Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Allergic Rhinitis

(Hay Fever; Seasonal Allergies)
by Rosalyn Carson-DeWitt, MD
Definition

Allergic rhinitis is the set of symptoms that occurs when you breathe in substances you are allergic to. These substances are called allergens and are small proteins.

  • Perennial (persistent) allergic rhinitis—This condition is caused by allergens that may be present year round. These may include chemicals, dust, dust mites, cockroaches, animal dander, or mold spores. Symptoms may be present any time of year.
  • Seasonal (intermittent) allergic rhinitis (sometimes called hay fever or rose fever)—This occurs during times of the year when allergens are in the air, like spring, summer, and fall. The most common allergen are tree, grass or weed pollens.
Causes

An allergic reaction occurs when your body's immune system overreacts to an allergen. When you breathe in an allergen, cells in your nasal passages release a chemical called histamine. Histamine causes your nose to feel itchy and also causes swelling and mucus production in the nasal passages.

Risk Factors

These factors increase your chance of developing allergic rhinitis. Tell your doctor if you have any of these risk factors:

Symptoms

Allergic rhinitis can cause the following symptoms:

  • Postnasal drip and cough
  • Dark circles under your eyes
  • Headache
  • Itching in the nose, eyes, throat, ears
  • Red, watery eyes
  • Runny nose, nasal congestion
  • Sinus pressure
  • Sneezing
Diagnosis

Your doctor will try to find out which allergens you are allergic to. Your doctor may refer you to an allergist or immunologist. This is a doctor who specializes in allergies.

Tests may include:

Skin Prick Test

A tiny bit of an allergen is placed under the skin with a needle. The doctor watches to see if the skin in that area becomes red, raised, and itchy. This can be done for multiple allergens at the same time.

RAST Testing

A small sample of blood is taken and tested for different allergens.

Provocation Testing

You breathe in air containing an allergen. The doctor will watch to see if you have an allergic reaction, such as wheezing or trouble breathing. This test is usually reserved for research settings.

Treatment

The most effective way to treat allergies is to avoid the allergen. Since this can sometimes be difficult or impossible, other treatments are available.

Treatments may include:

Medications
  • Decongestants—decrease congestion by constricting blood vessels, taken as pills or as a nasal spray
    • Note: Use of the nasal spray may lead to rebound congestion.
  • Antihistamines—block the action of histamine; available as nasal spray, pill, or syrup
  • Mast cell inhibitors—nasal sprays that interfere with the chemical reactions leading to histamine release
  • Topical corticosteroids—nasal sprays that decrease swelling in the nasal passages
Immunotherapy (Allergy Shots) and Sublingual Therapy

With immunotherapy, very small amounts of allergens are injected over weeks, months, or even years. The goal is to make your body's immune system less sensitive to those allergens. This treatment may be effective in reducing or eliminating the symptoms of allergic rhinitis.

There's another, similar type of treatment called sublingual immunotherapy . It involves placing small amounts of allergens under the tongue. This treatment is more popular in Europe and is not approved in the United States. While it has shown to reduce symptoms in some studies, more research is needed.

If you are diagnosed with allergic rhinitis, follow your doctor's instructions .

Prevention

The following strategies may help prevent allergic rhinitis :

  • Avoid outside activities during the time of year when the trees, grasses, weeds, or molds are blooming.
  • Clean your air conditioner's filters regularly.
  • Consider running an air purifier in your home, especially in your bedroom.
  • Cover pillows and mattresses with vinyl covers to reduce your exposure to dust mites.
  • Decrease or avoid outdoor activities on hot summer days, when ozone levels may make your symptoms worse.
  • If you can't avoid having a furry pet, vacuum frequently and keep your pet out of bedrooms and other rooms with carpets.
  • Keep the windows of your house and car closed to keep pollen out.
  • Stay inside during the morning hours when pollen counts are highest.
  • Use an air conditioner to reduce indoor humidity and to prevent mold and mildew growth.
  • Use fewer dust-collecting items, such as curtains, bed skirts, carpeting, and stuffed animals, especially in your bedroom.
  • Use vacuum cleaners and air conditioners with HEPA filters to trap allergens.
  • Wash bedding weekly in very hot water.

Last reviewed: September 2011 by Purvee S. Shah, MD.

RESOURCES:
CANADIAN RESOURCES:
References:
  • Conn HF, Rakel RE. Conn's Current Therapy 2001 . 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.
  • Joint Council of Allergy, Asthma, and Immunology website. Available at: http://www.jcaai.org . Accessed June 15, 2008.
  • Middleton E. Allergy: Principles and Practice . 7th ed. St. Louis, MO: Mosby-Year Book, Inc; 2009.
  • National Institute of Allergy and Infectious Disease website. Available at: http://www3.niaid.nih.gov/ . Accessed June 15, 2008.
  • Patients and Consumer. American Academy of Allergy, Asthma, and Immunology website. Available at: http://www.aaaai.org/patients.stm . Accessed June 15, 2008.
  • 8/11/2006 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Durham SR, Yang WH, Pedersen MR, et al. Sublingual immunotherapy with once-daily grass allergen tablets: a randomized controlled trial in seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol . 2006;117:802-809.