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Other Articles/Links 1) Allergic Rhinitis 2) Asthma 3) Hives/Urticaria 4) Food Allergy Guidelines 4) A to Z guide to Allergy 5) Allergist YouTube A TO Z GUIDE TO ALLERGIC CONDITIONS

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Allergic Rhinitis

Medicine Plus Article

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.

Causes

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 an 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 include:

• Trees (deciduous and evergreen)
• Grasses
• Ragweed

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 and asthma.

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

Symptoms that occur shortly after you come into contact with the substance you are allergic to may include:

• Itchy nose, mouth, eyes, throat, skin, or any area
• Problems with smell
• Runny nose
• Sneezing
• Tearing eyes

Symptoms that may develop later include: Stuffy nose (nasal congestion) Coughing Clogged ears and decreased sense of smell Sore throat Dark circles under the eyes Puffiness under the eyes Fatigue and irritability Headache Memory problems and slowed thinking

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 other allergens. 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 allergies.

Treatment

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 exposure.

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 a pinch of baking soda.

Treatments for allergic rhinitis include:

Antihistamines

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 learning.
• Newer antihistamines cause little or no sleepiness. Some are available over the counter. They usually do not interfere with learning. These medications include loratadine (Claritin) and cetirizine (Zyrtec). Other antihistamines are available by prescription.
• Azelastine (Astelin) is an antihistamine nasal spray that is used to treat allergic rhinitis.

Corticosteroids

• 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 time.
• Many brands are available. You will need a prescription from your doctor. They are safe for children and adults.

Decongestants

• Decongestants may also be helpful in reducing symptoms such as nasal congestion.
• Nasal spray decongestants should not be used for more than three days.
• Be careful when using over-the-counter saline nasal sprays that contain benzalkonium chloride. These may actually worsen symptoms and cause infection.

Other Treatments

• 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

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.

Outlook (Prognosis)

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.

Possible Complications

• Sinusitis

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.

Prevention

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 the spring.
• Grasses usually produce pollen during the late spring and summer.
• Ragweed and other late-blooming plants produce pollen during late summer and early autumn.

Alternative Names

Hay fever; Nasal allergies

References

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 Suppl 2): S306-13.

Hives

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 that 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 results.

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 "triggers" identified?

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.

What are the different types of hives/urticaria?

There are two 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.

Non-Immunologic Urticarias 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. Coldwater or liquids can provoke symptoms on the lips or in the mouth

Cholinergic urticaria is the term for hives that can develop after activities that increase 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 exercise-induced anaphylaxis.

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 the 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 inquiries 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 the 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.

There is Much More Information Available!

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