seasonal Allergy?
A seasonal allergy is an allergic reaction to a trigger that is typically only present for part of a year, such as spring or fall. This type of allergy refers to a pollen allergy, such as trees, weeds and grasses. Perennial allergies, on the other hand, are usually present year-round, and include allergens such as pet dander and house dust mite. Molds can be a seasonal or perennial allergy trigger.
What are Pollens?
Pollens are tiny egg-shaped powdery grains released from flowering plants, which are carried by the wind or insects, and serve to cross-pollinate other plants of the same type for reproductive purposes. When pollen is present in the air, it can land in a person’s eyes, nose, lungs and skin to set up an allergic reaction.
Symptoms may include allergic rhinitis (hay fever), allergic conjunctivitis (eye allergies) and allergic asthma.
Pollens that are spread by the wind are usually the main cause of seasonal allergies, while pollens that rely on insects (such as the honeybee) to be carried to other plants do not. Most plants with bright, vibrant flowers (such as roses) are insect pollinated and do not generally cause seasonal allergies since the pollen is not usually present in the air.
Pollen can travel long distances and the levels in the air can vary from day to day. The pollen level can be quite different in various areas of a particular city or area. Levels of pollen tend to be highest from early morning to mid-morning, from 5AM to 10AM.
What Causes Springtime Allergies?
Spring allergies are a result of pollen from trees, which can start pollinating anytime from January to April, depending on the climate and location. Trees that are known to cause severe allergies include oak, olive, elm, birch, ash, hickory, poplar, sycamore, maple, cypress and walnut.
In some areas of the world, some weeds will also pollinate in the springtime.
What Causes Summertime Allergies?
Grass pollen is typically the main cause of late spring and early summer allergies. Grass pollen is highest at these times, although grass may cause allergies through much of the year if someone is mowing the lawn or lying in the grass. Contact with grass can result in itching and hives in people who are allergic to grass pollen, this is called contact urticaria.
Grasses can be divided into two major classes, northern and southern grasses. Northern grasses are common in colder climates, and include timothy, rye, orchard, sweet vernal, red top and blue grasses. Southern grasses are present in warmer climates, with Bermuda grass being the major grass in this category.
What Causes Fall Allergies?
Weed pollen is the main cause of seasonal allergy in the late summer and early fall. Depending on the area of North America, these weeds include ragweed, sagebrush, pigweed, tumbleweed (Russian thistle) and cocklebur.
In some areas of the world, some trees can pollinate in the fall as well.
How Do I Know What Pollens are Present?
In most areas, pollen is measured and counted, with the different types of pollen identified. This may be reported in terms of trees, weeds and grasses, or may be further divided into the types of trees and weeds identified. Specific grasses are not usually identified on pollen counts, as grasses look the same under a microscope.
Find out what the pollen counts and types of pollen currently found in your area.
How Do I Know Which Pollens I am Allergic To?
An allergist can help determine if you have seasonal allergies, and to which types of pollens to which you are allergic. This is accomplished through allergy testing, which typically involves skin testing or a blood test (RAST). Allergy testing can be helpful in predicting the times of the year that you are likely to experience allergy symptoms, and is needed if you are interesting in taking allergy shots.
How Can I Avoid Pollen Exposure?
Unlike avoidance of pet dander and dust mites, it is more difficult to avoid exposure to pollens, since it is present in the outdoor air. Here are some tips to minimize pollen exposure:
- Keep windows closed prevent pollens from drifting into your home
- Minimize early morning activity when pollen is usually emitted-between 5-10 a.m.
- Keep your car windows closed when traveling.
- Stay indoors when the pollen count is reported to be high, and on windy days when pollen may be present in higher amounts in the air
- Take a vacation during the height of the pollen season to a more pollen-free area, such as the beach or sea.
- Avoid mowing the lawn and freshly cut grass
- Machine dry bedding and clothing. Pollen may collect in laundry if it is hung outside to dry
Want to keep learning? Find out more about the treatment of allergic rhinitis.
Source: American Academy of Allergy, Asthma and Immunology. http://www.aaaai.org/patients/publicedmat/tips/outdoorallergens.stm. Accessed February 13, 2007.
DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.
Updated: March 9, 2007
Non-allergic Rhinitis
From Daniel More, MD,
Your Guide to Allergies.
Stay up to date!
What is Non-allergic Rhinitis?
Non-allergic rhinitis is a medical condition of unknown cause, leading to symptoms very similar to allergic rhinitis, or hay-fever. Approximately half of people suffering from allergies also have a non-allergic component to their symptoms. Unlike allergies, which can be a seasonal problem, symptoms of non-allergic rhinitis are typically year-round. Non-allergic rhinitis also tends to be more common as people age, whereas allergic rhinitis tends to affect children and young adults. Non-allergic rhinitis has many different forms:
• Vasomotor rhinitis is triggered by physical conditions such as strong odors, perfumes, changes in temperature and humidity, smoke, fumes and bright sunlight. Most patients experience a runny nose, post nasal drip and/or nasal congestion.
Itching of the nose and eyes is typically not present.
• Infectious rhinitis is typically related to a viral or bacterial infection, and symptoms can mimic a sinus infection, with facial pain and green nasal discharge. However, these patients do not have evidence of a sinus infection on x-rays. This disease process resolves on its own within a few days, and responds to oral antibiotics in severe or prolonged cases, just as a sinus infection would.
• Hormonal rhinitis can occur during pregnancy and in patients with low thyroid function. Pregnant women usually have symptoms of severe nasal congestion occurring during their second month of pregnancy, and this can persist until the baby is born. Symptoms typically disappear shortly after delivery.
• Medication-induced rhinitis can occur in many patients using high blood pressure medication, birth control pills and non-steroidal anti-inflammatory drugs (such as aspirin and ibuprofen).
• Rhinitis medicamentosa is related to overuse of over the counter decongestant sprays, such as oxymetazoline, with symptoms of severe nasal congestion and runny nose. People who over-use these sprays essentially become “addicted” to the medication, needing more and more medication to control their symptoms.
• Gustatory rhinitis can be related to food or alcohol intake, but is rarely due to an allergic cause. People suffering from this form of rhinitis experience a runny nose, usually of a clear, watery fluid, particularly after eating hot or spicy foods.
• Rhinitis related to acid reflux disease is particularly common in young children, with symptoms of nasal congestion, runny nose and post-nasal drip. Symptoms may tend to occur after heavy meals, or in the morning after the person has been having acid-reflux while lying flat at night.
How is Non-allergic Rhinitis Diagnosed?
It can be very difficult to diagnose non-allergic rhinitis by a person’s symptoms alone. A diagnosis is usually based on the history of symptoms, medication use, other known medical problems, and a physical examination. Allergy testing will be negative in patient with non-allergic rhinitis, and this testing is usually required to make sure that allergies are not playing a role in the person’s symptoms.
How is Non-allergic Rhinitis Treated?
Avoiding the irritant triggers which cause the symptoms is the best way to treat non-allergic rhinitis, but not always possible. Typically, patients with non-allergic rhinitis do not respond to anti-histamine medications, since histamine is not causing their symptoms.
Medications which are at least partially effective include prescription nasal steroid and antihistamine sprays, and oral decongestants. Patients with symptoms of constant “dripping” nose and post nasal drip may benefit from the drying effect of an anti-cholinergic nasal spray, and seem to be most helpful in vasomotor and gustatory rhinitis.
Rhinitis during pregnancy can respond to saline nose sprays, and rhinitis medicamentosa requires stopping the over-the-counter topical decongestant and often replacing it with a prescription nasal spray.
Treatment of other forms of non-allergic rhinitis may be patient-specific and require the care of a physician. Allergy shots, or immunotherapy, are ineffective in the treatment of non-allergic rhinitis.
Source: Diagnosis and Management of Rhinitis: Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 1998;81:463-518.
DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.
Updated: January 13, 2007
