Dr. Susan Waserman - Allergic Rhinitis

Definition:

  • Allergic Rhinitis (Rye - night - us) are nasal symptoms caused by inflammation or swelling of the nose
  • Allergic rhinitis is caused by inhaling particles (allergens) to which you are allergic

Signs and Symptoms:

  • Runny /stuffy nose
  • Itchy nose
  • Sneezing
  • Itchy/watery eyes
  • Sore throat
  • Post nasal drip
  • Sense of fullness in ears, head

Allergic rhinitis can lead to:

  • Sleep disturbance
  • Snoring
  • Loss of taste and smell
  • Poor concentration
  • Cough

Triggers:

  • Common allergens which cause allergic rhinitis are found indoors and outdoors
  • Outdoor allergens: these are pollens or mold spore which appear during certain seasons and cause symptoms during those times. The pollen season will vary according to the area of the country you live in.

For southern Ontario:

  • Tree pollen: early April-early June
  • Grass pollen: mid May-mid July
  • Ragweed: mid August-end September or first frost
  • Mold spores: appear as soon as snow melts until end of fall. Counts highest in July-August

Indoor allergens are present all year round:

  • Cat/dog dander
  • House dust mites
  • Cockroach
  • Molds

Treatment:

  • Allergy testing is important to identify the allergen(s) which cause(s) your symptoms
  • Avoidance of your particular allergen is an important part of your treatment

Pollens:

  • Keep windows and doors closed in the house and car during pollen season. Air conditioning will help you do this. If you have a window air conditioner, keep the vent closed to the outside
  • Pollen counts are high on dry, windy days. They are lower after rain, and in the evening and night. Though somewhat impractical, you can do outdoor activity during times when counts are lower
  • Avoid grass cutting if grass pollen allergic

House dust mites:

  • House dust mites are found mainly in the bedding as mites feed on human skin scales
  • House dust mite impermeable mattress and pillow covers are recommended
  • Wash all bedding weekly in hot water (55-60 degrees Celsius) and dry on high heat
  • Use a vacuum cleaner fitted with a HEPA filter
  • Choose hardwood and laminate flooring, not heavy pile carpets if possible
  • Discourage soft toys and clutter
  • Keep home humidity between 30-50 per cent

Cat/dog:

  • It is best to remove the pet from the home permanently.
  • If impossible, at minimum the pet should not be in the bedroom.
  • However, pet allergens spread in the air throughout the home, even if they are restricted to certain areas

Molds:

  • Avoid raking and working with compost heaps
  • Keep damp areas of your home such as the basement cool, clean and dry
  • Use a dehumidifier if needed

Cockroach:

  • Removal of food sources and household food wastes. Foods should be stored in sealed containers
  • Reduce their access to water. Fix leaking faucets and/or prevent water condensation on pipes
  • Spray around kitchen cabinets and drawers with insecticides known to kill cockroaches. Note: Insecticides will kill the parent cockroach but will not kill their eggs. Therefore repeated spraying every one to two months is necessary to effectively control cockroach populations.
  • Thorough and frequent housecleaning to remove dust and cockroach byproducts

Medications:

  • Medications are often necessary for complete relief of your rhinitis symptoms. These include:

Antihistamines:

  • Generally available in the pharmacy, without a prescription
  • May be enough for mild symptoms
  • Best for symptoms like runny nose, sneezing, and itchy, runny eyes, and are less effective for congestion
  • Use daily during allergy season

Long acting "non drowsy" antihistamines are recommended, these include:

-- Aerius (desloratidine)

-- Allegra (fexofenadine)

-- Claritin (loratidine)

-- Reactine (cetirizine)

There are shorter acting "sedating" antihistamines but these are not generally recommended for allergic rhinitis as they cause tiredness and may interfere with your ability to drive or work:

--Atarax (hydroxyzine)

--Benadryl ( diphenhydramine )

--Chlorotripolon (chlorpheniramine)

--Dimetapp (brompheniramine maleate)

Nasal steroid sprays:

  • Most effective treatment for allergic rhinitis
  • Effective for all symptoms including nasal congestion
  • For seasonal symptoms, they should be started about 2 weeks before for best results and used daily until the season is over
  • Treatment needs to be continuous for those with symptoms to indoor allergens

Nasal steroid sprays are available by prescription and include:

-- Beconase (beclamethasone diproprionate)

-- Vancenase (beclamethasone diproprionate)

-- Rhinocort (budesonide)

-- Flonase (fluticasone proprionate)

-- Nasacort (triamcinolone acetonide)

-- Nasonex (mometasone furoate)

-- Avamys (Fluticasone furoate)

-- Omnaris (ciclesonide)

  • Nasal sprays must be used appropriately. Point the spray away from the nasal septum. They may cause dryness and some nasal bleeding.
  • Decongestant tablets and sprays will help relieve a stuffy, blocked nose, but should not be used for more than a few days
  • If avoidance and medication do not relieve your symptoms, ask your doctor about allergy shots, which are effective especially for pollen and house dust mite allergy. These are given all year round or right before the season that bothers you.

Eye Drops:

Antiallergic:

  • Opticrom (sodium cromoglicate)
  • Alomide (lodoxamide)
  • Patanol (Olopatadine)

Antihistamine with decongestant

  • Vasocon A (naphazoline)
  • Naphcon A (naphazoline)
  • If you are still experiencing symptoms see your doctor!!