Allergic rhinitis is an inflammation of the nasal passages and is usually associated with watery nasal discharge, sneezing, itching of the nose and eyes, and congestion. It affects approximately 20% of the American population, making it one of the most common illnesses in the United States.
Although two-thirds of all allergic rhinitis patients have symptoms before the age of 30, the onset can occur at any age. If left untreated, allergic rhinitis can cause recurrent sinus infections and frequent upper respiratory infections. There is growing evidence that allergic rhinitis contributes to asthma. It is also an important cause of chronic cough, fatigue, and sinus headaches.
Everyone breathes in pollens, dust mites, pet dander, and molds; but for those who have allergies, the body is overreacting to these substances. The immune system responds by releasing chemical substances such as histamine and other mediators that cause swelling within the nose as well as itching and sneezing. Dust mites, cockroaches, molds, and animal dander are examples of year-round allergens. Pollens are primarily seasonal outdoor allergens. Tree pollens are most common in the spring, grasses in the summer, and ragweed in the fall.
It is important to check with your doctor if you are experiencing allergy symptoms because infections can mimic the symptoms of allergic rhinitis. An allergy specialist can perform a skin test to confirm the diagnosis of allergic rhinitis and to identify what allergens trigger the symptoms. Avoidance of allergens is the best treatment. Your doctor or respiratory therapist can offer common-sense ways for avoiding seasonal allergens (tree, grass, and ragweed pollens). Excessive exposure to allergens can be prevented by avoiding extended outdoor activities, especially on windy days when the pollen counts are higher. Maintaining an allergen-free environment also includes covering pillows and mattresses with plastic covers and removing dust-collecting household fixtures (e.g., carpets, drapes and bedspreads). Air purifiers (HEPA filter) may also help.
There are various options of medications that can give relief. They include antihistamines, oral and topical decongestants, and nasal sprays. Many of the first-generation antihistamines, which are sold over the counter (e.g., diphenhydramine, chlorpheniramine), can cause drowsiness and functional impairment, which could be especially dangerous for an older person. Additionally, certain antihistamines may complicate prostate hypertrophy, cause bladder disturbances, or cause problems with visual accommodation. Other kinds of antihistamines — loratadine (Claritin), desloratadine (Clarinex), fexofenadine (Allegra), cetirizine (Zyrtec) — are less likely to cause drowsiness and side effects.
Oral and topical decongestants can interfere with urinary flow in men, may increase blood pressure, and should be used with caution. This can be especially problematic in elderly patients with an enlarged prostate. Oral decongestants include phenylephrine (Sudafed PE) and pseudoephedrine (Sudafed), and topical decongestant nasal spray include oxymetazoline (Afrin) and phenylephrine (Vicks Sinex).
Nasal corticosteroid sprays provide a safe, effective way to control nasal allergy symptoms. They act locally on the nasal mucosa and are highly effective without producing side effects. Common intranasal steroids include fluticasone (Flonase), triamcinolone (Nasacort), mometasone (Nasonex), and budesonide (Rhinocort). Systemic steroid use should be avoided due to its wide range of side effects. Other options of nasal spray include intranasal antihistamine, azelastine (Astelin); and mast cell stabilizer, cromolyn sodium (Nasalcrom). Saline nasal sprays are effective also in washing out allergens from the nasal passages.
With older patients, there is the potential of drug-drug interactions, which are more common due to the higher number of medications taken.
If your allergy symptoms do not improve or if you cannot use conventional medications, allergy injections (immunotherapy) can be considered. It is a process in which an you can become desensitized to allergens that trigger your symptoms by altering their immune response. It is a highly effective and long-lasting way of controlling allergy symptoms.
Allergic rhinitis is one of the most common chronic conditions in the United States, affecting quality of life for 20% of the population.
Given the current available therapy, the patient suffering from allergic rhinitis should expect marked symptom relief and improvement in quality of life. Whenever a new symptom appears, it helps to have a thorough discussion with your health care provider regarding prescription and over-the-counter drugs. Your doctor and respiratory therapist can help you with your allergies by keeping watch over your symptoms and helping you manage your allergies effectively.
Jane Lee, MD, is a staff physician at Baylor Medical Center and Presbyterian Hospital of Dallas. She is also an assistant professor in the division of allergy, asthma and immunology at the University of Texas Southwestern Medical School in Dallas, TX.