Spring is here and along with it comes allergy season. According to the WHO, up to 25% of the US population suffers from allergies; it is the second leading chronic illness in the US. Allergies can be broken down into two distinct types: perennial and seasonal. Perennial allergies exist all year round and usually include the inside type of allergens, dust, pet dander, and molds. Seasonal, as the name sounds, refers to allergens that vary with the season and when certain plants bloom.
Symptoms
Classic symptoms of allergic rhinitis include swelling of the nasal mucousa, sneezing, watery eyes, scratchy throat, headache, and fatigue. Truly enough to make a person miserable.
Grades of allergic rhinitis
Not everyone suffers at an equal rate with allergic rhinitis. The grades, which indicate increasing severity of symptoms are:
- Grade I- symptoms are present less than four days per week and less than four consecutive weeks.
- Grade II- mild persistent- symptoms are present at least four days per week and have occurred for at least four consecutive weeks.
- Grade III- moderate to severe, intermittent- tolerable symptoms, but interrupt sleep and activities of daily living. They are present all the time.
- Grade IV- moderate to severe, persistent- symptoms that are present all the time and definitely interrupt sleep and activities.
Treatment Options
Guidelines for the treatment of allergic rhinitis were published by the committee on Allergic Rhinitis and its Impact on Asthma (ARIA), in conjunction with the World Health Organization, in 2001. They were updated in 2008.
The best option is to avoid the allergen. That is easier said than done and may not be realistic in some cases. Other strategies include blocking ports of entry, reducing exposure time, and blocking the effects of histamine.
Nasal Lavage
For moderate to severe allergies, the first line treatment is nasal saline lavage. Use of lavage will help reduce allergen exposure time and can help prepare for the application of a topical nasal spray. In one study, the irrigation improved symptoms by 64% in patients with chronic allergies.
Intranasal Cortisosteroid Sprays
Intranasal corticosteroid sprays should follow nasal saline lavage. Intranasal sprays help to reduce the tissue inflammation. Occasional side effects from these sprays include nasal and pharyngeal irritation, bad taste, and headache.
Antihistamines
Antihistamine intranasal agents are effective for reducing the histamine mediated symptoms, but are less effective than nasal corticosteroid sprays. Currently, azelastine (Astelin) and olopatadine (Pataday) are the only available prescription intranasal antihistamine sprays.
Oral and ophthamic antihistamine products selectively block peripheral H1 receptors, which helps to reduce drainage viscosity. The down side of these are that they may cause thickening of the secretions and increase sinus pain and pressure. The original oral antihistamines, such as Benadryl, work well, but are not well tolerated because of the excessive sedation that occurs. No one should take this medication if they are required to be alert or operate machinery. The second generation antihistamines are better tolerated and are less sedating. The most common ones include loratadine, prescription desloratadine, and the newest over the counter product, fexofenadine (Allegra).
Immunotherapy
For those with severe symptoms that are unresponsive to conventional therapy, immunotherapy may be considered. Standard immunotherapy consists of a two to three year course where weekly subcutaneous allergen injections are administered with the ultimate goal of better tolerance of allergen exposure. This path requires a strong committment to the weekly appointments and can be quite costly.
Individuals living with allergic rhinitis have multiple treatment options. Finding the right treatment can improve quality of life.
Sources
- Bousquet J, Khaltaev, N, Cruz AA, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update ( in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63 suppl 86:S8-S160.
- Smith A. Managing Allergic Rhinitis, Making Sense of the Options.Clinician Reviews/Convenient Care. Spring 2011. 4-10.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
Rosemary King - Stay well; stay healthy; stay focused.
