Rhinitis is the inflammation of the nasal passage lining. Allergic rhinitis is where this inflammation is caused by an allergic reaction to common particles in the environment. Hay fever is the common name for these reactions when they are caused by seasonal allergens such as plant pollens. The terms "allergic rhinitis" and "hay fever" are often used interchangeably.
Approximately 20% of New Zealanders suffer from allergic rhinitis. Whilst it can develop at any time of life, about one third of sufferers first develop symptoms in childhood (usually before the age of ten).
Allergic rhinitis symptoms include a recurrent runny, stuffy, itchy nose and sneezing. The eyes, throat and ears may also be itchy. Treatment can include avoiding allergens, medications (including nasal sprays and tablets) and immunotherapy.
People with allergic rhinitis react to common particles in their environment, such as pollen, dust, mould or animals. Particles that elicit an allergic response are called allergens or triggers. Some people are sensitive to only one or two allergens, while others are sensitive to many.
When a person inhales the allergen that they are allergic to, antibodies react to it. A chemical called histamine is released, causing the inflammation and symptoms characteristic of the condition.
The two main types of allergic rhinitis are:
Perennial allergic rhinitis
This occurs year-round and includes reactions to allergens such as house dust, animal dander (hair, fur, feathers) and moulds. It is commonly aggravated by tobacco smoke, perfumes and air pollution.
Seasonal allergic rhinitis
This type of allergic rhinitis is often called hay fever. It most commonly occurs during spring, early summer and autumn. It is usually caused by different types of pollens from trees and grasses, as well as mould spores.
It is not known why some people are more susceptible than others to the allergens that cause allergic rhinitis. However, a person who has other allergies such as eczema (atopic dermatitis)
, or who has relatives with allergies, is more likely to suffer from the condition. Living or working in an environment that constantly exposes a person to allergens can also increase the risk of developing hay fever.
The symptoms of allergic rhinitis are similar to those of the common cold but may last longer and are seasonal in occurrence. Symptoms include:
- Stuffy or running nose
- Frequent sneezing
- Itchy eyes, nose, roof of mouth, or throat
- Watery eyes
- Blocked nose
- Pressure in the nose and cheeks
- Ear fullness and popping
- Dizziness and/or nausea
- Dark circles under the eyes
- Headache, earache
A doctor will try to establish whether the allergic rhinitis is perennial or seasonal. They may ask when the symptoms occur and when they are most severe. It may be advisable to keep a diary, noting when the reaction occurred. An examination of the nasal passages may be performed and blood tested for the presence of antibodies.
If allergic rhinitis causes significant interference to daily life the doctor may refer the patient to an allergy specialist (allergist). They are likely to perform a series of skin prick tests to determine which allergens cause the most sensitivity.
Treatment is aimed at minimising inflammation and reducing symptoms. This may be achieved by avoiding allergens, with medications or with immunotherapy.
Minimising or avoiding contact with problem allergens can be effective in minimising symptoms. Tips for avoiding allergens include:
- Avoid open grassy areas, particularly in the evenings and on windy days
- Using a pollen filter in your car
- Keep doors and windows closed
- Wear sunglasses
- Use air conditioning
- Be aware of pollen counts and stay indoors when counts are high.
Household dust mites:
- Remove items that collect dust
- Use an efficient vacuum cleaner fitted with a HEPA filter
- Wash bedding frequently in hot water
- Use dust mite covers on mattresses and pillow.
- Do not keep pets
- If pets are kept, keep them outside and wash them regularly.
- Avoid smoky environments
- Avoid perfumes.
Medications may be prescribed to treat the condition. Antihistamines and decongestants, taken in tablet form or as nasal sprays or drops, can help to relieve symptoms. Antihistamines help reduce the sneezing, runny nose and itchiness, while decongestants can help relieve nasal congestion.
It is advisable to avoid using over the counter nasal decongestants for longer than five to seven days. They may relieve symptoms at first but after this time the nose may become increasingly congested and more frequent doses of the spray or drops are required. This is known as "rebound" congestion.
When eye redness and irritation is a problem, the use of eye drops may be recommended.
Corticosteroid nasal sprays may be prescribed to help reduce inflammation and to help prevent attacks from occurring. These do not cause worsening of nasal congestion and can be particularly effective when used as a longer-term preventative at times when symptoms are expected to be most problematic eg: spring and early summer. For rapid short-term relief from severe symptoms, oral corticosteroids may be prescribed. However, the use of oral corticosteroids for longer than 10 days is not recommended due to adverse effects such as weight gain, mood changes and acne.
Various non-corticosteroids medications may be prescribed, such as to prevent the release of histamines or block the action of immune system chemicals.
This treatment may be considered for people whose allergic rhinitis is not controlled by avoiding allergens or the use of medications. Immunotherapy involves administering a series of injections that can desensitise a person to certain allergens. Increasing amounts of the allergen causing the problem are injected under the skin over time. This helps to reduce the immune response that triggers the body's allergic reaction. Injections may need to be given every few months for up to two or three years for this treatment to be effective. The offending allergen(s) can also be given as a tablet that dissolves under the tongue (sublingual immunotherapy).
Whilst this treatment is not effective in all cases, the majority of people who undertake it show some degree of improvement.
Information and support
For further information and support about allergic rhinitis, talk to your doctor or practice nurse, or contact:
Allergy New Zealand
Freephone: 0800 34 0800
Allergy New Zealand (2008). Allergic rhinitis (hay fever) (Web Page). Auckland: Allergy New Zealand. http://www.allergy.org.nz/A-Z+Allergies/allergic+rhinitis+hay+fever.html [Accessed: 10/07/17]
Mayo Clinic (2015). Hay fever (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/hay-fever/basics/definition/con-20020827 [Accessed: 10/07/17]
NHS Choices (2015). Hay Fever (Web Page). Redditch: National Health Service (NHS)
England. http://www.nhs.uk/Conditions/Hay-fever/Pages/Introduction.aspx [Accessed: 10/07/17]
Last reviewed July 2017