Allergic Rhinitis

Cause

Allergic rhinitis occurs when your immune system overreacts to particles in the air that you breathe. In other words, you are allergic to them. The particles are called allergens. Your immune system causes symptoms such as sneezing and a runny nose.

Allergens that cause allergic rhinitis include pollens and animal dander. Although polluted air is not an allergen, it can irritate your nose and lungs. An irritated nose or lungs may make an allergic reaction more likely when you breathe in an allergen.

What Increases Your Risk

You may be more likely to have allergic rhinitis and other allergies if:

• You have a family history of allergies, especially allergic rhinitis. A child is more likely to have an allergy if both parents have an allergy or have the same type of allergy.
• You are exposed to dust mites, animal dander, or other indoor allergens.
• You are exposed to pollens or molds.

Symptoms

Allergy symptoms may start within minutes or hours after you breathe in an allergen. And the symptoms can last for days.

When symptoms start right away, you may sneeze over and over again. This often happens after you wake up in the morning. You may have a tickle in your throat or coughing caused by postnasal drip. Your nose may be runny. And your eyes may be watery and itchy. Your ears, nose, and throat may also be itchy.

Other symptoms may take longer to appear. For example, you may have a stuffy nose. You may feel pressure in one or both ears, or have pain in your face. Your eyes may be sensitive to light. You may also have a long-lasting cough. Some people notice dark circles under their eyes.

Your symptoms may be better or worse at different times of the year.

When to Call a Doctor

Call your doctor if:

• You have pain in the sinus area and other symptoms of sinus infection. (Symptoms may include fever or a creamy, yellow or green discharge from the nose.)
• Your allergy symptoms get worse and you don't know why.
• You are taking a prescription or over-the-counter allergy medicine that does not help your symptoms.
• Your allergy medicine is causing side effects that bother you, such as decreased coordination or increased drowsiness.
• You have a fever or ear pain.
• You have a cough or cold that lasts longer than 1 to 2 weeks.
• You have severe itching of the eyes or nose.
• Your allergy disturbs your life.

Who to see for allergies

Health professionals who can evaluate and treat mild allergic rhinitis symptoms include:

You may need to see an allergy specialist (allergist). This depends on your symptoms or which other treatments you may need. For example, you may need to see a specialist if your medicines are not working or cause severe side effects. Another reason is if you are thinking about getting immunotherapy (such as allergy shots).

Your doctor may refer you to an ear, nose, and throat (ENT) specialist (also called an otolaryngologist or otorhinolaryngologist). An ENT specialist may be helpful if your doctor thinks you may have nasal polyps or other things blocking your nose.

Exams and Tests

Your doctor can most often diagnose allergic rhinitis by doing a physical exam and asking you questions about your symptoms, activities, and home.

You may need allergy tests if:

• You and your doctor need to find out exactly what things you are allergic to. And then you can take steps to avoid them.
• Treatment is not helping your symptoms.
• You have severe symptoms.
• You are thinking about trying immunotherapy (such as allergy shots).

A skin test can show how your skin reacts to an allergen. Or a blood test can measure the level of antibodies that your body makes in response to certain allergens.

These tests can help your doctor know what is causing your symptoms and find the best treatment.

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Treatment Overview

There are three main treatments for allergic rhinitis:

• Avoid the things you are allergic to (allergens). For example, you may need to clean your house often to get rid of animal dander. Or you may need to stay indoors when pollen counts are high.
• Manage your symptoms with medicine. Over-the-counter corticosteroid nasal spray, antihistamine or decongestant pills, or prescription nasal spray antihistamines may help relieve some of your symptoms.
• Get immunotherapy (such as allergy shots). For this treatment, you get shots or take pills that have a small amount of certain allergens in them. Your body "gets used to" the allergen, so you react less to it over time.

Self-Care

Taking care of yourself is an important part of staying healthy when you have allergies.

Your doctor will help you find out what may be causing your allergies. As soon as you know what triggers your symptoms, try to avoid those things. This can help prevent allergy symptoms, asthma, and other health problems.

There are steps you can take to avoid your allergy triggers. For example, if you are allergic to house dust, it helps to wash your bedding in hot water each week. If your allergies are caused by pollen, try to stay inside when pollen counts are high. It also helps to stay away from smoke. Being around smoke can make your allergies worse.

Ask your doctor about allergy medicine, including over-the-counter medicine. There may also be other treatments that can help reduce or prevent allergy symptoms.

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Medicines

Medicines are a key part of treatment for allergic rhinitis.

Over-the-counter medicines

You can get corticosteroid nasal sprays over-the-counter or by prescription. These help reduce inflammation in the nose. They work well for most people. They start working quickly, but it may be several weeks before you get the full effect.

There are other types of allergy medicines you can buy without a prescription.

Antihistamines.

These help your sneezing, runny nose, itching, and watery eyes.

Decongestants.

These help relieve a stuffy nose.

Eyedrops.

These help red, itchy, and watery eyes.

Prescription medicines

If over-the-counter medicines don't work or in special cases, such as if you are pregnant, your doctor may suggest other medicines. For instance, for worse symptoms, an antihistamine nasal spray may be prescribed.

Antihistamine nasal spray.

May help moderate to severe symptoms.

Ipratropium bromide.

It can relieve a runny nose.

Leukotriene modifiers.

These can relieve a stuffy nose, itching and sneezing, and a runny nose.

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Immunotherapy (Allergy Shots)

If medicines can't control your allergic rhinitis, you may think about having immunotherapy. This comes in the form of allergy shots or tablets. Allergy shots are small doses of allergens that your doctor injects under your skin. Or you may dissolve a tablet under your tongue daily. Each tablet has a small amount of allergen in it. These treatments help your body "get used to" the allergen, so your body reacts less to it over time.

Allergy shots work best if you are allergic to pollens, animal dander, or dust mites. If you are allergic to more than one type of allergen, you may need to get shots for each type of allergen to help all of your symptoms.

You may need allergy shots for 3 to 5 years. And there is some risk of severe whole-body reactions (anaphylaxis).

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