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Allergic Rhinitis

  1. What is allergic rhinitis?
  2. Symptoms
  3. Causes
  4. Risk factors
  5. Diagnosis
  6. Treatment
  7. Management
  8. Complications
  9. FAQ

What is allergic rhinitis?

Allergic rhinitis is a condition in which inflammation develops inside the nose; this is caused by an allergic reaction to particles in the air. These particles, which are otherwise harmless to the body, are known as allergens.

Typical symptoms of allergic rhinitis include:

  • A runny nose
  • Sneezing
  • Itchy eyes

Allergic rhinitis is one of the most common chronic diseases and is estimated to affect between 40 and 60 million people in the U.S.[1]

Allergic rhinitis can be differentiated into three types:

  • Hay fever, also known as seasonal rhinitis, which is triggered by exposure to outdoor allergens, such as pollen from plants
  • Perennial rhinitis, which occurs all year round and is commonly provoked by allergens contained in dust, animal hair and mold
  • Occupational rhinitis, which describes an allergic reaction to particles encountered in a particular work environment, such as flour in a bakery

Read more about hay fever »

There is no cure for allergic rhinitis, but the effects of the condition can be lessened with the use of nasal sprays and antihistamine medications. A doctor may recommend immunotherapy - a treatment option that can provide long-term relief. Steps can also be taken to avoid allergens. The severity of allergic rhinitis can also change over the course of an affected person’s life. This means, for example, that the effects of allergic rhinitis may fade during puberty, or that an affected person may develop a sensitivity to new allergens during adulthood.

Allergic rhinitis symptoms

The symptoms of allergic rhinitis can develop minutes after exposure to the allergen. The most commonly experienced symptoms of allergic rhinitis include:[1][2]

  • Sneezing
  • A stuffy, runny or itchy nose
  • Red, itchy and watery eyes, also known as allergic conjunctivitis
  • Coughing, caused by a mucus build up at the back of the throat, also known as postnasal drip
  • Swelling around the eyes
  • A sore throat
  • Headache

In addition to the symptoms listed above, people who suffer from both asthma and allergic rhinitis are likely to experience asthmatic symptoms during an attack of hay fever. Most commonly, these include:[3][4]

  • A tight feeling in the chest
  • Wheezing
  • Shortness of breath

Read more about asthma »

Worried you may have this condition? Start a symptom assessment on the Ada app.

Allergic rhinitis causes

An allergic reaction happens when the immune system produces a type of antibody called Immunoglobulin E (IgE) after it is exposed to an allergen such as pollen.

The IgE antibodies prompt the body to release chemicals, such as histamine, that cause inflammation in the nose and itchiness in the eyes.[5] The allergens that trigger this kind of reaction vary from case to case.

Causes of hay fever or seasonal rhinitis

Hay fever is caused by exposure to pollen [6] and sometimes other outdoor allergens, such as mold. Plants produce most pollen in summer months, making it the season when hay fever symptoms are generally at their most intense. Four of the primary triggers of hay fever are:[1][2]

  • Grass pollen
  • Pollen from trees
  • Weed pollen
  • Airborne mold

Read more about hay fever »

Causes of perennial rhinitis

Perennial rhinitis or persistent allergic rhinitis describes a reaction to allergens that are present all year round. One regular definition is that symptoms last for an hour or more each day However, in some cases the severity of the condition will vary over the course of the year.[7] Some of the main causes are:[1][8]

  • Dust mite feces
  • Pet dander
  • Pet saliva
  • Pet and rodent urine
  • Cockroach and other insect feces
  • Indoor mold

Causes of occupational rhinitis

When the symptoms of allergic rhinitis only occur in a particular work environment, then this is known as occupational rhinitis. Allergens that cause perennial rhinitis are often involved, such as animal allergies for laboratory and farm workers. Some other examples include:[7][9]

  • Grain dust affecting farmers and agricultural workers
  • Flour affecting bakers
  • Latex affecting medical workers wearing gloves
  • Fish and seafood proteins affecting factory and kitchen workers

Irritants that can worsen allergic rhinitis

While not allergens themselves, there are certain substances and situations that can worsen the symptoms of allergic rhinitis. Some of these irritants include:[1][10]

  • Cigarette smoke or wood smoke
  • Fumes
  • Humidity
  • Pollution
  • Changes in temperature

Good to know: For a person with allergic rhinitis, the irritants listed above can only worsen symptoms once an allergic reaction has taken place. If rhinitis symptoms are triggered by irritants alone, then the person affected may have non-allergic rhinitis instead.

Read more about non-allergic-rhinitis »

Allergic rhinitis risk factors

People whose families have a history of allergies are more likely to be diagnosed with allergic rhinitis. The genetic tendency to develop allergic rhinitis and other allergic conditions, such as asthma and atopic dermatitis (eczema), is known as atopy. Up to 40 percent of those with allergic rhinitis also have asthma, and as many as 80 percent of those diagnosed with asthma report experiencing allergic rhinitis symptoms.[11]

Research indicates that there are some environmental factors that can increase the likelihood of children developing allergic rhinitis. These include:[12]

  • Inhaling cigarette smoke during childhood
  • A mother using tobacco products while pregnant with the child
  • Exposure to mold at home

However, additional studies suggest that exposure to environmental or microbial biodiversity at a young age, such as living on a farm, may lessen the risk of developing allergic conditions.[13]

Allergic rhinitis diagnosis

Guidelines for diagnosis of allergic rhinitis are usually based on the symptoms reported by the affected person and their family history. Additional tests are sometimes required if the trigger for the allergic rhinitis is unknown. These tests involve giving the affected person small amounts of specific allergens to see if an allergic reaction takes place. This may include one or more of the following tests:[1][7]

Intradermal test

An intradermal test is normally the most accurate way to determine whether an individual is suffering from allergic rhinitis. Possible allergens, such as grass and weed pollen, are injected under the skin. After 20 minutes, the site is monitored for an allergic reaction, which usually involves reddening of the skin and an itching sensation.

Prick or scratch test

The prick or scratch test is the most common type of skin test. It involves pricking or scratching the skin before exposure to an allergen-containing solution. The results are known within 10 to 20 minutes.

Blood test

This method is often chosen if a reaction to an allergen is likely to be too severe to do a skin test. A blood test looks for the level of Immunoglobulin E (IgE) antibody in the blood when exposed to different allergens. The more IgE there is when an allergen is introduced, the likelier it is that the affected person is allergic to that allergen. The results are generally less accurate than skin testing.

Allergic rhinitis treatment

There is no cure for allergic rhinitis but its effects can be lessened by medication in the short-term, and, in some cases, sensitivity to the allergen can be reduced.

Antihistamines

Histamine is one of the chemicals released in the body after an allergic reaction, provoking uncomfortable symptoms for the affected person. Antihistamines work to limit the release of histamine or lessen its effects once it has been released into the body. They most commonly come in tablet form, but can also be administered in the following:[14][15]

  • Syrups and liquids
  • Eye drops
  • Nasal sprays
  • Ointments and creams
  • Injections (in extreme cases)

There are two types of antihistamine:

  • The older first-generation or sedating antihistamines cause tiredness in the user
  • Non-sedating or second-generation antihistamines are less likely to create fatigue

Both types are generally as effective as each other in lessening the effect of allergic rhinitis. However, sedating antihistamines may be recommended if the condition is causing sleeping trouble.[15]

It usually takes an antihistamine tablet about 30 minutes to begin working, and it will be at its most effective between one and two hours after consumption.[14]

Nasal corticosteroids

Nasal corticosteroids are sprays that reduce swelling and inflammation in the nose. They are also known as steroid nasal sprays. When suffering from seasonal rhinitis, it is often recommended start using the spray before symptoms are expected to begin showing.[16][17] If nasal corticosteroids are used daily, then nasal congestion, sneezing and other symptoms of allergic rhinitis are often significantly reduced[18].

Other medicines and treatment methods are sometimes recommended in combination with the more common treatments or as alternatives. These include[7][8]:

Mast cell stabilizers

Mast cell stabilizers, also known as chromones, work to block a type of white blood cell, known as a mast cell, from releasing histamine. They are produced as both nasal sprays and eye drops.[7] Mast cell stabilizers are generally a preventive measure, but are also known to lessen the effect of symptoms.[19]

Nasal saline washouts

Some allergens will linger in the nose after exposure. Washing them out with a mixture of water and salt helps to alleviate the symptoms. This treatment is also known as nasal douching or saline sinus washouts. Kits are available to buy with the ingredients premixed, but a homemade mixture can be made out of:[20][21]

  • One teaspoon of salt containing no iodine, anti-caking agents or preservatives
  • One teaspoon of baking soda
  • Two and a half cups of boiled water that has been left to cool

The mixture is inserted into an affected person’s nostril repeatedly as they breathe in gently. This can be done using an instrument , such as a soft rubber ear bulb syringe. Cupping a small amount of liquid in a hand and sniffing it while the other nostril is sealed with a finger also works. Breathing in too intensely risks the liquid going into the back of the throat or the ears and causing discomfort. Other nasal medications may work better after a saline washout.

Decongestants

Decongestant nasal sprays and nose drops make it easier to breathe by shrinking the blood vessels in the nose and relieving inflammation. However, they can only be used in the short-term.

After too much use, increasingly large doses are needed to achieve the intended effect. At this stage, blood vessels begin to swell up again after the medication has worn off, causing what is known as rebound congestion. This risks the danger of a person becoming dependent on decongestant spray to relieve the congestion caused by the medication itself.

The upper limit for the use of decongestants to treat allergic rhinitis is generally a week.[19]

Immunotherapy (hyposensitization)

In severe cases, for example, if antihistamines and nasal corticosteroid medications do not manage the allergic rhinitis symptoms effectively, the doctor can prescribe a course of immunotherapy.

This long-term treatment option serves to alter the body’s auto-immune response to the particular allergens which trigger allergic rhinitis. A course of immunotherapy typically begins about three months before exposure to hay fever triggers is likely to occur and involves either:

  • A series of injections
  • The administration of sublingual allergy tablets

Treatment with sublingual immunotherapy involves daily administration of the allergens in liquid or tablet form, which is placed under the tongue.[^22] Treatment with injections is divided into two stages. In the first stage, the affected person will be injected over a period of several weeks with increasingly concentrated doses of the allergen. During the second phase, the affected person will receive monthly top-up injections of the the allergen at a uniform dose.[22]

Management

The trigger for allergic rhinitis is always a specific allergen, so doing as much as possible to avoid it is the most effective way to manage the affected person’s symptoms. Preventive measures vary depending on what kind of allergen is the trigger.

Pollen

Research and preparedness can be very helpful in avoiding exposure to pollen. It is easy to find pollen counts online that tell the affected person how much of the allergen they are affected by is circulating in the atmosphere. Other tips for avoiding pollen are:[^24][23]

  • Keeping windows closed when the pollen count is high
  • Washing thoroughly, including hair and eyes, after being outside
  • Buying a pollen filter for a car, if driving
  • Staying indoors until the afternoon, where possible
  • Not mowing the lawn and, if someone else is, making sure to be inside
  • Wearing sunglasses to protect eyes
  • Avoiding extended outside activities, such as picnics
  • Changing clothes after being outside

Dust mites

Dust mites are difficult to remove from a home and it is often hard to detect when they are there. However, the following steps may help reduce the number of mites and the allergens they produce:[^24][24]

  • Washing bedding regularly at high heat; at temperatures of over 130 degrees Fahrenheit or 60 degrees Celsius
  • Covering bedding in dust mite resistant covers
  • Keeping a home dry and well aired
  • Removing soft toys, sheepskin and woolen underlays from sleeping areas or cleaning them regularly
  • Removing upholstered furniture and using leather, plastic, vinyl and wood instead
  • Avoiding carpets, rugs and mats; wooden floors are preferable
  • Vacuuming thoroughly every week and wearing a mask while doing so
  • Replacing heavy curtains with flat blinds that are easier to wipe down
  • Opting for synthetic bedding rather than feather

Animal allergies

Not having a pet that causes an allergic reaction is the best solution for managing this type of allergic rhinitis. However, if that is impossible, the following steps are advisable for owners of dogs and/or cats:[25][26]

  • Do not have the pet in the bedroom and try to confine it to specific areas of the house
  • Bathe the animal weekly
  • Keep the pet away from carpets
  • Regularly wash all bedding the animal comes into contact with
  • Use high-efficiency particulate air cleaners

Mold

Mold tends to grow best in damp and enclosed environments such as:[^24][27]

  • Bathrooms
  • Basements
  • Refrigerators
  • Wardrobes
  • Closets
  • Humidifiers
  • Mattresses
  • On upholstery
  • In waste containers
  • Bedrooms with an en-suite bathroom

Dealing with mold problems means trying to make the house as dry and ventilated as possible. All visible mold should be removed as a first step, with bleach or specially designed cleaning products. Other steps to take include:[^24][27]

  • Improving ventilation by opening doors and windows and installing extractor fans
  • Regularly cleaning affected rooms
  • Avoiding the use of humidifiers
  • Keeping carpets dry and removing wet ones
  • Fixing leaks in the house
  • Getting rid of pot plants from inside and avoiding garden waste
  • Unblocking gutters and vents

Allergic rhinitis complications

There may be various complications that arise for those affected by allergic rhinitis. These can include:

Tiredness and distraction

Allergic rhinitis can be very uncomfortable for the person affected. As a result of their symptoms, people with the condition can experience:[1][2]

  • Tiredness, because of trouble sleeping
  • Problems remembering things
  • Irritability
  • Decreased concentration

Adults with allergic rhinitis are estimated to be 20 percent less productive than usual when the symptoms are at their worst.[28]

Middle ear infections

A middle ear infection, otherwise known as otitis media, is a viral or bacterial infection of the usually air-filled cavity behind the eardrum. In most cases, a middle ear infection affects just one ear, but can also occur in both ears simultaneously.

Rhinitis can cause a blockage or swelling of the Eustachian tubes, which connect the throat and the middle ear. This results in a reduced ventilation of the cavity behind the eardrum and may lead to a build-up of fluid in the middle ear. [29][30] A middle ear infection develops when bacteria or viruses that rise up, most often from the nasopharynx, grow in this fluid.[29] The infection can cause painful inflammation.

Read more about middle ear infections »

Sinusitis

Sinusitis, also referred to as sinus infection or rhinosinusitis, is an inflammation of the sinuses. The sinuses are air-filled cavities within the bones of the face and nose. Sinusitis occurs when these cavities become inflamed and blocked, leading to a number of uncomfortable symptoms. One possible cause of the condition is rhinitis or associated complications such as nasal polyps. Symptoms of sinusitis include:

  • Nasal discharge
  • A blocked nose
  • Tenderness around the head
  • Sinus headaches

Generally, sinusitis is a non-serious condition which can be managed through self-care methods and over-the-counter medication. In most cases, symptoms will disappear within two to three weeks.[7]

Read more about viral sinusitis »

Nasal polyps

Nasal polyps are soft swellings on the inside of the nose and sinuses. Rhinitis may act as a trigger for the development of polyps. They may have no effect, but sometimes they are so large or numerous that they cause blockages between the nose and sinuses. This can lead to the conditions conducive for sinusitis to develop. Corticosteroid sprays, which are often prescribed for allergic rhinitis, can also be effective in treating nasal polyps.[7]

Transverse nasal crease

Attempts to relieve the symptoms of allergic rhinitis by excessive rubbing or pushing the nose upwards with the hand can lead to damage of skin and cartilage. This has the potential to create a transverse nasal crease, a small groove in the skin of the affected person’s nose.[31]

Allergic rhinitis FAQs

Q: Are there any home remedies for allergic rhinitis?
A: The mixture for a saline nasal spray to wash the irritants out of the affected person’s nose can be made out of salt, baking soda and boiled then cooled water. Steps can be taken at home to minimise exposure to specific allergens, such as closing windows to keep out pollen.

Read more about allergic rhinitis treatment »

Q: What is the difference between allergic rhinitis and non-allergic rhinitis?
A: Allergic rhinitis is triggered by small particles known as allergens. Non-allergic rhinitis is caused by other factors, the most common of which is a cold.

Read more about non-allergic-rhinitis »


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