Dr Claudia Gray, Paediatrician and Allergist at Kidsallergy Centre, Cape Town and Red Cross Children’s Hospital, Cape town
Allergic rhinitis is an allergic reaction of the nasal lining to allergens in the environment. Such allergens, like pollens, house dust mites or animal dander, should usually be harmless. However, when the allergic person breathes in certain allergens, the immune system is activated, and chemical messengers are released inside the nose and surrounding tissues. This causes symptoms such as an itchy, runny nose, sneezing, postnasal drip and a blocked nose. In many people the eyes are affected too.
Main symptoms of allergic rhinitis
- Itchy nose
- Runny nose and postnasal drip
- Congestion/swelling of the nose
- Eye itching/swelling
Although symptoms of allergic rhinitis are often thought of as annoying rather than serious, many studies have shown that allergic rhinitis can have a significant impact on the quality of life, by impacting sleep, concentration and performance at school or work. If allergic rhinitis is not managed well, it can also lead to complications such as middle ear infections, sinusitis and even asthma.
Allergic rhinitis can start in young children, or it can start later in life, even as adults. The course usually waxes and wanes over time. Some people are lucky enough to outgrow it, but in some it persists and can be a lifelong battle.
What causes allergic rhinitis?
Allergic rhinitis is caused by allergens in the environment. It is important to note that it is NOT usually caused by food allergies.
Some allergens can be present all year round, such as house dust mites, mould, cockroach and animal dander, which tend to undergo a peak in autumn and winter when our household ventilation decreases because of colder weather; or seasonal, such as grass and tree pollens, which peak in spring and summer.
Your home environment, school/work environment and where you live (e.g. coastal versus inland) also affects your allergen exposure. For example, coastal regions are rich in house dust mites, and the highveld is rich in grass pollens.
South Africa has a particularly long grass pollen season, from September right through to March, so those with seasonal allergies may be affected for a significant proportion of the year!
Diagnosing nasal allergies
It is important to make a correct diagnosis of allergic rhinitis so that the correct treatment can be started. Many conditions can mimic allergic rhinitis, including recurrent colds in children, so it is best to see your doctor and have some allergy tests done to confirm the condition.
Allergists are doctors who have specialised in the diagnosis and treatment of allergies. The doctor will take a detailed history of your symptoms and environment, and then perform allergy tests, either in the form of skin prick tests, or blood tests, to check for allergies.
Management of allergic rhinitis
Management depends on what you are allergic to, and the predominant symptoms.
Reduction in the allergen you are allergic to should be discussed. For example, for a house dust mite allergy, reducing the number of fluffy toys, washing sheets and bedding at 60°C or more and acquiring protective mattress and pillow protectors can help.
When it comes to medical treatment, intranasal corticosteroid nose sprays tend to be the best overall treatment. Intranasal corticosteroids are safe with minimal absorption into the system in the spray form. Nose bleeds are a potential side effect, especially if sprays are angled incorrectly towards the nasal septum (partitioning), which is rich in blood vessels. Doctors advise that you angle the spray towards the outside of the nose. Nasal cortisone sprays are best taken daily during your allergy season to prevent the symptoms.
Steroid injections have many side effects and are NOT recommended.
Antihistamines may be of good use if itching and sneezing are predominant. They can be used together with nose sprays. Newer generation antihistamines are preferred with their cleaner side effect profile.
If basic treatment is inadequate, then specialist referral to discuss further management options is advised. This may include immunotherapy/desensitisation, which entails giving regular tiny amounts of the allergen in the form of drops/sprays (under the tongue ) or injections for several years to help shift the immune system into accepting the allergen rather than fighting it.
With the correct diagnosis and treatment, allergic rhinitis can be managed very well.