Allergic Rhinitis

(Hay Fever; Seasonal Allergies)

Definition

Allergic rhinitis is inflammation in the nose after contact with allergens. An allergen is anything that causes an abnormal response of the immune system. There are 2 main types:

  • Seasonal allergic rhinitis (sometimes called hay fever or rose fever)—happen at specific times of the year. Common causes are pollens from tree, grass, or weeds.
  • Persistent allergic rhinitis—can happen throughout the year. Common causes are chemicals, dust, dust mites, cockroaches, animal dander, or mold spores.

Causes

An allergic reaction is an overreaction of the immune system. A chain of events is started when the allergen makes contact with the inside of the nose. Immune cells in the nose release a chemical called histamine. Histamine causes itchiness and swelling. It also increases the amount of mucus in the nose.

Site of Histamine Production

Nasal passage
This area has swelling and increased mucus production after contact with an allergen.
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Risk Factors

The risk of allergic rhinitis is higher in those with:

Symptoms

Allergic rhinitis can cause:

  • Sneezing
  • Itching in the nose, eyes, throat, and ears
  • Red, watery eyes
  • Runny nose, nasal congestion
  • Congestion with sinus pressure
  • Postnasal drip and cough
  • Headache
  • Dark circles under your eyes

Diagnosis

The doctor will ask about symptoms and past health. Allergic rhinitis may be suspected based on symptoms. Tests may be done to see what allergens are causing problems. Tests may include:

  • Skin prick test—A tiny bit of an allergen is placed under the skin. The doctor watches to see if the skin in that area becomes red, raised, and itchy.
  • RAST testing—A small sample of blood is taken. It will be tested for different allergens.

Treatment

Avoiding the allergens is the best way to treat allergies. Specific steps will depend on the type of allergen, for example:

Reducing dust mite allergens:

  • Wash pillows and bed sheets regularly in hot water.
  • Remove carpeting, feather pillows, and upholstered furniture, especially in bedroom.
  • Keep clothes off bedroom floor.
  • Use acaricides solutions to kill dust mites.
  • Keep humidity levels < 50%.
  • Use double-bag vacuum bags and HEPA filters.

Reducing mold contact:

  • Wear facemasks when working with soil, leaves, or compost.
  • Try to avoid moist, damp areas within the home.
  • Use a dehumidifier in damp places of the home like the basement.
  • Repair leaky roofs or pipes.

Reducing animal allergens:

  • Keep your pet out of your bedroom and off of furniture.
  • Vacuum often or remove rugs.
  • The pet may need to be removed for severe allergens. It may take 4 to 6 months to clear the home of pet allergens.

Use news reports or online resources to track pollen levels in you area. If the allergen level is high:

  • Stay indoors and keep windows closed.
  • Consider using an air purifier inside.
  • Do not dry clothes outside.
  • Shower when you get home. Keep clothes that were worn outdoors out of the bedroom.

General steps that may reduce contact with allergen:

  • Use petroleum jelly on the nostrils. The jelly may catch some of the allergens before they pass into the nose.
  • Nasal filters—Device inserted into the nostrils that can filter allergens before they reach the nose.
  • A neti pot, nasal sinus rinse, or saline nasal spray can help flush nasal passage. It may clear irritants and help to loosen congestion.

It is not always possible to avoid all allergens. Other treatments may help reduce the body's reaction to the allergen:

Medicine

Medicine can help to decrease the reaction of the immune system. This will lead to fewer and less severe symptoms. It may be given alone or in combination. Options include:

  • Nasal corticosteroid (glucocorticoid)—very effective for allergic rhinitis
  • Antihistamine—may be pills taken by mouth or as nasal spray

This medicine is most effective when taken before contact with the allergen. It will also need to be taken as long as the allergen is present.

Other medicine that may be added include:

  • Nasal mast cell stabilizers
  • Leukotriene receptor antagonists
  • Anticholinergics

Decongestants may be recommended for severe congestion. Overuse of nasal decongestant sprays can actually make symptoms worse.

Immunotherapy

Immunotherapy uses injections or pills to slowly introduce an allergen to the body. The goal is to make your body less sensitive to those allergens. This may stop allergic rhinitis for some, in others it may help to decrease symptoms. The therapy is delivered in small amounts over weeks, months, or even years. Immunotherapy is only available for specific allergens but more may become available after appropriate testing.

This therapy is most often used for those who don't respond well to medicine.

Prevention

There are no steps to prevent the chance of having allergies.

RESOURCES:

American Academy of Allergy, Asthma & Immunology
http://www.aaaai.org
Asthma and Allergy Foundation of America
http://www.aafa.org

CANADIAN RESOURCES:

Allergy Asthma Information Association
https://www.aaaai.org

References:

Allergic rhinitis. American College of Allergy, Asthma & Immunology website. Available at:
...(Click grey area to select URL)
Updated February 6, 2018. Accessed February 10, 2020.
Allergic rhinitis. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T116217/Allergic-rhinitis. Updated April 19, 2019. Accessed February 10, 2020.
Durham SR, Yang WH, et al. Sublingual immunotherapy with once-daily grass allergen tablets: a randomized controlled trial in seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2006;117(4):802-809.
Managing indoor allergen culprits. American Academy of Allergy Asthma and Immunology website. Available at:
...(Click grey area to select URL)
Accessed February 10, 2020.
Rhinitis (hay fever). American Academy of Allergy, Asthma & Immunology website. Available at:
...(Click grey area to select URL)
Accessed February 10, 2020.
Wheatley L, Togias A. Clinical practice: allergic rhinitis. N Engl J Med. 2015;372(5):456-463.
8/27/2013 DynaMed Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116217/Allergic-rhinitis: Kim JM, Lin SY, et al. Allergen-specific immunotherapy for pediatric asthma and rhinoconjunctivitis: a systematic review. Pediatrics. 2013;131(6):1155-1167.
Last reviewed September 2019 by EBSCO Medical Review Board Marcin Chwistek, MD
Last Updated:8/11/2020

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