Coastal Allergy & Asthma, P.C.

By Bruce D. Finkel, MD and Monica Rama, MD

Do you suffer from itchy, runny or stuffy nose that does not seem to go away? If so you may be one of millions of Americans who are affected by allergic rhinitis, commonly known as “hay fever”.

What is allergic rhinitis?

Allergic rhinitis is a condition that results in inflammation of the lining of the nose/sinuses following exposure to airborne allergens. Allergens are common substances in the environment (i.e., pollens, pet dander) that can cause allergic reactions in susceptible people. Exposure to these allergens triggers a cascade of events in the immune system that leads to inflammation and irritation of the nasal cavity, resulting in the familiar symptoms of “hay fever”

What are the symptoms?

Symptoms of allergic rhinitis can generally be divided into early and late phase symptoms

Early Phase Symptoms- occur within minutes of exposure to the allergen, and typically include:

• Itchy nose, eyes, throat
• Runny nose
• Frequent sneezing

Late Phase Symptoms- occur four to six hours after the allergen exposure, and with chronic disease. These can include:

• Nasal congestion
• Postnasal drip
• Sinus pressure
• Plugged ears
• Dark circles under the eyes
• Fatigue
• Irritability

What are the triggers?

Triggers of allergic rhinitis include exposure to a variety of airborne allergens. Allergens can be seasonal, often found outdoors during certain months of the year. These include tree, grass, and weed pollens, as well as certain mold spores. Sensitivity to these allergens results in seasonal allergic rhinitis. In general, tree pollens induce spring time symptoms while grass pollens elicit symptoms in the summer, and weed pollens cause symptoms in the fall. Perennial allergens are often found indoors throughout the year, and include pet dander (dried skin flakes/saliva), indoor mold, droppings from cockroaches, dust mites. Sensitivity to these allergens leads to perennial allergic rhinitis.

Who is prone to developing allergic rhinitis?

Allergic rhinitis affects about 40 million Americans of all ages. It most often develops in childhood, but can begin later in life. The major risk factors for developing allergies are genetics or a family history of allergies. Children whose parents are both affected by allergies have a 75% risk of developing allergies themselves; this risk decreases to about 50% if only one parent is affected. The risk of developing allergic rhinitis increases when patients have other allergic conditions. For example, young children with a history of eczema (an allergic skin disorder) have a higher risk of developing allergic rhinitis and asthma later in life.

What are some of the complications?

Although allergic rhinitis is not considered a serious or life threatening condition, the condition can have a significant impact on quality of life. The following are some of the reported complications of chronic allergic rhinitis:

• Sleep disorders
• Daytime fatigue resulting in poor school/work performance
• Higher risk of behavioral problems in children
• Increased number of sinus and ear infections
• Abnormal development of face/oral cavity (overbite) in children
• Higher risk of asthma
• Loss of smell and taste

How is it diagnosed?

Diagnosis begins by obtaining a medical and family history, as well as a detailed history of your symptoms, and a physical examination. The history and examination helps determine other potential causes of your symptoms. The simplest and most reliable method for detecting allergies is an allergy skin test. An allergy skin test consists of applying small amounts of allergens to the skin (usually on your back or arm) via a device that lightly scratches or pricks the skin. The test usually includes a panel of common indoor and outdoor allergens that are prevalent in your area. If an allergy is present, a hive forms at the site within 20 minutes. This relatively painless test helps determine whether or not you have allergies, and if so, the allergens to which you are sensitive.

How is it treated?

The first step in treatment is avoiding the allergens that are known to be triggering the symptoms. The second step usually involves medications which are recommended as needed for milder symptoms, and daily for more chronic or persistent symptoms.
Medications typically used include:

• Avoidance of the offending triggers
• Antihistamine tablets/liquid (relieve itching, sneezing and runny nose)
  • - Sedating antihistamines such as Benadryl, Chlortrimeton, and Tavist
  • - Nonsedating antihistamines such as Claritin, Allegra, Zyrtec, Xyzal, and Clarinex
• Anti-inflammatory medications (reduce inflammatory response and help prevent allergic symptoms):
  • - nasal corticosteroids such as Flonase, Nasonex, Veramyst,and Rhinocort
  • - leukotriene-antagonists such as Singulair
• Immunotherapy (allergy shots) – usually recommended for people with more severe symptoms who are not responding adequately to medications.

What is immunotherapy?

Immunotherapy or “allergy shots” refers to a mixture that contains the allergens to which an affected patient is sensitive. The sensitivities are determined by the results of allergy skin testing. The personalized mixture or vaccine is administered by injection into the skin (generally the upper arm) in small but increasing amounts over the course of many months. Over time the shots help your immune system become more resistant or tolerant to the specific allergens, lessening the need for future medications. Immunotherapy is generally recommended for 3-5 years. Allergy shots are approved by the FDA, and are the most effective, long term therapy for allergic rhinitis.

Some non board certified practitioners prescribe sublingual immunotherapy (also known as allergy drops) as a substitute for allergy shots. Sublingual immunotherapy in its current form has never been shown to be effective in treating allergy symptoms and is not approved by the FDA because of its lack of effectiveness. A newer form of sublingual immunotherapy that is delivered in a sublingual lozenge form is under clinical investigation in the United States. European investigators have enjoyed some success with the new form of sublingual lozenge, but the results have not been as effective as traditional allergy shots.

What is an Allergist?

Patients requiring immunotherapy should choose a board certified Allergist/Immunologist in order to receive the best and most up to date therapies for allergic disease. An allergist is a physician specifically trained to manage and treat allergies and asthma. Following a 3 year residency in Pediatrics or Internal Medicine, board certified Allergists/ Immunologists complete a two to three year Fellowship in Allergy and Immunology during which they receive extensive training in Allergic disease and therapies. After completion of the fellowship, Allergists must successfully pass the certifying examination of the American Board of Allergy and Immunology.