Overview
In allergic rhinitis the immune system treats a harmless substance in the air as a threat. When that substance lands on the lining of the nose, the body releases chemicals including histamine, and the lining swells, itches and produces fluid.
It may be seasonal, when pollen from trees, grasses and weeds is in the air at particular times of year, or it may last all year when the trigger is something indoors such as house dust mites, mould or a pet. It often runs in families, alongside asthma and eczema.
Symptoms
- Repeated sneezing, often in bursts
- An itchy nose, and itching of the roof of the mouth or the throat
- A runny nose with clear fluid, or a blocked nose
- Itchy, red, watery eyes
- A cough, or a tickle from mucus running down the back of the throat
- A reduced sense of smell
- Tiredness, poor sleep and difficulty concentrating
- Dark shadows under the eyes
Symptoms often begin within minutes of meeting the trigger. Congestion, cough and tiredness tend to build up over the following hours.
When to see a doctor
See a doctor within a few days if symptoms disturb sleep, school or work, if pharmacy treatments have not helped, if the nose is blocked on one side only or bleeds repeatedly, if there is thick coloured discharge with facial pain and fever for more than a few days, if asthma has become worse, or if the sense of smell has gone and not returned.
Causes
The common triggers are pollen from trees, grasses and weeds, which is carried on the wind and is worse on dry windy days and less troublesome after rain; house dust mites, which live in bedding, mattresses, carpets and soft furnishings; flakes of skin, saliva and urine from cats, dogs, birds and other animals; and mould spores in damp places.
Some people react to substances at work, such as flour, wood dust, latex or chemicals. Smoke, strong perfume, incense and cold air do not cause the allergy but irritate an already inflamed nose. The tendency to become allergic often runs in the family.
Risk factors
- A family history of allergy, asthma or eczema
- Having asthma or eczema yourself
- Living or working in dusty or damp surroundings
- Pets in the house
- Exposure to tobacco smoke
- Work involving flour, wood dust, latex or chemical fumes
Complications
- Poor sleep, daytime tiredness and difficulty concentrating at school or work
- Worsening of asthma symptoms
- Sinus infection, with facial pain and thick discharge
- Fluid behind the eardrum, with dulled hearing, particularly in children
- Soft swellings in the nose called nasal polyps
- Repeated mouth breathing and a persistently blocked nose
Prevention
- Staying indoors and keeping windows shut when pollen counts are high, and showering and changing after being outdoors
- Wearing wraparound sunglasses outdoors during the pollen season
- Washing bedding regularly at a hot wash, and using covers designed to keep dust mites out
- Damp dusting and vacuuming with a filtered vacuum cleaner, and keeping clutter and heavy curtains to a minimum
- Keeping the home dry and well ventilated to discourage mould
- Keeping pets out of the bedroom, and grooming and washing them regularly
- Avoiding tobacco smoke, incense and strong sprays
Diagnosis
The diagnosis is usually made from the pattern of symptoms: what they are, when in the year or the day they happen, and what makes them worse. The doctor examines the nose, throat and eyes, and asks about asthma, eczema and family history.
When the trigger is not obvious, or when treatment is not working, allergy testing may be arranged. A skin prick test places drops of common allergens on the skin and looks for a small raised reaction, and a blood test can measure allergic antibodies to particular substances.
Treatment
Reducing contact with the trigger is the first step, and for many people it is enough on its own for mild symptoms.
Rinsing the nose with a salt water solution, made with distilled or previously boiled and cooled water, clears pollen and mucus and soothes the lining. Antihistamines, as tablets, syrup or a nasal spray, ease sneezing, itching and a runny nose. Steroid nasal sprays reduce the swelling of the lining and are the most effective treatment for persistent symptoms, but they need to be used regularly and correctly for several days before they work fully. Decongestant sprays or drops are used for only a few days at a time. Allergic eye symptoms respond to anti allergy eye drops.
If symptoms remain severe despite these measures, a doctor may consider immunotherapy, in which small, gradually increasing amounts of the allergen are given as injections or as tablets under the tongue over a period of years to reduce sensitivity. Asthma that occurs alongside allergic rhinitis is treated at the same time.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“It is just a cold that never goes away.”What is true?
Fact
Allergic rhinitis is an allergic reaction to something breathed in, not an infection. Symptoms often begin within minutes of exposure, itching of the nose, eyes and roof of the mouth is typical, and it is not caught from anyone or passed on. Antibiotics do not help.
Myth“Steroid nasal sprays are strong medicine, so it is safer to take a tablet when things get bad.”What is true?
Fact
A steroid nasal spray is described by health services as the most effective treatment for allergic rhinitis. It acts on the lining of the nose, and it needs to be used regularly for some days before the full benefit shows, so using it only on bad days gives disappointing results. Whether it suits a particular person is a question for the doctor or pharmacist.
Myth“Decongestant nose drops are harmless and can be used as long as symptoms last.”What is true?
Fact
Decongestant sprays and drops open a blocked nose quickly, but health services advise using them for only a few days at a time. For symptoms that go on longer, a doctor or pharmacist can suggest treatments meant for regular use.
Myth“Nothing can be done except stay indoors and put up with it.”What is true?
Fact
A great deal can be done. Reducing contact with the trigger helps, as do antihistamines, salt water rinses and steroid nasal sprays. For people whose symptoms are severe and do not respond to medicines, immunotherapy, given as injections or as tablets under the tongue, can reduce sensitivity over time.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How do I tell allergic rhinitis from a cold?
A cold usually builds over a day or two, comes with a sore throat and sometimes a mild fever, and clears within about a week. Allergic rhinitis starts within minutes of meeting the trigger, itches a great deal in the nose, eyes and roof of the mouth, causes no fever, and lasts as long as the trigger is around.
Do I have to use the nasal spray every day, even when I feel fine?
For seasonal symptoms, steroid nasal sprays usually work best when they are used regularly through the season rather than only on bad days, and it can take several days of regular use before the full effect shows. Your doctor or pharmacist will say how long to continue and how to use the spray correctly.
Can allergic rhinitis affect my asthma?
Yes. The nose and the airways often react to the same triggers, and uncontrolled nasal symptoms commonly go with worse asthma. Tell your doctor if your breathing, cough or need for a reliever inhaler has changed, so that both conditions can be treated together.
Will my child grow out of it?
Some children do become less sensitive as they grow, and symptoms can settle for long periods. For many people, though, the tendency lasts into adult life. Either way the symptoms can usually be controlled well, so there is no need to simply wait it out.
