ALLERGIC RHINITIS ( HAY FEVER )

Symptoms of allergic rhinitis (Hay Fever) include itchy, runny, sneezy, or stuffy noses, and itchy eyes. Allergic rhinitis is a common illness affecting an estimated 20-40 million Americans, and resulting in 10 million lost days of school or work each year. Often caused by pollens from trees, grass or weeds, it is most commonly known as hay fever. Hay fever subsides with the onset of cold weather. Perennial allergic rhinitis, however, occurs year around and is caused by indoor allergens such as dust, mite, mold spores, and animal dander.

What Causes Allergic Rhinitis?

Chemical substances, such as histamine, are normally stored in mast cells in tissues of the body, including the nose and eyes. The allergic person forms antibodies against pollens and other allergens. These antibodies attach themselves to the mast cells, and when combined with the allergen the result is the release of histamine and other chemical substances from the mast cells. These chemical substances cause the allergic responses of itching, sneezing, congestion, and dripping.

Treatment:

Avoidance is the best treatment for any allergy whenever possible. Keeping doors and windows closed in the home and in your car and avoiding vigorous outside activity will help to lessen your exposure during times when the pollen count is high. Removing pets from the home and dust and mold control measures can significantly relieve symptoms due to perennial allergens.

Antihistamines may relieve many hay fever symptoms by inhibiting the action of histamine on nasal and eye tissues. When a person first starts to take these medications they often cause drowsiness, but this usually goes away after a day or two of taking antihistamines on a regular basis. If this does not occur, then using a newer antihistamine which does not cause drowsiness in most people may be effective. Be careful not to drive or operate dangerous machinery until you know how you are affected by an antihistamine. It is generally best to start with a low dose and increase the dose gradually until symptoms are controlled or until the maximum dose is reached.

Nasal decongestants act to decrease the swelling of the nasal tissue and the resulting feeling of stuffiness. Oral decongestants may cause sleeplessness and jitteriness. Topical nasal decongestants cause "rebound" congestion and irritation of the nasal passages if used more than 2-3 days. This means the stuffiness returns, but the nose spray doesn't help as much.

Nasalcrom nose spray works by blocking the allergic reaction on the mast cell. It prevents or reduces the release of histamine and other chemical substances which cause the allergic symptoms. It does not cause drowsiness and does not cause "rebound" congestion. It is best started before exposure to known allergens, such as before the grass pollen season.

Nasal corticosteroids (Nasalide, Vancenase, Beconase) are effective in treating allergic symptoms and are best used locally to minimize side effects. It often takes several days to become effective. A burning sensation may occur with Nasalide. Nose bleeding has been reported with nasal steroid use. Corticosteroids are not related to androgenic steroids sometimes taken by athletes.

Oral corticosteroids (prednisone) are different in that when taken internally the risk of side effects is much greater than when used in small amounts locally, such as in the nose. Similarly, long acting injections of steroids may have an increased incidence of side effects. When possible, the Allergy Clinic prefers to treat with topical steroids rather than oral or injectable. Short bursts of oral steroids on alternate day use minimizes side effects.

Eye drops (Naphcon-A, Opcon-A, Vasocon-A): Antihistamine decongestant eye drops act similarly to oral preparations and given quick relief of allergic symptoms of red, itchy, watery eyes. Opticrom acts like Nasalcrom and blocks the release of chemical substances from the mast cells around the eyes, thus preventing or reducing allergic symptoms.

Saline (salt water) nose drops are often helpful in relieving nasal symptoms. You may purchase these already mixed (Salinex, Ocean) or you may make your own by mixing 1 cup of water, 1/2 teaspoon salt, and a pinch of baking soda. Inhale a handful of this solution at a time. Discard the home-made solution after twenty-four hours because it contains no preservative.

VASOMOTOR RHINITIS

Nasal passages have rich supplies of blood vessels. When they become engorged with blood, the nose gets stuffy. As fluid leaks out of the vessels, a veritable Niagara of mucus flow can start and some of it can leak back into the throat (post-nasal drip). It is all a part of vasomotor rhinitis - vasomotor for the blood vessel connection and rhinitis for the nasal tissue inflammation.

You cannot really call this an illness as much as an exaggeration of normal events. The cells involved produce up to a pint of fluid a day, even in normal people. Patients with vasomotor rhinitis are super-sensitive to the irritants that give rise to all of this nasal activity.

Temperature or humidity changes, strong odors, alcohol, tobacco smoke, even changing a position in bed at night can cause it. You have to avoid such situations. It is a chronic problem, so don't expect time to take care of it.

A lot of vasomotor rhinitis sufferers get relief from decongestants taken orally. They can cause tissue constriction and get you over particularly bad times. Those that contain pseudoephedrine help. Some people may have such a severe onset of the problem that they need cortisone drugs applied to the nasal membranes.

Over-the-counter decongestant nasal sprays may give temporary relief, but it is usually quite short-lived and they can, with excessive use, cause rebound swelling worse than the original problem. Try to get along without them.