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Rhinitis: focus on allergic rhinitis Causes, Symptoms and Treatment

What is allergic rhinitis?

The allergic rhinitis is characterized by sneezing repeatedly, the “runny nose” tickling in the nose, watery eyes and eye irritation. When it is caused by pollen, it is called seasonal rhinitis or, more commonly, hay fever .

These symptoms result from abnormal sensitization and an overreaction of the immune system to a substance foreign to the body named allergen . Depending on the person, it may be plant pollen, mold, and substances on the hair or skin of animals or other particles. When this substance comes in contact with the allergic person’s eyes or respiratory tract, the immune system starts an inflammatory reaction. Histamine and other inflammatory substances are then “needlessly” released. This reaction causes dilation of the blood vessels and increased secretions related to the onset of allergic rhinitis symptoms .

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The allergic rhinitis appears mostly between 5 and 20 years. According to the Canadian Allergy, Asthma and Immunology Foundation, 20% to 25% of Canadians suffer from allergic rhinitis. The symptoms tend to be more pronounced than before, according to the observation of several doctors. This phenomenon could be explained, among other things, by the increase in greenhouse gas emissions.These would have the effect of increasing the production of pollen from plants and trees.

Hay fever or persistent rhinitis?

Seasonal rhinitis: hay fever

Often called hay fever or ”  hay fever  “, it occurs periodically, most often in spring and summer, with the flowering of the allergenic plant.

In the early spring, tree pollen is frequently involved, while in July, grass pollen (grassland grass, hay and grass) are more common. People with allergies to ragweed ( Ambrosia artemisiifolia ) suffer at the end of the summer when the plant blooms. It should be noted that mold , which is more important at the time of snowmelt and lawn care, can also trigger allergic rhinitis.

The symptoms of seasonal rhinitis are usually aggravated by country trips as well as by exposure to the outdoors . People with allergies suffer less when it rains (rain flaps the pollen on the ground) and when they stay inside, doors and windows tightly closed.

And the “hay fever”? 
The term originated in the early XIX Th  century. At the time, doctors were observing the symptoms, especially among farmers, after the hay season. It was called fever because those who had it became agitated. Formerly, agitation was considered one of the characteristics of fever. Note: Patients with allergic rhinitis do  not have fever .

Persistent rhinitis

The majority of people with persistent rhinitis have rhinitis called vasomotor that is non-allergic . It usually appears after the age of 20, and often occurs under stress. It is triggered by changes in temperature or humidity, in the presence of smoke, dust, strong chemical odors or in response to medication or hormonal changes.

Persistent rhinitis can also be caused by allergenic substances permanently present in the person’s environment, at home or at work. The person seems to have a perpetual cold . The dust, the animals and some molds are all possible triggers. The crisis is triggered often waking up and can be repeated several times a day.

The mites are a very common cause of persistent allergic rhinitis. These are microscopic mites that feed on the dander of human skin. They enjoy warm, humid environments. They are found in mattresses , pillows, couches, carpets and dust . People who react to dust mites are actually allergic to their droppings.

The symptoms of rhinitis

The  symptoms  persist as long as the person is exposed to allergens. Even though hay fever symptoms reappear every year as the plant blossoms, they tend to decline with age. On the other hand, some people develop pollen allergies only in adulthood.

  • The  nose  that stings, runs and secretions very liquid;
  • Itching, watery eyes and redness in the  eye;
  • Of  sneezing  series;
  • A  congestion  nasal;
  • Tension in the sinus region ;
  • Sore  throat , hoarseness or coughing
  • Of  itching  in the throat or palate;
  • An  alteration of taste, smell and hearing damage (especially in children);
  • The tiredness, irritability and insomnia, when symptoms last for several days.

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Causes of rhinitis

The exact causes of allergic rhinitis are not known , but genetic background is a fairly important factor. A person whose genes are more sensitive to allergies is said to have “atopic terrain”. In other words, it reacts excessively to the contact of normally banal and harmless allergens.This can lead to various manifestations: allergic rhinitis, asthma, urticaria, eczema, food allergies, conjunctivitis, etc. They can appear in isolation, simultaneously or successively, depending on the person.

The pollens are involved in seasonal allergies. In Canada, ragweed remains the most important source of pollen. That’s why public health authorities are conducting, with the population, awareness campaigns to eradicate this plant.Quebecers are advised to tear off ragweed before it blooms in August.

Pollen sources
Spring (from mid-March to the end of June) Trees and shrubs
Summer (late May to mid-October) Grasses (grass, hay, rye, wheat, corn)
End of summer (from the end of July to October) Ragweed

.People at risk for Rhinitis

  • The heredity seems to play an important role in the onset of allergies, including allergic rhinitis. When both parents have an allergy (no matter which), the risk for the child to suffer from allergic rhinitis is even higher;
  • Men are more at risk than women, for reasons that are unknown;
  • The eldest of the family.

Risk factors

  • Repeated exposure   to airborne allergens.
  • Exposure to cigarette smoke,especially during the first year of life28.
  • Exposure to   air pollution and other respiratory tract irritants (house fire smoke, pollutants in the air).
  • Abuse of   topical (aerosol) decongestants may aggravate the condition of the mucous membranes of the nose and, therefore, cause drug-induced (non-allergic) rhinitis.

Possible complications

Even if the symptoms are mild, untreated allergic rhinitis can worsen and lead to chronic sinusitis. Persistent rhinitis is often associated with asthma, regardless of the intensity of the symptoms. Finally, in children, allergic rhinitis increases the risk of otitis media.

It is better to consult a doctor if:

  • The symptoms are persistent and affect the quality of life;
  • Symptoms are not relieved by over-the-counter medications;
  • Side effects of drugs are poorly tolerated.

Diagnostic of Rhinitis

It is sometimes possible to discover the allergen that causes rhinitis. The doctor makes the history of the symptoms: when they occur and how. We then list the allergens present in the person’s environment (house, office, school). By trial errors, we can discover which elements are actually allergenic. When the allergen is difficult to find or when the medication is not working, a skin or blood test is done.

Skin test  : the skin is exposed to very small doses of purified allergenic substances. These substances can be pollen from various plants, mold, animal dander, mites, bee venom, latex, penicillin, etc. The signs of allergic reactions (redness or small bump similar to an insect bite) are then observed after about twenty minutes.

Blood test (or RAST for radioallergosorbent test ): a blood sample is subjected to different allergens. If the patient is allergic, for example to birch pollen, antibodies (IgE) specific to birch pollen will bind to this allergen. This test also provides information on the concentration of antibodies present in the blood in response to the allergen. Although more expensive, this technique has the advantage of being safe since it does not expose the person directly to allergens.

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Prevent and avoid allergic rhinitis

Can we prevent?
Once allergic rhinitis is established, there is no known treatment to get rid of it. However, sometimes it goes away on its own.

For now, the only recognized basic preventive measure is to avoid smoking and second-hand smoke. Tobacco smoke irritates the airways, creating a breeding ground for respiratory diseases. Otherwise, there is no known measure that will certainly prevent allergic rhinitis. Nevertheless, the medical community is exploring various avenues of prevention. They could especially interest parents with allergies, who want to reduce the risk that their child suffers too. To know them, consult our page Allergies.

 

Measures to reduce the frequency and intensity of symptoms
With allergic rhinitis, it is possible to reduce or prevent the worsening of symptoms by various means.

Reduce exposure to allergens

Pollen and mold
– Avoid activities that expose to large amounts of pollen , such as mowing the lawn, mowing and weeding.
– Provide indoor ventilation using an air purifier with a high-efficiency particulate filter or electrostatic filter rather than opening the windows. During hot summer days, use an air conditioner if necessary. Make sure that ventilation is adequate if you heat with wood.
– Avoid drying your clothes outside, as pollen may settle.
– Maintain the humidity levelless than 50%. Use a dehumidifier in an unfinished or wet basement to prevent mold growth.
– Keep the minimum amount of plants and eliminate the clay pots to limit mold.
Note . The times when the amount of pollen in the air is the lowest are 10 hours in the morning until sunset, as well as during a rain or after.

Mites
 Wash bedding frequently with hot water (at least 54 ° C or 130 ° F).
– Cover the mattress with an anti- mite cover and get washable synthetic foam pillows.
– Keep the humidity rate below 50%.
– Clean carpets and rugs with a vacuum cleaner equipped with a good quality filter.
– Avoid carpets and abundant draperies in the bedroom.
– There are acaricidesaerosol. After spraying the product on the mattresses, carpets, armchairs, ventilate the room thoroughly for several hours before staying there again.
– To kill mites and mite larvae in stuffed toys, they can be put in the freezer for 72 hours. Repeat the operation every 3 months.

Animals
– Do not keep animals in the house as much as possible. The cats are the most allergenic pets. There are no dogs or non-allergenic cats, but some breeds are worse than others. Animals with woolly hair cause fewer reactions.
– Give the bath to his pet every week.
– Remove animal hair from the ground as often as possible.
– Keep the pet out of the bedroom sleeping.

Foods
Some people who suffer from seasonal allergies are prone to a particular form of allergy to fruits, fresh vegetables or nuts. This reaction is called oral allergy syndrome . Depending on the case, ingestion of the food or its contact with the mouth causes itching on the lips, tongue, palate and throat. Sometimes swelling of the lips, tongue and uvula occurs.

A person allergic to birch pollen may have allergic reactions when eating an apple or raw carrot, while a person allergic to ragweed pollen may have this reaction when eating melons, bananas or raw cucumbers. These cross-reactions occur because the allergens in these pollens and foods are chemically similar.

Symptoms of this type of food allergy usually remain mild. They occur only with raw foods. It is advisable to refrain from consuming them, especially during the allergy season.

 

On the other factors irritants can worsen symptoms:

  • Tobacco smoke and house fires;
  • The perfumes ;
  • Air pollution ;
  • Wind or drafts;
  • Temperature differences.

 

Measures to prevent complications
Treating the symptoms of allergic rhinitis as soon as they occur helps prevent complications, such as otitis media, asthma and chronic sinusitis.

 

How to treat allergic rhinitis?

Ceasing exposure to known allergens is the first step in antiallergic treatment. Eliminating the allergen is not always possible, as in the case of pollen allergies.

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Pharmaceuticals

Different medications can alleviate the symptoms of rhinitis . Some are taken orally, others are nasal sprays or eye drops (eye drops). If over-the-counter products do not work, the doctor may prescribe other products that work differently.

  • The antihistamines act by blocking the production of histamine, a substance which causes the allergy symptoms . They relieve sneezing, runny nose, and tingling of the eyes and throat. First-generation antihistamines caused somnolence (Benadryl). We now find, over-the-counter in pharmacies, antihistamines that do not have this side effect (Claritin, Allegra, and Zyrtec).
  • The decongestants decrease rapidly swelling of the nasal tissue. They are often used in combination with antihistamines. They are in the form of syrups, tablets (Sudafed, Actifed) and nasal sprays (Neo-Synephrine). They contain pseudoephedrine. The topical decongestants (as spray) should not be used for more than 3 consecutive days, as they can cause rebound rhinitis . This is a temporary measure that should not be abused.
  • Rinsing the nasal passages . Rinsing nasal passages with salt water is a simple, inexpensive and effective method of relieving nasal congestion. A good rinsing removes mucus and allergens from nasal passages. Get a saline solution available at the pharmacy or prepare your homemade solution with ¼ c. teaspoon salt in 2 cups (500 ml) warm water. Use a spray bottle or nasal syringe.
  • The nasal corticosteroids are anti-inflammatory drugs that block the allergic reaction (Flonase, Nasacort, and NASONEX). They are usually prescribed when antihistamines do not provide relief, more often in people who suffer from persistent rhinitis. They are administered directly into the nose, using a vaporizer. They can, however, cause irritation of the mucous membranes of the nose.
  • The oral corticosteroids are sometimes used to relieve severe allergic symptoms. However, they are prescribed for a short time because their long-term use can cause serious side effects.
  • The antidégranulants (sodium cromoglycate) act by inhibiting the release of histamine and other chemical mediators, initiators of allergic reactions. Products such as Cromolyn, Opticrom and Nasalcrom are used in nasal spray or eye drops. Particularly effective in children and well tolerated, they seem to play a preventive role against allergic reactions when taken before the onset of symptoms . However, they must be administered several times a day.
  • The anti-leukotrienes , of prescription medications (Singulair, Accolate), blocking the effects of leukotrienes. These are produced by the immune system during an allergic reaction and contribute to the onset of symptoms. Antileukotrienes are often used when a nasal spray is not well tolerated.

Progressive desensitization treatment

When the cause of the allergy is well defined and the drug treatments are not effective, it is possible to consider a desensitization or immunotherapy treatment . It involves injecting, over a period of 3 to 5 years, increasing doses of the allergenic substance . This treatment is only available for common allergens, such as pollen, cat and dog dander, mites and molds. It is particularly effective in case of allergies to pollen and mites. According to a meta-analysis collecting data from 16 clinical studies, 1 in 2 is an improvement of symptoms through desensitization therapy, compared with 1 in 4 placebo treatment.

Desensitization can also be done by taking daily drops or tablets that are allowed to melt under the tongue. This technique is called sublingual desensitization or SLIT ( sublingual immunotherapy ). Several studies and meta-analyzes have found a decrease in symptoms compared to taking a placebo.However, no study has compared this technique to injection-based immunotherapy. Sublingual desensitization is commonly used in Europe, but is not permitted in Canada.

Surgery

If the drug treatment is insufficient or in case of anatomical abnormalities of the nasal cavity, surgical treatment may be considered. Surgery is indicated for diverting the nasal septum, for nasal polyps or for draining infected sinuses. Surgery is used primarily to facilitate breathing, but in no case will it prevent an allergy from manifesting itself.

To unblock the nose of a baby or a young child , remove some of the mucus using a syringe or a nose. A drop of warm saline water is then placed in each of the nostrils by placing the child so that the drop is flowing towards the back of the nose. The child is straightened up as soon as the gout has entered the nose.

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