Allergic Rhinitis

  • What Is Allergic Rhinitis?

    Allergic rhinitis and related nasal or upper respiratory conditions involve inflammation of the mucous membranes in the nasal passages, caused by a hypersensitive response of the immune system to an airborne allergen or irritant. The specific allergens that trigger allergic rhinitis (commonly called hay fever, though neither hay or fever play a role) vary from person to person and often include pollen, mold, animal dander, or dust. There are two main types of allergic rhinitis: seasonal (spring through fall) and perennial (all-year long). Seasonal allergic rhinitis often is caused by outdoor allergens (mold spores and pollen from trees, grasses, and weeds) and perennial allergic rhinitis is an allergic reaction to indoor allergens (dust mites, mold spores, and animal proteins like saliva and cat dander).

    Symptoms can occur at any age but usually first appear between ages 10 and 20, and tend to diminish later in life. Allergic rhinitis is exceedingly common (as many as 25 percent of young adults are afflicted with it) but it is highly treatable.


    Who Gets Allergic Rhinitis?

    According to the American Academy of Allergy, Asthma & Immunology (AAAAI), more than 40 million people in the United States (15–20% of the population) are affected by hay fever allergies. The Asthma and Allergy Foundation of America reports that hay fever is the fifth leading chronic condition in the United States and the third most common chronic condition in children and adolescents younger than age 18. Outdoor and seasonal allergies account for more than half of all allergy-related medical appointments.



    • Frequent sneezing.
    • Profuse nasal discharge (usually clear and watery).
    • Nasal congestion and itching.
    • Red, watering, itching eyes.
    • Puffiness and dark circles around the eyes.
    • Possible cough or wheezing.
    • Impaired sense of taste or smell.
    • Itching in the back of the throat.


    Causes/Risk Factors

    It’s not clear why some people are sensitive to specific allergens. A number of different irritants, or allergens, can trigger allergic rhinitis, and they vary from person to person. Among the irritants and other factors that can trigger rhinitis are the following:

    • Airborne pollen from various seasonal plants, including grasses, flowers, trees, and ragweed.
    • Mold spores.
    • Animal dander (small scales of dead skin or dried saliva, shed from the hair of certain mammals).
    • Household dust, which may contain house dust mites, animal dander, or cockroaches.
    • Hereditary factors affecting immune sensitivity.
    • Overuse of decongestant sprays.
    • A hypersensitivity to medications, including aspirin and other nonsteroidal anti-inflammatory drugs.
    • Hormonal disturbances that may occur with pregnancy, oral contraceptive use, or hypothyroidism.


    What If You Do Nothing?

    As long as the allergens remain present, and you remain sensitive to them, you can have attacks.



    • Physical exam along with a history of your symptoms and a family history of known allergies. You may be referred to an allergy specialist.
    • If allergic rhinitis is suspected, skin tests will be performed. The skin is scratched or pricked with a number of needles, each containing a small amount of an allergen; a specific allergen is implicated if the area becomes red or itchy, or a raised welt appears.
    • Analysis of nasal secretions.
    • Blood tests to reveal a heightened antibody count, indicating an allergic response.



    • Antihistamines are the first line of treatment for allergic rhinitis. Many nonprescription varieties are available, although they may cause drowsiness or drying of the mucous membranes. Newer nonsedating antihistamines are available by prescription; these include fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec).
    • Short-term use of decongestant sprays such as Neo-Synephrine or Afrin may be beneficial. (Combinations of oral antihistamines and decongestants are also available.) Decongestants should not be used for more than a few days, since routine use can cause rebound nasal congestion.
    • Special eye drops may be prescribed when eye symptoms persist despite other treatment.
    • Inhaled or oral corticosteroids may be prescribed to reduce extreme inflammatory symptoms. Nasal sprays containing steroids and/or antihistamines are commonly prescribed to reduce nasal congestion. Some nasal steroid sprays are now available without a prescription.
    • When all else fails, an allergist may administer increasing amounts of the offending allergen (immunotherapy or allergy shots), initially at regular intervals, then less frequently, in an effort to desensitize the patient to the allergen. Many people, children as well as adults, find the injections really do reduce symptoms, often long-term or even permanently.



    • When seasonal allergies flare up, be alert to pollen counts (which are broadcast by the AAAAI) and if you need to go outdoors, take medication with you.
    • If your symptoms tend to be severe, try to stay inside a climate-controlled environment as much as possible on days that pollen counts are high.
    • Saline nasal rinses may help to reduce the total allergic load inside the nasal cavity.
    • Try the nasal spray Nasalcrom. Available over the counter, it is safe and effective for preventing such symptoms as runny nose and nasal congestion. However, it won’t help after symptoms start—you need to spray before being exposed to the allergen. It can also take a week or so to begin working.
    • Consider relocating to pollen-free areas if symptoms are sufficiently severe.
    • If necessary, avoid or isolate furred animals.
    • If you’re allergic to dust and dust mites, take steps to combat them. To eliminate dust mites commonly found in bedding, use machine-washable polyester pillows, seal your mattress in a zippered cover, and launder bed linens frequently. Use air filters in bedrooms.
    • If you find you’re allergic to a pet, the best remedy is to find another home for it. If that is out of the question, at least keep the pet out of your bedroom.


    When To Call Your Doctor

    • Call a doctor if allergic rhinitis interferes with normal activities or if over-the-counter antihistamines cause excessive drowsiness (your doctor can prescribe a nonsedating antihistamine).


    Reviewed by Alan Lipkin, MD, Otolaryngologist, Private Practice, Denver, Colorado. Review provided by VeriMed Healthcare Network.