Doctor's Blog

Allergic Rhinitis
August, 2009

Allergic rhinitis is very common. It is believed to affect up to 40 percent of children and 10 to 30 percent of adults in the United States.

Rhinitis is inflammation of the nasal passages causing symptoms such as nasal discharge, itching, sneezing, congestion, and pressure. Postnasal drip, cough, irritability, and fatigue are also common. The combination of nasal itching and postnasal causes people to push their nose up with their hand. This leads to a transverse crease across the nose. Swelling and darkening under the eyes is often called "allergic shiners." This is caused by enlargement of the veins around the eyes.

Two types of inflammatory cells, mast cells and basophils, trigger the allergic reaction. These cells produce inflammatory substances, such as histamine, that cause fluid to build up in the nasal tissue. Over several hours, these substances activate other inflammatory cells that can cause persistent symptoms.

Avoiding the allergens is the simplest solution, but not always feasible. Nasal irrigation with saline solution helps by rinsing out allergens from the nose. Saline rinses also clean the nasal lining and can be used before applying medicated sprays. Bulb syringes, Neti pots, and bottle sprayers may be used to perform nasal lavage.

Steroids nasal sprays (for example, Flonase, Nasacort, Rhinocort) are the first-line treatment for the symptoms of allergic rhinitis. These drugs have few side effects and dramatically relieve symptoms in most people. Studies have shown that nasal steroids are more effective than oral antihistamines for symptom relief. Some symptom relief may occur on the first day of therapy with nasal steroids, although their maximal effectiveness may not be noticeable for days to weeks. For this reason, nasal steroids are most effective when used regularly.

Oral antihistamines (for example, Claritin, Allegra, Zyrtec) relieve the itching, sneezing, and runny nose of allergic rhinitis, but they do not relieve nasal congestion. Decongestant such as pseudoephedrine (Sudafed) are often combined with antihistamines. Oral decongestants elevate blood pressure and are not appropriate for people with high blood pressure. Combined treatment with nasal steroids or decongestants may provide greater symptom relief than use of either alone.

Immunotherapy via injections are given to reduce a person's sensitivity to allergens. The solution is made up individually for each patient. Exposure to small doses of the allergens changes the person's immune response to the allergens over time. As a result, being exposed to the allergen causes fewer or even no symptoms. Immunotherapy is usually started by an allergist.

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