Allergic Rhinitis (Hay Fever)

Allergic rhinitis or “hay fever” is a common allergic condition affecting the nasal and sinus tissues. Patients of any age can be affected, but it is more often seen in patients older than 2-3 years. “Hay fever” often runs in families as it has a significant genetic component. Allergic rhinitis is often seen in patients with asthma and eczema.

Symptoms of allergic rhinitis

Common symptoms include runny nose, congestion (#1 complaint of most patients), sneezing, post-nasal drainage, cough, headache, decreased smell and/or taste, fatigue, sleep disruption, and poor school or work place performance.

Allergic conjunctivitis

Allergic conjunctivitis is a condition which causes inflammation of the eyes and surrounding tissues characterized by itchy/watery eye complaints. Patients will also complain of burning and stinging in and around the eyes. This condition often is seen with allergic rhinitis, and it is believed that at least 50% of allergic rhinitis patients will also suffer with allergic conjunctivitis.

Diagnosis of allergic rhinitis/conjunctivitis

Evaluation of allergic rhino-conjunctivitis involves a thorough history, physical exam, and often allergy testing. Allergy skin testing is most commonly used to identify allergens such as pollens, pet dander, dust mites, cockroach, and molds. Certain blood tests or serum-specific IgE allergy tests can also be used to evaluate for allergy in individual patients where skin testing is not able to be done. Skin testing is still the most accurate and effective method to define allergic disease.

Treatment of allergic rhinitis/conjunctivitis

Therapy involves 3 main components:

  1. Allergen avoidance/environmental control
  2. Medical therapies; both OTC and prescription
  3. Allergen Immunotherapy
    • Allergy shots or SCIT
    • Sublingual/oral tablet or liquid immunotherapy

Environmental controls

Environmental controls are measures taken to try and avoid or decrease exposure to an individual allergen.

Examples would be using an air filtration system to try and remove pet dander, using a dehumidifier to remove moisture and decrease mold growth and dust mite proliferation, or having periodic pest control measures employed to decrease cockroaches and other insects.

Allergen avoidance measures are individualized or tailored to the individual patient’s particular allergic disease, and can be formulated once the allergy evaluation is completed.

Medical options for treatment

Medical therapies commonly used include inhaled nasal steroids, oral, nasal and ocular antihistamines, decongestants, anti-leukotriene blockers, nasal saline and mucous thinners.

Many of these medicines are now available over the counter without a prescription, and are readily available to patients.

Inhaled nasal steroids come in wet and dry formulations and are considered to be the most effective treatment for allergic rhinitis. Examples of inhaled nasal steroids are flonase, nasonex, nasacort, veramyst, rhinocort, nasalide, zetonna, and qnasl.

Oral antihistamines are the most utilized allergy meds, and most are available over the counter. Examples include claritin, zyrtec, allegra, clarinex, xyzal, benadryl, chlortrimeton, or actifed. Singulair is an anti-leukotriene blocker which is available by prescription to treat allergic rhinitis.

There are a number of over the counter and prescription eyes drops used to treat allergic conjunctivitis including zaditor, optivar, lastacaft, pataday or patanol. An allergy specialist will formulate a treatment regimen specific to the individual patient’s needs.

Allergen immunotherapy

Allergen immunotherapy can come in the form of injection or allergy shots. This form of therapy has been utilized for more than 100 years in the treatment of allergic disease.

Allergy shots vaccinate patients with small amounts of allergen over time to create a tolerance. In other words, as the dose of immunotherapy is increased, allergy symptoms can be decreased or even eliminated.

Typical allergy shot regimens start with weekly injections. Over a few months, the allergy patient will reach a maintenance dose. Shots can then be spaced out to every 2-4 weeks, and are continued for a period of 3-5 years. After this period of time, most patients can stop allergy shots and maintain tolerance or control of their allergy symptoms.

Sublingual immunotherapy, or SLIT, is a form of oral immunotherapy that employs either liquid or oral tablet vaccine that is self-administered by the patient at home. This form of allergy vaccine has been used in Europe for quite some time. Only recently, SLIT was FDA approved here in the United States.

Currently, only grass and ragweed SLIT are approved for use. SLIT has proven to be quite safe, and is shown to improve a patient’s tolerance and symptom control. However, SLIT has not been shown to be as effective as traditional allergy shots, and can only be used at this time to treat grass or ragweed pollen allergy in the United States.

What happens if my allergies are not controlled?

Untreated or poorly controlled allergic rhinitis and conjunctivitis can lead to increased risk for sinus infections, ear infections, upper and lower respiratory infection, sleep disruption, fatigue, and poor school or work performance.

In addition, allergic disease can worsen or increase the chance to develop asthma. It has been shown that quality of life overall is decreased among allergy sufferers in general. So, don’t let allergic disease negatively affect your life!! Come see us at Allergy and Asthma Specialists, PSC and let us create the most effective treatment plan to combat your allergy troubles.