Symptoms of Allergic Rhinitis
If you have allergies when the nose is exposed to an offending allergen (such as dust, pollen, or mold) a substance called histamine is released. This causes the membranes of the nose to swell and gives you a stuffy nose. Histamine also causes glands in the nose to secrete mucus, which runs down the back of your throat (post nasal drainage). This drainage is unpleasant and can make you feel the need to clear your throat. Your nose may also itch because of histamine’s effect on the nerve endings.
Many people’s allergies are worse in the spring and fall when plants are blooming. For others, the dust dander, or mold may cause symptoms throughout the year.
What is the treatment of allergic rhinitis?
We prefer a stepwise approach to the treatment of allergic rhinitis. Antihistamines are drugs which block the release of histamine. Older types (Chlortrimeton®, Benadryl®) may cause sedation while the newer ones (Claritin®, Zyrtec®, Allegra®) are called “non-sedating”. Some patients respond well to certain antihistamines while not others. I suggest that patients try as many as they need to find the one that works best for them. Many patients find a certain antihistamines will work for several weeks but then will become less effective. You can switch antihistamines with no deleterious effects, and often people will rotate them to maintain their effectiveness. Most antihistamines come in pill form but one (azelastine) is provided as a spray.
Sometimes antihistamines don’t work or you may not tolerate the side effects. Nasal steroid sprays are the next (and sometimes even the first) line of treatment. Steroids calm the inflammation caused by the release of histamine. These sprays are not absorbed by the body so you are not “taking steroids”. Using these sprays is similar to putting hydrocortisone cream on a rash, not taking steroid pills.
Most people with nasal allergies can control their symptoms with antihistamines, steroid sprays, or a combination of both. If the allergies are seasonal the medicines are only taken as needed. If the symptoms are constant, many patients taper their medication dose down to the lowest level that works for them while taking them on an ongoing basis.
If you do not obtain significant relief from antihistamines and steroid sprays we proceed with allergy testing. Once we know what you are allergic to, we may tell you to avoid the offending agent or, may recommend that you take allergy shots, known in medical terms as “desensitization therapy”. The shots have small amounts of what you are allergic to (antigens) in them and over time you develop a tolerance to the allergens. You usually take one shot every one to two weeks. You may have immediate results but the greatest effect may not be seen for several months or even a year or two.
If left untreated allergic rhinitis can lead to a sinus infection (sinusitis). This occurs because the sinuses (bony cavities between and below your eyes) have narrow drainage ports into the nose. When the nasal membranes swell, these narrow ports close. Fluid accumulates in the sinuses and they become infected. Most people then need antibiotics to get better. Sometimes the allergic membranes in the nose become permanently swollen, requiring surgery to shrink them down.
Occasionally, allergic rhinitis can be complicated by a deviated septum and other sinus problems. We will speak to you about these if we think you have them. Thankfully, the great majority of patients who have allergic rhinitis can be treated easily with either intranasal steroid sprays or antihistamines.
What is the treatment for Non Allergic (Vasomotor) Rhinitis?
Some patients experience constant post nasal drainage, but do not have allergies. This is known as Non-Allergic (Vasomotor) Rhinitis. This may be rather constant, or might be intermittent, such as getting worse after eating. The cause is not understood. The treatment is consistent use of intranasal steroid sprays (Flonase®, Nasacort AQ®, Rhinocort Aqua®). Occasionally we add an antihistamine spray (Astelin®). In extreme cases we can offer anticholinergic medications such as a compounded scopolamine spray.
Many procedures have been tried in an attempt to decrease the drainage from vasomotor rhinitis, however none have thus far proven to be effective over the long-term.
Finally some patients have an extreme sensitivity to certain chemicals such as fragrances, cleaning fluids, rubber compounds, and various strong odors. This is not actually an allergy but represents a heightened sensitivity to certain chemicals. Most of these patients have learned to simply avoid the offending agents. There is no good treatment other than avoidance at this point however an evaluation by us will be helpful to rule out any other cause of the nasal irritation.
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