Allergic Rhinitis

Allergic rhinitis is the inflammation of the nasal airways. It is a collection of symptoms primarily occurring in the nose and eyes. It occurs when you breathe in something you are allergic to allergens such as dust, pollen, insect venom, and indoor fungi. If it is attributed to outdoor triggers, such as pollen, it is called hay fever. Allergic rhinitis occurs when your immune system overreacts to particles in the air that you breathe, causing symptoms such as itchy nose, mouth, eyes, throat, skin, watery eyes, sneezing and a runny nose. If you have allergies, you will usually have symptoms for many years. You may have symptoms at certain times of the year or often during the year. Over time, allergens may affect you less, and your symptoms may not be as severe as they used to be.

Types

Allergic rhinitis can be classified according to: How often a person has it and how severe it is:

1. Intermittent – have symptoms fewer than four days a week or fewer than four weeks a year.
2. Persistent – have symptoms four or more days a week and four or more weeks a year.
3. Mild – symptoms that do not bother you a lot, i.e. they do not affect your daily activities, sleep and work or school.
4. Moderate to severe if your symptoms

• Interfere with your sleep
• Make daily activities or work or school difficult
• Bother you a lot

The type of allergens a person reacted to and when the reactions occurred:

1. Seasonal Allergic Rhinitis (SAR): Occurs at the same time each year and is often called hay fever. The most common allergens are windblown pollens from trees, grasses or weeds. Usually, the symptoms occur when certain plants are in bloom. Some types of mould seasonally occur, causing similar symptoms.
2. Perennial Allergic Rhinitis (PAR): A perennial, year-round allergy. Occurs any time during the year, and the symptoms of a year-round allergy may be more severe in winter. The most common causes of this type of allergy are dust mites, animal dandruff, cockroaches or mould.
3. Occupational Allergic Rhinitis (OAR): Caused by an allergic reaction to a substance present in the workplace (e.g. grain, wood dust, chemicals or lab animals).

Causes And Risk Factors

Causes

An allergen is something that triggers an allergy. When you are exposed to an allergen for the first time, your body’s immune system recognizes the allergen as a foreign substance. Your body reacts by making antibodies against the allergen. The next time you are exposed to the allergen, the antibodies attack it and release chemicals, including histamine that cause your allergy symptoms. This is called sensitization. In hay fever, there is an allergic reaction to pollen. Certain allergens that cause allergic rhinitis are dust mites, animal dandruff, cockroaches, and mold. Things in the workplace such as cereal grain, wood dust, chemicals or lab animals can cause allergic rhinitis. Common causes for perennial allergic rhinitis (PAR) include:

1. Indoor fungi
2. Animal dandruff and the most important being the cat.
3. Dandruff from rodents, rabbits, dogs, and birds can cause rhinitis.
4. Dust mites
5. Other insects (cockroach, gipsy moths , spiders, ladybugs and beetles)

Common causes for seasonal allergic rhinitis (SAR) include:

1. Tree pollens – symptoms in winter and spring
2. Grass and weed pollens – symptoms in summer
3. Ragweed – symptoms in late summer and autumn

Many people with allergies are very sensitive to strongly scented products. Incense burning during prayers (puja) and Indian rituals (havan) emits smoke containing particulate matter, gas products and other organic compounds and causes air pollution, airway disease and health problems. However, multiple conflicting reports have been documented. Some studies reported that there was no association between exposure to incense burning and respiratory symptoms such as chronic cough, chronic bronchitis, runny nose, wheezing, asthma, and allergic rhinitis. According to Hindu Vedic practices, the smoke that rises from a receptacle (havan kind) in the home contains powerful healing energy.

Risk Factors

The following factors increase your chances of getting allergic rhinitis:

1. Genes – Family history of allergies. A child possibly has an allergy if both parents have an allergy.
2. Environment – Exposure to indoor allergens and pollens or moulds.
3. If you already suffer from eczema or asthma, you have greater chance of having allergic rhinitis.

Symptoms

Symptoms that immediately occur after you come into contact with the allergen may include:

1. Itchy nose, mouth, eyes, throat, and skin
2. Problems with smell sensation
3. Runny nose – drainage from a runny nose caused by allergies is usually clear and thin
4. Sneezing
5. Watery eyes
6. Symptoms that may develop later are listed below:
7. Stuffy nose (nasal congestion)
8. Cough
9. Clogged ears
10. Decreased sense of smell
11. Sore throat
12. Puffiness and dark circles under the eyes
13. Fatigue and irritability
14. Headache

Diagnosis

Generally, allergic rhinitis is diagnosed based on your history of symptoms through –

1. Physical examination
2. Skin test: A skin prick test is a standard diagnostic test in which the doctor places different types of allergens on the patient's skin and scratches or pricks the particular area with a needle. This gives the allergens a chance to get under the skin surface. If the patient is allergic to any of the allergens, then he or she will develop a red, itchy spot in 15–30 min.
3. Blood test: An immunoglobulin E (IgE) is a type of blood test that can help to identify whether someone is allergic to a specific protein such as moulds, animal fur, food allergy, house dust mites, certain drugs and cosmetics, and tree pollen. People with allergic rhinitis have higher than normal levels of IgE.
4. A CT scan is sometimes used to exclude other complications such as chronic rhinitis or tumours.
5. Nasal endoscopy can be used to obtain a better look inside the nose. This examination is performed to look for nasal polyps.

Treatment

Allergic rhinitis can be treated with the help of -

1. Self-care: This involves the use of home remedies or over-the-counter (OTC) drugs to combat its symptoms.
2. Medications: Drugs that are commonly prescribed to treat allergic rhinitis include

• Antihistamines
• Corticosteroids
• Decongestants
• Leukotriene modifiers
• Mast cell stabilizers
• Allergy shots
• Immune-based therapies

Complications And Prevention

Complications

In case allergic rhinitis is not treated, it can trigger a number of health complications such as –

1. Nasal Polyps: The development of swelling in the sinuses or the nose's inside lining is called nasal polyps. It is one of the complications of allergic rhinitis caused by the inflammation of the nose membrane. Smaller polyps can be treated with steroids. If the nasal polyps are very big in size, they can cause problem with breathing, decrease the sense of smell, and can block the sinuses. They need to be surgically removed.
2. Sinusitis: It is one of the most common complications of allergic rhinitis. Rhinitis can cause the inflammation or infection of the sinuses, leading to a condition called sinusitis.
3. Otitis media: Otitis media is an infection of the middle ear.
4. Allergic rhinitis can cause problems with the eustachian tube, whereas rhinitis can cause accumulation of fluid within this tube, which can lead to ear infections.
5. Asthma: Allergic rhinitis can cause additional complications in people already suffering from asthma. It further worsens the symptoms of asthma.
6. Upper respiratory infections
7. Dental implication

PREVENTION

Allergic rhinitis can be prevented by avoiding contact with the responsible allergens. The following steps may help one to prevent allergic rhinitis:

1. People should avoid touching their face and rubbing their noses.
2. Hands should be regularly washed with soap and water, particularly after playing with pets.
3. Windows of homes and cars should be closed during the seasons when there is a high pollen count in the environment.
4. Bedcovers and pillowcases should be washed with detergents in hot water.
5. Sunglasses and wide-brimmed hats can be used to prevent pollens from getting into the eyes.
6. Do not allow your pets to come onto beds or couches Filters can be used in vacuum cleaners and air conditioners to reduce exposure to allergens.

Alternative Remedies

Alternative therapies that are extensively used to treat allergic rhinitis are listed below:

1. Acupuncture
2. Herbs
3. Neutralization therapy
4. Detoxification
5. Enzyme potentiated therapy
6. Biologically based therapies
7. Ayurveda
8. Homoeopathy

Prognosis

Allergic rhinitis has a good prognosis as most of its symptoms can be managed with lifestyle modifications and over-the-counter (OTC) medicines. People with severe cases may require an allergy shot.

References

1. Cleveland Clinic. Allergic Rhinitis (Hay Fever) [Internet] [Updated on July 30, 2020] Available at: https://my.clevelandclinic.org/health/diseases/8622-allergic-rhinitis-hay-fever. Accessed on March 23, 2021. (https://my.clevelandclinic.org/health/diseases/8622-allergic-rhinitis-hay-fever)
2. NHS. Diagnosis Allergic Rhinitis [Internet] [Updated on April 29, 2019] Available at: https://www.nhs.uk/conditions/allergic-rhinitis/diagnosis/. Accessed on March 23, 2021. (https://www.nhs.uk/conditions/allergic-rhinitis/diagnosis/)
3. DermNet NZ. Immunoglobulin E tests [Internet] Available at: https://dermnetnz.org/topics/immunoglobulin-e-tests/. Accessed on March 23, 2021. (https://dermnetnz.org/topics/immunoglobulin-e-tests)
4. Varshney J, et al. Indian J Otolaryngol Head Neck Surg. 2015;67(2):143-149.
5. NHS. Complications Allergic rhinitis [Internet] [Updated on April 29, 2019] Available at: https://www.nhs.uk/conditions/allergic-rhinitis/complications/. Accessed on March 23, 2021. (https://www.nhs.uk/conditions/allergic-rhinitis/complications)
6. National Asthma Council. Hay Fever (allergic rhinitis) and your asthma [Internet] Available at: https://www.nationalasthma.org.au/living-with-asthma/resources/patients-carers/brochures/hay-fever-allergic-rhinitis-and-your-asthma. Accessed on March 23, 2021. (https://www.nationalasthma.org.au/living-with-asthma/resources/patients-carers/brochures/hay-fever-allergic-rhinitis-and-your-asthma)
7. AAFA. Rhinitis (Nasal Allergies) [Internet] [Updated on October, 2015] Available at: https://www.aafa.org/rhinitis-nasal-allergy-hayfever/. Accessed on March 23, 2021. (https://www.aafa.org/rhinitis-nasal-allergy-hayfever/)
8. Medline Plus. Allergic Rhinitis [Internet] [Updated on February 2, 2020] Available at: https://medlineplus.gov/ency/article/000813.htmhttps://medlineplus.gov/ency/article/000813.htm. Accessed on March 23, 2021. (https://medlineplus.gov/ency/article/000813.htmhttps://medlineplus.gov/ency/article/000813.htm)