Allergic Rhinitis

Spring has sprung and so has my hay fever!

Hay fever or seasonal allergic rhinitis is one of the most common problem that we as Family Practitioners encounter in South Africa, especially in KwaZulu-Natal. Around a quarter of the population will battle with allergic rhinitis (allergy of the nose lining) at some time or another, and are as a result of inhaled allergens trapped by the nose filtering system.

Girl sneezing 1024
The problem with allergic rhinitis is that it can mimic the common cold, but instead of clearing up in a few days, just last for weeks and weeks. Both children and adults can be affected by the consequences of this problem, with disturbed sleep, poor concentration and hearing difficulties some of the more common issues.

Seasonal allergic rhinitis is most often due to grass and tree pollens, fungal spores or weed pollens. Perennial allergic rhinitis occurs year-round, and is most often due to house dust mites, cat and dog dander and fungi.

So, what do we do about it? The most obvious answer would be to avoid the allergen or cause of the rhinitis to reduce the symptoms. Unfortunately, this is not entirely possible because the allergens are all around, and medications are often needed to help. Let us look at some general measures to reduce allergens and then we will look at medications.

  1. Allergen management
    1. With regards house dust mites, reduce stuffed animals in the room, wash curtains more regularly, remove carpets in favour of tiles, and look at mattress and pillow case covers.
    2. Where people are allergic to cat and dog dander, most people will be very reluctant to get rid of their pets. The answer then is to make sure their pets are not allowed to sleep on their beds or pillows, and try and give them a wash on a weekly basis. Good luck with the cats!
    3. Chlorine in swimming pools, cigarette smoke, deodorants or any other type of aerosol sprays can also be an irritant to the nose and will need to be avoided where possible.
  2. Medications
    1. The newer longer acting, non-sedating anti-histamines have been a wonderful advancement in rhinitis treatment over the older shorter-acting, sedating anti-histamines like Allergex. They are good for treating the nose itch and watery discharge, but don’t help the nose blockage much. They can be used once a day and can be bought over the counter. Examples include are Zyrtec, Clarityne and all their generics.
    2. The intranasal corticosteroid sprays are definitely more effective at dealing with the nose blockage than the anti-histamines, and are often the easiest option to use with children as well. Examples include Flixonase, Nasacor, Nasonex and all their generics.
    3. Another group of medications is the Leukotriene Receptor Antagonists that work by suppressing a chemical that worsens the allergic reaction in the nasal lining. They generally work best for patients with nasal blockage and can be used together with other medications. They are also used in asthma and examples include Singulair and all their generics.
  3. Immunotherapy
    1. This is a process that is also known as desensitisation and can be quite a successful form of treatment for allergic rhinitis. It is the most helpful if the person is allergic to only a single allergen.
    2. For perennial or year-long allergic rhinitis, there are often more than a single allergen, and allergic rhinitis will not be as useful.
  4. Other nasal sprays and oral decongestants (WARNING!)
    1. One of the biggest problems we as family practitioners encounter when dealing with allergic rhinitis is the over-use of the decongestant nasal sprays and syrups.
    2. Often through lack of knowledge, or desperation due to the symptoms, patients tend to use the decongestant nasal sprays and syrups too often or for too long.
    3. The problem they cause through closing off the nasal mucosal blood vessels to stop the running is that the nose gets too dry, and then the lining starts to swell, causing blocking. This is called Rhinitis Medicamentosa and the only treatment for it is to stop using the nasal spray or syrup.
    4. In general, decongestants nasal spray should not be used longer than five days at the recommended dose before seeing your family practitioner for review.

Having said all of this, there will be times that you may need to seek the help of your family practitioner. These will include times when:

  • You have severe hay fever symptoms.
  • Treatment that once worked for you no longer works.
  • Your symptoms worsen leading to a complication of the rhinitis like an ear infection or sinusitis.
  • You start running a fever.
  • Your nasal secretions get a lot thicker and become coloured.

Above all else, it is important to remember that most cases of allergic rhinitis can be treated, and some children may “outgrow” the allergy as their immune system becomes less sensitive to the allergen. Most people will find that even if their symptoms do lessen with time, they will probably continue to have a long time effect on the person. If you are able to control your symptoms better, you will have less complications of the allergy like ear infections and sinusitis, and you will not mind that spring has sprung!