Background
Allergic rhinitis is a potentially debilitating condition that is probably more common than you think. More than 1 in 10 people suffer with allergies and more often than not the nose is one of the main areas affected.
The term allergic rhinitis indicates a condition causing inflammation of the lining of the nose and sinuses in which the underlying problem is related to allergy. The most common allergies are to pollens, house dust mite, animal hair and moulds. It is rare for foods to cause rhinitis except in rare conditions such as food-pollen allergy syndrome and salicylate intolerance with aspirin intolerance.
Symptoms
The symptoms of allergic rhinitis can have a major impact on daily life. The inflammation causes swelling of the nasal lining which leads to nasal blockage, often alternating from side to side due to the nasal cycle. The blockage can be very frustrating during the day, particularly when doing exercise, but is most troublesome at night. Sufferers can’t find a comfortable position to lie in as they are so blocked and often have to breathe through their mouth. This leads to a very dry mouth and makes snoring more likely. The resulting poor quality sleep leads to tiredness and irritability during the day and an inability to function to your full potential.
The other main symptom is nasal discharge. This is usually watery and can come out of the front of the nose or down the back into the throat. The dripping can be socially embarrassing, irritate the skin above the upper lip, cause a sore throat and lead to a hoarse voice. If the discharge turns yellow or green it would indicate a sinus infection in addition to the allergy. There can be other more general allergic symptoms such as itchy and watery eyes, chest tightness and exacerbation of asthma and itchy skin.
It is well known that the exam performance of children with hay fever deteriorates as a result of these symptoms. Crucial exams are often scheduled when the pollen count is highest so it is imperative to manage these children as effectively as possible so their symptoms are reduced to a minimum.
Diagnosis
Having a skin prick test allergy test can be very helpful in determining exactly what you are allergic to. It is very quick, simple and reliable. In a few cases we will do blood tests to find the allergy. Following a positive test, advice can be given on how to avoid the allergen. Examples include the use of pollen air filters for hay fever, or removing carpets and curtains for dust allergy. However this is not always practical and frequently without much success so formal treatment is required.
Treatment
The first stage of treatment is to use anti-histamine medication which can be either taken by mouth or as a nasal spray. It works by blocking the allergic biochemical pathway to reduce inflammation. Combining this with a nasal saline rinse is effective. The rinse cleans the nose, flushing out any irritants such as pollen or dust particles. Oral anti-histamines are particularly relevant in the presence of more generalised allergic symptoms such as itchy skin. The next step would be to use a nasal steroid spray as an anti inflammatory medication.
There has been a game changer in this field with the introduction of Dymista. This combines an effective steroid and anti-histamine in one single spray. Studies have shown that this combination spray is even more effective than taking separate steroid and anti-histamine sprays. Occasionally we will use steroid tablets to provide fast effective relief in difficult cases but these must be used with caution due to potentially significant side effects.
For those patients who do not respond well to these medications there is the option of immunotherapy. This involves modifying the immune system so you become de-sensitised to the allergen and no longer mount an allergic response. It will effectively ‘cure’ the allergy. It is done either by a series of injections or with drops under the tongue. In a few difficult cases surgery can be effective to reduce nasal blockage by removing some of the most swollen parts of the nose in a procedure known as a turbinoplasty.
Conclusion
Allergic rhinitis as a very common condition which can have a severe impact on the daily lives of children and adults. It can cause disruption of sleep patterns leading to tiredness. This in turn may affect their ability to work effectively and reduce performance.
There are many treatment options for this condition so sufferers must be made aware that their symptoms can be improved. A stepwise approach is usually the best way forward, starting with ensuring a correct diagnosis. Avoiding situations that expose you to the allergen and taking medication when appropriate is also important.
