Do you suffer from frequent nasal problems? If so, you might have a condition called rhinitis. This is a more accurate word than “allergies,” because nearly half of sufferers aren’t actually allergic.
The symptoms of non-allergic rhinitis are similar and usually year-round. Strong smells, pollution, weather changes and smoke – rather than environmental allergens – can aggravate symptoms. For this reason, “sensitive nose” is a commonly used phrase. Avoidance of allergens is unnecessary, because the inflammation is thought to be caused by factors internal to the nose.
Less common causes for nasal discomfort also exist, including simply having frequent colds, sometimes catching a new virus just as a previous one is recovering. Testing by an allergist, such as skin-prick testing, is useful in defining which kind of rhinitis you may have.
Nasal Allergies: Overview
“Hay fever” is something everyone has heard of and many regularly complain about. Known officially as allergic rhinitis, this inflammation occurs in the nose and eyes after exposure to allergens in the air. These allergens include pollens and molds (mostly outdoor) and animal dander and dust mites (mostly indoor). This is a disorder of overactive immunity, since unwanted inflammation occurs when the immune system overreacts to otherwise harmless allergens.
Pollens become airborne at predictable times of the year in a particular geographical location and are therefore seasonal. Pollens are classified among three groups: trees, grasses and weeds. The table explains when the major and minor pollens in our area cause problems.
Similar to pollens, molds are mainly outdoor allergens but can be found indoors in limited circumstances. Molds vary somewhat from day to day but are bothersome throughout the year. When viewing an allergy test report, molds can seem strange and difficult to understand, because they are listed by their scientific names. An example is Alternaria, the Latin genus name of one of the most important mold allergens. Thus, they are considered perennial.
Of the indoor allergens, allergies to cats and dogs often are obvious. Sometimes, an allergy test is still needed to confirm whether cats and dogs are responsible for symptoms, or if there is an unsuspected cause. Dust mites are found in bedding and carpeting but can actually be quite difficult to eliminate completely. Heat and humidity (including body heat inside a comfy bed in wintertime) favor dust mites. Individuals living in dry climates, especially at high elevations, often have the least exposure to dust mites.
Nasal Allergies: Treatment
Avoidance – trying not to be exposed to the allergens in question – offers limited success. Even those with pet allergies might be unexpectedly exposed to pets or suffer while waiting the several months required for pet dander to degrade after pet removal from the home.
Therefore, some type of active therapy is often necessary for all but the mildest cases. For both over-the-counter medicines and prescriptions, proper selection can be surprisingly difficult. Anyone needs only to check out a well-stocked shelf in the “allergies” section to see how many choices are available. The complexity of having so many choices can be confusing but could be a huge advantage when you are armed with the proper knowledge. One system that can help you choose wisely is to match exact symptoms with known effects of categories of medications.
The Four Cardinal Symptoms of Rhinitis (and Eye Irritation):
- Congestion—stuffy nose (“dry”) or nasal congestion (“wet”)
- Runny nose, including postnasal drip if draining down the back of the throat
- Itching (nose, palate, throat, ears)
- Eye symptoms (itching, redness, tearing)
Once the exact problems from the list of cardinal symptoms (see table) are identified, you and your doctor can evaluate the different classifications of medication and identify the type(s) most likely to offer success.
Rhinitis: Selecting Correct Medication(s)
The classification of medication must be explained by your doctor or identified by reading the packaging carefully. Many available medications are combinations, for example, of an antihistamine plus pain reliever. In this example, if a pain reliever is not needed, then you should take a simpler medication with just the antihistamine instead. Common mistakes are selecting a medication that does not correctly match the list of symptoms or taking a combination that includes unnecessary therapy. Also, medications are not always clearly marketed according to their exact classification, making a doctor’s advice or careful reading of the entire packaging necessary.
Those with more than mild nasal allergies might have no success with any of the available over-the-counter medications. In such cases, a prescription or more advanced options, such as immunotherapy (desensitization therapy) provided by an allergist, might be needed to control the inflammation. Many of the over-the-counter medications listed in the table were originally prescription medications or still have similar medications available only by prescription.
Prescriptions that offer additional valuable options include medications that block a pathway in the body called leukotrienes (such as montelukast), nonsteroid nasal sprays (such as azelastine), and still other types of less commonly used choices, some only familiar to specialists.
The most advanced therapy for true nasal allergies is desensitization, which involves exposing the body’s immune system to the same allergens causing the nasal inflammation. Over time, this decreases the unwanted inflammation. Another way to think about this is “building up” or correcting the immunity against the allergen. This is most effectively done by injections.
The traditional inconvenience of these “allergy shots” can be moderated by starting with multiple injections given in blocks of several hours (“rush” or “cluster” desensitization) and using higher, more effective doses that allow less frequent, monthly injections. The success of allergy shots varies greatly, depending on the skill of the doctor in deciding which allergens to include, as well as correct dosing of individual allergens. Modern allergy shots are given in the office and never at home due to the small risk of a severe allergic reaction and ability to use higher, much more effective doses in the office setting.
What is the latest approach? In fact, it has become available most recently but is not actually new at all. Sublingual desensitization is like allergy shots but involves giving the allergen under the tongue instead of by injection. Previously, this was accomplished by an extract prepared by a doctor, to be taken at home rather than an office. But these are not considered “established” practices and are usually not covered by insurance. Recently, approved sublingual therapies became available for grass and ragweed pollen. These are best for patients who are allergic to relatively few allergens, since these sublingual pollen tablets do not specifically treat any other co-existing allergies, such as other grasses and weeds. Immunotherapy given by injection remains the most effective therapy, but the sublingual approach is an excellent alternative for those with specific allergies but unable to do office-based injections.
Finally, just how important is it to treat nasal allergies? Even though this is not a life-threatening problem, studies suggest quality of life can be just as poor for people who suffer from allergies as for those who are living with serious heart disease. Also, consider the fact that nasal allergies left untreated can cause additional problems you might not think about, such as sinus disease, asthma and even fatigue or difficulty concentrating, leading to poor school or job performance.
About the author: Matt Morgan, M.D., who practices in McKinney, received his medical degree from Baylor College of Medicine and completed fellowship training at The University of Texas Southwestern Medical Center. He is a fellow of the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology, as well as a diplomate of the American Board of Allergy and Immunology.