Allergic rhinitis is a collection of
symptoms, mostly in the nose and eyes, which occur when you breathe in
something you are allergic to, such as dust, dander, or pollen.
This article focuses on allergic
rhinitis due to outdoor triggers, such as plant pollen. This type of allergic
rhinitis is commonly called hay fever.
An allergen is something that triggers
an allergy. When a person with allergic rhinitis breathes in an allergen
such as pollen or dust, the body releases chemicals, including histamine. This
causes allergy symptoms such as itching, swelling, and mucus production.
Hay fever involves an allergic
reaction to pollen. (A similar reaction occurs with allergy to mold,
animal dander, dust, and similar inhaled allergens.)
The pollens that cause hay fever vary
from person to person and from region to region. Tiny, hard to see pollens more
often cause hay fever. Examples of plants commonly responsible for hay fever
- Trees (deciduous and evergreen)
The amount of pollen in the air can
play a role in whether hay fever symptoms develop. Hot, dry, windy days are
more likely to have increased amounts of pollen in the air than cool, damp,
rainy days when most pollen is washed to the ground.
Some disorders may be associated with
allergies. These include eczema
Allergies are common. Your genes and
environment may make you more prone to allergies.
Whether or not you are likely to
develop allergies is often passed down through families. If both your parents
have allergies, you are likely to have allergies. The chance is greater if your
mother has allergies.
Symptoms that occur shortly after you
come into contact with the substance you are allergic to may include:
Symptoms that may develop later
nose (nasal congestion)
- Clogged ears and decreased
sense of smell
- Sore throat
- Dark circles under the eyes
- Puffiness under the eyes
- Fatigue and irritability
- Memory problems and slowed
Exams and Tests
The health care provider will perform a
physical exam and ask you questions about your symptoms. Your history of
symptoms is important in diagnosing allergic rhinitis, including whether the
symptoms vary according to time of day or the season, and exposure to pets or
Allergy testing may reveal the specific
substances that trigger your symptoms. Skin testing is the most common method
of allergy testing. See the article on allergy
testing for detailed information.
If your doctor determines you cannot
undergo skin testing, special blood tests may help with the diagnosis. These
tests can measure the levels of specific allergy-related substances, especially
one called immunoglobulin E (IgE).
A complete blood count (CBC),
specifically the eosinophil white blood cell count, may also help reveal
The best treatment is to avoid what
causes your allergic symptoms in the first place. It may be impossible to
completely avoid all your triggers, but you can often take steps to reduce
There are many different medications
available to treat allergic rhinitis. Which one your doctor prescribes depends
on the type and severity of your symptoms, your age, and whether you have other
medical conditions (such as asthma).
For mild allergic rhinitis, a nasal
wash can be helpful for removing mucus from the nose. You can purchase a saline
solution at a drug store or make one at home using one cup of warm water, half
a teaspoon of salt, and pinch of baking soda.
Treatments for allergic rhinitis
Antihistamines work well for treating
allergy symptoms, especially when symptoms do not happen very often or do not
last very long.
- Antihistamines taken by mouth
can relieve mild to moderate symptoms, but many can cause sleepiness. Some
may be bought over the counter, without a prescription. Talk to your
doctor before giving these medicines to a child, as they may affect
- Newer antihistamines cause
little or no sleepiness. Some are available over the counter. They usually
do not interfere with learning. These medications include loratidine
(Claritin) and cetirizine (Zyrtec). Other antihistamines are available by
- Azelastine (Astelin) is a
antihistamine nasal spray that is used to treat allergic rhinitis.
- Nasal corticosteroid sprays are
the most effective treatment for allergic rhinitis.
- They work best when used
nonstop, but they can also be helpful when used for shorter periods of
- Many brands are available. You
will need a prescription from your doctor. They are safe for children and
- Decongestants may also be helpful
in reducing symptoms such as nasal congestion.
- Nasal spray decongestants
should not be used for more than 3 days.
- Be careful when using
over-the-counter saline nasal sprays that contain benzalkonium chloride.
These may actually worsen symptoms and cause infection.
- The leukotriene inhibitor
Singulair is a prescription medicine approved to help control asthma and
to help relieve the symptoms of seasonal allergies.
Specific illnesses that are caused by
allergies (such as asthma and eczema) may require other treatments.
Allergy shots (immunotherapy) are
occasionally recommended if the allergen cannot be avoided and if symptoms are
hard to control. This includes regular injections of the allergen, given in
increasing doses (each dose is slightly larger than the previous dose) that may
help the body adjust to the antigen.
Most symptoms of allergic rhinitis can
be treated. More severe cases require allergy shots.
Some people (particularly children) may
outgrow an allergy as the immune system becomes less sensitive to the allergen.
However, as a general rule, once a substance causes allergies for an
individual, it can continue to affect the person over the long term.
When to Contact a Medical Professional
Call for an appointment with your
health care provider if severe symptoms of allergies or hay fever occur, if
previously successful treatment has become ineffective, or if your symptoms do
not respond to treatment.
Symptoms can sometimes be prevented by
avoiding known allergens. During the pollen season, people with hay fever
should remain indoors in an air-conditioned atmosphere whenever possible:
- Most trees produce pollen in
- Grasses usually produce pollen
during the late spring and summer.
- Ragweed and other late-blooming
plants produce pollen during late summer and early autumn.
Hay fever; Nasal allergies
Wallace DV, Dykewicz MS, Bernstein DI,
Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of
rhinitis: an updated practice parameter. J
Allergy Clin Immunol. 2008 Aug:122(2).
Frew AJ. Allergen immunotherapy. J Allergy Clin Immunol. 2010 Feb;125(2
Asthma is a chronic disease involving the airways in the lungs. These
airways, or bronchial tubes, allow air to come in and out of the lungs.
If you have asthma your airways are always inflamed. They become even
more swollen and the muscles around the airways can tighten when
something triggers your symptoms. This makes it difficult for air to
move in and out of the lungs, causing symptoms such as coughing,
wheezing, shortness of breath and/or chest tightness.
For many asthma sufferers, timing of these symptoms is closely
related to physical activity. And, some otherwise healthy people can
develop asthma symptoms only when exercising. This is called
exercise-induced bronchoconstriction (EIB), or exercise-induced asthma
(EIA). Staying active is an important way to stay healthy, so asthma
shouldn't keep you on the sidelines. Your physician can develop a
management plan to keep your symptoms under control before, during and
after physicial activity.
People with a family history of allergies or asthma are more prone to developing asthma. Many people with asthma also have allergies. This is called allergic asthma.
is caused by inhaling fumes, gases, dust or other potentially harmful substances while on the job.
impacts millions of children and their families. In fact, the majority
of children who develop asthma do so before the age of five.
There is no cure for asthma, but once it is properly diagnosed and a
treatment plan is in place you will be able to manage your condition,
and your quality of life will improve.
An allergist / immunologist is
the best qualified physician in diagnosing and treating asthma. With
the help of your allergist, you can take control of your condition and
participate in normal activities.
Click for More Information: http://www.aaaai.org/conditions-and-treatments/asthma.aspx
First the skin
itches, then it erupts into red welts. The itching may be severe, keeping
people from working or sleeping.
It's a distressing disorder which affects an estimated 20 percent of the
population at one time or another in their lives. Commonly known as
hives, urticaria has two forms: most cases are acute (lasting from a few hours
to less than six weeks); some are chronic (lasting more than six weeks). The
welts may appear in one place, disappear after a short time, and then erupt in
another area. They are made worse by scratching. Each individual hive lasts no
more than 24 hours.
What kinds of things can trigger
attacks of urticaria?
Bouts of urticaria
have been traced to such triggers as certain foods and additives, infections,
drugs (including antibiotics, aspirin, ibuprofen), cold, sun exposure, insect
stings, alcohol, exercise, endocrine disorders (thyroid disease) and emotional
stress. In some people, pressure caused by belts and constricting clothing
causes the eruption. Urticaria may be a response to infection including the
common cold, strep throat and infectious mononucleosis. In the
urticaria-prone person, these triggers cause the body to release chemical
mediators, including histamine, from cells. Histamine (which causes itchy,
runny noses and watery eyes in hay fever sufferers) dilates the walls of blood
vessels, allowing fluids to leak out into the surrounding tissues. Swelling and
itching are the result.
While hives develop
on the skin's surface, angioedema is
a swelling of the deeper layers of the skin. It most often occurs on the hands,
feet and face. If the angioedema occurs in the throat, normal breathing or
swallowing can be blocked, and emergency measures must be taken. Hives and angioedema may appear
together or separately on the body.
Angioedema usually lasts one or two days but may reoccur with or without
hives over an indefinite period of time.
How are each person's urticaria
In some cases, the
trigger is obvious - a person eats peanuts or shrimp, then develops urticaria
within a short time. But because there are so many possible causes for
urticaria, other cases require careful detective work on the part of the
physician and, sometimes, forbearance on the part of the patient.
To unravel the
urticaria puzzle, your allergist will take a detailed history, looking for
clues in your lifestyle that will help pinpoint the cause. You'll be asked
about the frequency and severity of your symptoms . . your family's history . . medications you are taking. . . your work and home environment . . . and miscellaneous
matters. In some cases you may require tests to analyze blood and urine, and
other procedures such as x-rays. Although skin tests are not routinely
performed, they may provide useful information in some cases. Your allergist
will decide which tests to order based on the different types of urticaria and
the suspected cause.
are the different types of hives/urticaria?
are 2 major categories- Immunologic and Non-Immunologic.
Allergic or Immunologic Urticaria
is the least common form. It is
caused by the immune system's overreaction to foods, drugs, infection, insect
stings, blood transfusions or other substances. Foods such as eggs, nuts and
shellfish, and drugs such as penicillin and sulfa are common causes of allergic
or immunologic urticaria.
are those types of urticaria where
a clear-cut allergic basis cannot be proven. These take many forms.
Dermographism is a common form of urticaria which
occurs in approximately 8-10% of the population. It develops when the skin is
stroked with a firm object, and often occurs after scratching, or when
tight-fitting clothes rub the skin
Cold-Induced Urticaria appears after a person is exposed to
low temperatures - for example, after a plunge into a swimming pool or when an
ice cube is placed against the skin.
Cold water or liquids can provoke symptoms on the lips or in the mouth
Cholinergic urticaria is the term for hives that can develop
after activities which increase the the body's temperature. Activities that can cause this include
a warm bath, shower, jacuzzi, exercise, a fever, or emotional stress.
Solar Urticaria arises on parts of the body exposed to
the sun; this may occur within a few minutes.
Exercise is another cause of hives. Some
individuals can also have more severe reactions including wheezing and/or drop
of blood pressure with loss of consciousness. Such a severe reaction is called
Other: Some cases of non-immunologic urticaria
may be caused by non-allergic reactions to various non-steroidal anti-inflammatory
drugs (aspirin, ibuprofen) and, possibly, certain food dyes, sulfites, and
other food additives.
Idiopathic Urticaria: In many cases, particularly in chronic
urticaria, the trigger for the problem can't be found; in this instance it is
called Idiopathic Urticaria.
How is urticaria treated?
Your allergist first
will alleviate the discomfort with medications such as antihistamines. Severe attacks may require injections
of epinephrine. In some cases corticosteroids
such as prednisone may be prescribed for a short period. Other drugs may be required
for specific types of urticaria. Of course, if the cause can be identified, the
best course of treatment is avoidance of the offending substance. If a specific food is strongly
suspected, then it should be avoided. This may require careful reading of food
labels and inquiry about ingredients in restaurant meals. Persons with solar
urticaria should wear protective clothing and apply sunscreen when outdoors.
Loose-fitting clothing will help relieve pressure urticaria. Avoid harsh soaps
and frequent bathing to reduce the problem of dry skin, which can cause itching
and scratching that can aggravate urticaria. Vigorous toweling after a bath may
precipitate hives. Although
success of identifying the cause of chronic urticaria varies from clinic to
clinic according to patient populations, it usually is no higher than 20-40% of
cases. It may last for months or years and usually burns itself out, never to
bother the sufferer again.
Our Allergists are Board Certified in Pediatric and Adult Allergy, Asthma and Immunology.
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