Allergic Rhinitis

Sneezing, itchy nose, runny nose and stuffy nose are common symptoms of nasal allergies or allergic rhinitis. It is estimated that about 25% of the US population has allergic rhinitis. The incidence and severity of allergic rhinitis is worsening due to global warming. Allergic rhinitis affects all age groups and sexes. It is often considered the "tip of the allergy iceberg" as patients who have nasal allergies will often have other allergy problems such as asthma, exercise induced asthma, hives, allergic skin rashes, allergic eyes, food allergies, and drug allergies. Seeing an allergist for allergies can help you to find out what you are allergic to, how bad your allergies are, and how to make an individualized and cost effective treatment plan to combat your allergies.

Why treat nasal allergies?

While nasal allergies are not life threatening, they do make people feel miserable and affect their quality of life. A recent study in the "Journal of Family Practice," found that adult patients, who had allergies, did not sleep well, which contributed to less energy and productivity during work. Additionally, it was found that adults with allergies missed more days from work than non-allergic patients.

Children with allergic rhinitis have more sick days, have difficulty concentrating in school, may have problems sleeping and may have less exercise tolerance. Chronic allergies can even affect the development of teeth and facial bones in children.

What are complications of allergic rhinitis?

Untreated allergies can lead to other more serious problems such as asthma, sinusitis, nasal polyps, recurrent ear problems, recurrent postnasal drip. Recurrent postnasal drip can lead to even more problems: throat clearing, vocal cord problems, recurrent infections, snoring, and sleep apnea. 70% of asthmatic children have allergic rhinitis.

Who gets allergies?

Allergies can occur as early as 6 months of age. Since allergies are hereditary, it is not unusual for many family members to suffer from them.

Why do we get allergies?

Allergies are caused by a combination of heredity and one’s exposure to the allergens. Once you become allergic to something, especially as an adult, it is rare that you can "outgrow" your allergies. What the exact trigger is that causes a person to suddenly develop allergies is still the subject of much research today.

How to tell the difference between an allergy or a cold?

Sometimes it is difficult to tell the difference between an allergy and a cold, especially since allergic rhinitis patients are more susceptible to colds and respiratory infections. Allergies usually do not cause a fever. Colds and respiratory infections usually do not have itchy nose and itchy eyes as primary symptoms.

Do nasal allergies have a pattern?

Allergies can be seasonal, perennial or a combination of both. Peak seasons for seasonal nasal allergies are typically in the Fall and early Winter to Spring and are usually caused by pollen from trees, grasses, and weeds. Perennial symptoms occur all year round and are usually caused by pollens, dust mites, molds or animals. Occupational allergies, which occur at the workplace, usually get worse towards the end of the shift or work week and improve on days off and on vacations.

How is allergic rhinitis evaluated?

An evaluation for nasal allergies requires a thorough history, physical exam and allergy testing. The history should include types of symptoms, severity of symptoms, frequency of symptoms, and how these affect your quality of life. An environmental survey of home, work and/or school, a list of potential allergy triggers, family history and medication history are also useful information. We use this information to help pinpoint your allergies and to create an optimal treatment plan. A thorough physical exam is required. Radiographic studies of the nose and sinuses may be necessary.

Why test for allergies?

Allergy testing is important as it helps us to identify what is causing your allergy problems and to identify your allergy triggers. The less you are around your allergy triggers, the less symptoms you will have. The more exposure you have to your allergy triggers, the more severe symptoms, the more medication you will likely need, and the greater likelihood that you suffer from complications of your allergies.

Which type of allergy test is best?

Allergy testing is available by either skin testing or blood testing. Skin testing is generally favored over blood testing due to getting immediate results, the ability to be a better teaching tool for patients, the ability of discern more severe delayed reactions, and less cost per test. Disadvantages for skin testing are the need to stop anti-allergy medication prior to the test, the small risk of allergic reaction during the test, and the inability to perform this test in certain patients, such as pregnant women or patients with extensive skin disease.

How are allergies treated?

There are three steps for treating allergic rhinitis: avoiding known allergens, medications, and desensitization.

First, avoiding known allergens is an extremely important treatment. Medications may be less effective if there is a great deal of exposure to the causative allergen. Avoiding allergens will prevent allergies and will prevent more severe symptoms.

Second, allergy medications do not "cure" allergies, but they can control them. Medications include allergy pills, allergy liquids and nasal sprays. You may need a combination of different types of medication to control your allergies depending on the severity of your allergies and the type of symptoms you have.

Third, allergy desensitization can "teach" your body to become less allergic. This process involves giving your body small amounts of the allergen, the item it is allergic to, in order to "teach" your body to be less sensitive to these items. This treatment can dramatically reduce symptoms, medication use, and risk of future allergy symptoms. Patients who have been successfully desensitized will have little to no allergy symptoms and will take fewer medications or none at all. Desensitization can be administered through injections or oral delivery and works for pollens, dust mites, molds and animal antigens.

What is allergy desensitization?

Allergy desensitization by injection has been used for several decades and is the gold standard treatment for teaching your body to become less allergic. "Allergy shots" do not contain corticosteroid drugs, but contain the allergens you are allergic to. Improvements have been made in allergy serums and scheduling to make this treatment more convenient for patients. This treatment can be used for dust mites, molds, pollens, and animals antigens. It is available for both children and adults and can be continued during pregnancy. The injections must be given in a physician's office as there is a small risk of allergic reactions.

Sublingual desensitization is a newer form of treatment. Currently, only sublingual tablets for grass, ragweed, and dust mite allergens are available and these must be taken on a daily basis.  There are also daily oral drops, which are also effective. The oral desensitization treatments are self-administered on a daily basis. The first dose is administered in a physician's office, as there is a risk of allergic reactions. Patients who choose this method will need to keep injectable epinephrine such as an Epipen available at all times and will need to follow up in the office at regular intervals.