Don't Let Your Allergies Bloom This Spring
The term allergic rhinitis means allergic reactions occurring in the nose and surrounding tissues. These reactions are caused by airborne substances such as seasonal pollen, mold spores, house dust mites, dust from animals, and dust from cockroaches. Everyone breathes these materials, but some people make IgE antibodies (allergic antibodies) and become allergic to these substances. An estimated 60,000,000 people in the United States have allergic rhinitis, approximately 19 percent of the population. The symptoms of allergic rhinitis are nasal itching, sneezing, runny nose, nasal congestion, obstruction of the nose at night resulting in poor quality sleep (allergic inflammation becomes much more intense during the night), snoring, postnasal drainage, dry throat in the morning, popping and ringing and pressure sensations in the ears, and sinus pressure headaches. Some people with allergic rhinitis also have allergic conjunctivitis and experience intense itching and burning of the eyes, excessive tearing, swelling around the eyes, and dark discoloration beneath the eyes (allergic shiners). Some allergy sufferers develop a crease across the bridge of the nose (where the cartilage joins the nasal bones) because of constant rubbing of the nose to relieve the itching. Seasonal allergic rhinitis causes fatigue in approximately 80 percent of patients, and depression in 30 percent. Seasonal allergic rhinitis, caused by tree and grass pollen in the spring and weed and ragweed pollen in the fall causes several other problems to flare. Active seasonal rhinitis nearly doubles patients’ needs for doctor visits and new medications for anxiety, depression, asthma, sinus infections, middle ear infections, and tonsil infections (Crystal-Peters, et.al. Annals of Allergy, Asthma & Immunol. 2002;89:457-462). Migraine headaches are more frequent when allergies are active. Embarrassing symptoms occur in at least 25 percent of patients.
The economic impact of allergic rhinitis includes 3,500,000 workdays lost each year and approximately 2,000,000 days of school lost because of allergic rhinitis. When allergic rhinitis is active, productivity at work or school is impaired by fatigue, distraction by allergic symptoms, and sometimes by the sedating properties of over-the-counter allergy remedies.
How to control of allergic rhinitis
We have gained a detailed understanding of the mechanisms of allergic rhinitis. This has led to the development of a broad range of powerful interventions can provide nearly complete control of allergic rhinitis symptoms and methods to eliminate these allergic reactions, with mild or no adverse reactions from medications. Reasonable expectations of these interventions: · No symptoms. Symptoms of allergic rhinitis usually can be suppressed to the point that they are of little consequence in most patients. · No sleep disturbance. Aggressive interventions can eliminate nocturnal nasal obstruction which leads to poor quality sleep. This seems to be the main reason for fatigue and other allergic rhinitis complications. · No complications. Aggressive management of allergic rhinitis should minimize the chance of complications such as bacterial sinusitis or flares of asthma. Three levels of care for allergic rhinitis: Self-care, physician care, and specialist physician care Self- care: Approximately 80 percent of people with allergic rhinitis either endure the problems or use over- the-counter medications. Keeping the windows in the home and car closed helps. HEPA air filters in the bedroom may help. Oral antihistamines can be helpful for itching, sneezing, runny nose, and itching and burning of the eyes, reducing symptoms 25% better than a placebo. Older sedating antihistamines such as diphenhydramine can be helpful, but also have been shown to impair our ability to drive and learn. Newer, nonsedating antihistamines are available over-the-counter that provide relief and are much safer. Antihistamines have little effect on nasal or sinus congestion. Oral decongestants can provide some relief from the congestion, but they also disrupt normal sleep architecture, and can cause heart rhythm problems, dizziness, anxiety and tremors. Nasal spray decongestants can be effective for congestion, but many people quickly become dependent upon the decongestant sprays. Once the effect of the decongestant spray wears off, the nose swells shut and is very uncomfortable unless the spray is used again. Intranasal cromolyn and intranasal saline also help some individuals. Is self-care effective? For some individuals, self-care provides acceptable relief from symptoms, protection against sleep disturbance, and protection against complications such as sinusitis. Physician care: Approximately 20 percent of patients with allergic rhinitis see a physician for more powerful interventions. Prescription medications proven to be effective for allergic rhinitis include intranasal steroids, intranasal antihistamines, intranasal nerve blocking agents, oral medications that block leukotrienes (allergy mediators that along with histamine account for most of the allergic manifestations), and in extreme cases, oral or injected steroids. If the allergic rhinitis symptoms are suppressed, sleep isn't disturbed, and there are no complications, the goals reasonably expected have been achieved.
Expert care: When symptoms are not well controlled, and sleep is disturbed by nocturnal nasal obstruction, or when complications of allergic rhinitis such as asthma or sinusitis are present despite these interventions, an Allergy and Immunology specialist is able to provide effective relief. Accurate diagnosis is necessary to establish that the problem really is allergic rhinitis, to guide specific measures to avoid exposure to the causes and aggravating factors, and to identify patients whose problems can be minimized or eradicated by immunotherapy (allergy shots). The evaluation also includes searching for complications or concurrent problems such as nasal polyps, nasal septal deviation, other anatomical problems in the nasal passages, bacterial sinusitis, medication effects on the nose, and multiple other factors that modify or mimic allergic rhinitis. Concurrent problems such as asthma, sensitivity to non-steroidal anti-inflammatory drugs, Vitamin D deficiency, and antibody immunodeficiency should be identified and corrected. Interventions selected and adjusted for individualized care usually provide excellent control of allergic rhinitis. The likelihood allergic rhinitis will spontaneously go away is approximately 1-2 percent per year. Seasonal allergies usually return and being prepared is essential to the longterm management of this problem. Starting intranasal steroids before the pollen season can markedly reduce or eliminate the flare in some patients.
Immunotherapy (allergy shots), especially rush immunotherapy, may be useful to greatly reduce the severity or completely eliminate seasonal allergic rhinitis. Patients with allergic rhinitis severe enough to require the help of an allergist are usually excellent candidates for therapy aimed at cure, rather than relief.
Don’t accept disrupted quality of life because of allergic rhinitis.
We now have a large array of overthe-counter, prescription, and specialist interventions to suppress, and even, eliminate seasonal allergic rhinitis. You do not have to put up with seasonal allergies anymore. Don’t let your allergies bloom this spring. -Timothy J. Sullivan, MD and Vicki J. Lyons, MD