Nasal Allergies (Allergic Rhinitis)

Do you suffer from frequent sneezing, congestion or stuffiness and an itchy or runny nose? If so, you may have a condition called rhinitis.

There are two types of rhinitis: allergic rhinitis and non-allergic rhinitis. Let’s talk first about allergic rhinitis.

Allergic Rhinitis
Allergic rhinitis is caused by allergens like molds, pollen and animals. These are substances which are usually harmless, but can cause allergic reactions in certain people.

Allergy symptoms are the result of a chain reaction that starts in the immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to pollen, your immune system identifies pollen as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release histamine and other chemicals, causing an allergic reaction with symptoms such as sneezing, stuffiness, a runny nose, itching and post-nasal drip.

People with allergic rhinitis are also prone to itchy, watery eyes (from allergic conjunctivitis), and they may be more sensitive to irritants such as smoke, perfume or cold, dry air. Rhinitis can contribute to other problems such as asthma, sinus or ear conditions, or trouble sleeping.

Allergic Rhinitis Triggers
Seasonal allergic rhinitis, commonly known as hay fever, is triggered by outdoor allergens such as pollen and mold spores. Some people have symptoms year-round due to indoor allergens from pets, mold, dust mites and cockroach residue. This is called perennial allergic rhinitis. You can suffer from either seasonal or perennial allergic rhinitis, or a combination of both.

Diagnosis of Allergic Rhinitis
Dr. Jacobs, as a board-certified allergist, has specialized training and experience to determine which allergens, if any, are causing your symptoms. He will take a detailed health history, perform a physical exam and then most likely test you for allergies. Skin tests show the results within 20 minutes. These results, as well as how frequent and bad your symptoms are, will be considered when developing a treatment plan. Steps to manage your symptoms may include avoiding the allergens you are allergic to, medications or allergy immunotherapy (allergy shots).

Treatment and Management of Allergic Rhinitis
The first step to manage this condition is to avoid allergens that cause symptoms. For instance, if you are allergic to dust mites, it is important to take steps to prevent exposure to dust mites, such as frequently washing bed linens in hot water. The same is true for outdoor allergens. Limiting your exposure during times of high pollen and mold counts may help reduce symptoms.

Sometimes taking steps to avoid allergens isn’t possible or it isn’t enough to control allergic rhinitis symptoms. That is when your allergist may prescribe or recommend medications or allergy shots.

Some medications for allergic rhinitis are best used daily to control inflammation and prevent symptoms, while others are used only as needed to relieve symptoms.

Dr. Jacobs may recommend allergy shots if your symptoms are constant, if you don’t want to take medications or feel that they are not enough, or if you want long-term control of your allergies with less need for medications. This treatment involves receiving injections periodically over a period of three to five years. Allergy shots have been proven effective in decreasing sensitivity to allergens.

Non-Allergic Rhinitis
Many people with rhinitis symptoms do not have allergies. If you have non-allergic rhinitis, avoiding allergens is unnecessary and won’t help your symptoms. This distinction is why it is important to visit an allergist to determine what you are as well as what you are not allergic to.

Non-allergic rhinitis usually begins in adults and causes year-round symptoms, especially a runny nose and nasal stuffiness. Strong odors, pollution, weather changes, smoke and other irritants may cause symptoms of non-allergic rhinitis. Non-allergic rhinitis symptoms can also develop as side effects of medications, including some blood pressure medicines, oral contraceptives or medications used for erectile dysfunction. Another type of non-allergic rhinitis is caused by nasal decongestant sprays such as phenylephrine, when used for long periods of time (whether or not nasal oxymetazoline can cause this as well is controversial). This type of medication-induced rhinitis is called rhinitis medicamentosa.

Treatment of Non-Allergic Rhinitis
Oral antihistamines and anti-leukotriene drugs generally do not benefit non-allergic rhinitis. However, treatment options include nasal corticosteroid sprays and nasal antihistamine sprays. Ipratropium nasal spray can relieve a runny nose and decongestant pills can be used as needed to relieve nasal stuffiness.

Other forms of treatment may be considered if you have problems with the structure of your nose, such as narrow drainage passages, tumors or a shifted nasal septum (the bone and cartilage that separate the right from the left nostril). In these cases, an operation may be needed.