Allergic rhinitis

Allergic rhinitis, pollenosis or hay fever is an allergic inflammation of the nasal airways. It occurs
when an allergen such as pollen or dust is inhaled by an individual with a sensitized immune system,
and triggers antibody production. These antibodies mostly bind to mast cells, which contain histamine.
When the mast cells are stimulated by pollen and dust, histamine (and other chemicals) are released.
This causes itching, swelling, and mucus production. Symptoms vary in severity between individuals.
Very sensitive individuals can experience hives or other rashes. Particulate matter in polluted air and
chemicals such as chlorine and detergents, which can normally be tolerated, can greatly aggravate the
condition.

Classification
The two categories of allergic rhinitis include:

 Seasonal – occurs particularly during pollen seasons. Seasonal allergic rhinitis does not
usually develop until after 6 years of age.

 Perennial – occurs throughout the year. This type of allergic rhinitis is commonly seen in
younger children.

Signs and symptoms

Characteristic physical findings in individuals who have allergic rhinitis include conjunctival swelling
and erythema, eyelid swelling, lower eyelid venous stasis, lateral crease on the nose, swollen nasal
turbinates, and middle ear effusion.[2]

Cause
Allergies are common. Heredity and environmental exposures may contribute to a predisposition to
allergies. It is roughly estimated that one in three people have an active allergy at any given time and
at least three in four people develop an allergic reaction at least once in their lives.

Allergic rhinitis triggered by the pollens of specific seasonal plants is commonly known as "hay fever",
because it is most prevalent during haying season. However, it is possible to suffer from hay fever
throughout the year. The pollen which causes hay fever varies between individuals and from region to
region; generally speaking, the tiny, hardly visible pollens of wind-pollinated plants are the
predominant cause. Pollens of insect-pollinated plants are too large to remain airborne and pose no
risk.

Allergy testing may reveal the specific allergens an individual is sensitive to. Skin testing is the most
common method of allergy testing. This may include intradermal, scratch, patch, or other tests. Less
commonly, the suspected allergen is dissolved and dropped onto the lower eyelid as a means of
testing for allergies. (This test should only be done by a physician, never the patient, since it can be
harmful if done improperly).

Management
The goal of rhinitis treatment is to reduce the symptoms caused by the inflammation of affected
tissues. In cases of allergic rhinitis, the most effective way to decrease allergic symptoms is to
completely avoid the allergen. Vasomotor rhinitis can be brought under a measure of control through
avoidance of irritants, though many irritants, such as weather changes, are uncontrollable.

Allergic rhinitis can typically be treated much like any other allergic condition. Eliminating exposure to
allergens is the most effective preventive measure, but requires consistent effort. Many people with
pollen allergies reduce their exposure by remaining indoors during hay fever season, particularly in the
morning and evening, when outdoor pollen levels are at their highest. Closing all the windows and
doors prevents wind-borne pollen from entering the home or office. When traveling in a vehicle, closing
all the windows reduces exposure. Air conditioners are reasonably effective filters, and special pollen
filters can be fitted to both home and vehicle air conditioning systems.

Rinsing is very often recommended as part of the healing process after sinus or nasal surgery. For this
rinse, boiled or distilled water is only necessary during recovery from surgery, as the entire contents of
the bottle is used.

Antihistamines
Several antagonistic drugs are used to block the action of allergic mediators, or to prevent activation of
cells and degranulation processes. These include
antihistamines, cortisone, dexamethasone, hydrocortisone, epinephrine (adrenaline), theophylline and
cromolyn sodium. Anti-leukotrienes, such as montelukast, are FDA approved for treatment of allergic
diseases. One antihistamine, azelastine, is available as a nasal spray.

Many allergy medications can have undesirable side-effects, most notably drowsiness.

Steroids
Systemic steroids such as prednisone are effective at reducing nasal inflammation, but their use is
limited by their short duration of effect and the side effects of prolonged steroid therapy. Steroid nasal
sprays are effective and safe, and may be effective without oral antihistamines. They take several
days to act and so need be taken continually for several weeks as their therapeutic effect builds up
with time.

Decongestants
Pseudoephedrine is also indicated for vasomotor rhinitis,

Topical decongestants: may also be helpful in reducing symptoms such as nasal congestion, but
should not be used for long periods as stopping them after protracted use can lead to a rebound nasal
congestion (Rhinitis medicamentosa).

Desensitization
More severe cases of allergic rhinitis require immunotherapy (allergy shots) or removal of tissue in the
nose (e.g., nasal polyps) or sinuses.

Alternative treatments
Therapeutic efficacy of complementary-alternative treatments is not supported by currently available
evidence. Some evidence shows that acupuncture is effective for rhinitis well other evidence does not.
The overall quality of evidence is however poor.
BSN IV- D
CLINICAL INSTRUCTOR