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What is Allergic Rhinitis and what are the causes?

Referred to as simply “allergies” by many people, allergic rhinitis is a condition that causes nose and eye symptoms because of an allergic reaction to something that you breathe into your body. Allergic rhinitis can start at any age and often runs in families. There are many types of allergens that can trigger an allergic response, including plant pollen from grasses and trees, and also pet dander, mold, and dust.

This newsletter will focus on allergic rhinitis caused by plant pollen, which is often called “hay fever” or “seasonal allergies”. These allergies are typically worse in the spring and summer months. During spring, tree pollen allergies are generally worse while during the summer grasses dominate.

What are the symptoms of allergic rhinitis?

Symptoms usually start within a few minutes of exposure to an allergen and can include:

  • Itchy nose, eyes, and throat
  • Runny nose
  • Sneezing
  • Watery eyes

Without treatment, you may also develop:

  • Stuffy nose
  • Coughing
  • Sore throat
  • Eyelid swelling
  • Fatigue or irritability
  • Headaches

These symptoms are similar to those you may get with an upper respiratory infection, but usually do not include a fever.

How is Allergic Rhinitis diagnosed? Do I need allergy testing or other tests?

Allergic rhinitis can usually be diagnosed and treated without the need for tests. Your doctor will perform a physical exam and ask whether your symptoms vary by time of day or season. If the diagnosis is unclear, or your symptoms are severe or do not get better with treatment, your doctor may order allergy testing.

How is Allergic Rhinitis treated?

Allergic rhinitis can be treated with medication. The medicine your doctor prescribes depends on your symptoms and how severe they are. Your doctor will also take your medical history into consideration when deciding which medicines to prescribe.
Treatments for allergic rhinitis include:

  • Nasal steroid sprays. These are the first-line and most effective treatments for allergic rhinitis. Some, such as Flonase and Nasocort, are available over-the-counter, while others require a prescription. For optimal results, they should be used daily, particularly during spring and summer.
  • Oral antihistamines. When a nasal steroid spray alone is not sufficient, your doctor may recommend an oral antihistamine such as Benadryl or Claritin. These medicines are also available over-the-counter and are usually taken on an as-needed basis, although patients with severe symptoms may need to use them daily. Keep in mind that Benadryl causes sedation and should not be used while driving. Claritin and Zyrtec do not cause sleepiness.
  • Decongestants. For patients with particularly bad nasal symptoms, your doctor may recommend a decongestant such as pseudophedrine. We generally do not recommend Sudafed “PE” because is not very effective. Pseudophedrine is only available “behind the counter”–you have to ask the pharmacist, but you do not need a prescription. Nasal Sprays such as Afrin can also be helpful, but you should not use them for more than 3 days.
  • Leukotriene inhibitors such as Singulair are used in more severe cases that do not respond to standard therapy.
  • Allergy shots (immunotherapy) are only needed for patients who have severe symptoms that cannot be controlled by the above medicines.

 

When to Contact a Medical Professional?

See your Primary Care Doctor or stop by Access Now Urgent Care if:

  • You have never had allergic rhinitis and need to confirm your diagnosis.
  • You have severe symptoms.
  • Treatment that once worked for you no longer works.
  • Your symptoms do not respond to treatment.

 

Prevention

You can sometimes prevent symptoms by avoiding the pollen you are allergic to. Keep an eye on daily pollen counts by using any Weather app or website. Pollen counts tend to be high on warm, windy days and drop on cooler, rainy days. During pollen season, you should stay indoors on high-pollen days. Sleep with the windows closed, and drive with the windows rolled up.

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Shobhit Arora