With 10-30% of all people suffering from hay fever it’s hardly surprising you’ll frequently be faced with patients suffering symptoms of allergic rhinitis – the difficulty is recognising it.

While allergic sinusitis is not a life-threatening condition, for many of your patients it’s a chronic unpleasant condition leading to frequent respiratory tract infections, tiredness, congestion, and loss of smell and taste.

DEFINITION

Allergic rhinitis or hay fever is a condition which can be triggered by a wide variety of irritants. The allergic reaction causes the nose to flare up, becoming blocked, increasing mucous production (causing sneezing, post nasal drip), and leading to itchiness of the palate and ears.

Sinus headaches, itching red eyes, a runny red nose are some of the less pleasant indicators your patient may have allergic rhinitis.

Young children with allergic rhinitis may frequently develop middle ear infections. Very young allergic children are often seen rubbing their noses on sheets and their mother’s shoulders, even before the hands can find their way to the nose.

While allergic rhinitis may just occur in the spring, many people suffer from symptoms all year round. For many people this simply translates into frequent headaches, tiredness, and a reduced sense of smell and taste without them actually realising the cause of their symptoms.

Allergic rhinitis can be effectively treated, and by helping patients get their symptoms under control you ensure they experience an enormous change in their quality of life.

ORIGIN OF ALLERGIES

Allergic rhinitis is an abnormal immune system reaction to an otherwise harmless trigger. Essentially the person’s body reacts to something like pollen as if it’s the Ebola virus. This heightened immune system reaction causes swelling, itching, secretions, and tiredness.

While allergies can result in allergic rhinitis, they can also cause other allergic conditions such as asthma and skin eczema. One in four people with allergic rhinitis also suffer from asthma symptoms.

TRIGGERS OF ALLERGIC RHINITIS

Patients will often try to find the allergic trigger for their condition. There are, however, thousands of triggers, and exactly what they are reacting to depends on their allergic profile. However, you can tell your clients that the most common allergens (allergy-inducing triggers) include: pollens, house dust mite, mould, and animal dander.

SEASONAL VS YEAR-ROUND SYMPTOMS

Pollen allergies tend to worsen in spring and summer and improve in autumn and winter. Allergies all year around suggest an allergen like house dust mite, animal dander, or food as the likely cause.

SYMPTOMS WORSE OUTDOORS VS INDOORS

Pollen allergies mean symptoms are noticeably worse after being outdoors for any length of time.  Sometimes an obvious trigger such as worsening symptoms after mowing the lawn or sitting on the grass should be an indicator.

TESTING FOR ALLERGIES

Patients with severe uncontrolled allergies may need to be tested for the underlying specific cause of their allergy. Finding a cause can sometimes help with removing the trigger, especially if the cause is a food allergy.

There are two main types of allergy testing:

  • Skin testing

A small amount of the suspected allergen is applied to the skin (usually on the forearm). The skin may be lightly pricked. The doctor will then measure the degree of skin swelling or reaction to each allergen over the next 10 minutes. The degree of reaction indicates the sensitivity of the individual to the allergen.

  • Blood testing

Laboratory tests which check for immune markers to specific allergens (known as CAP RAST testing) can help identify allergic triggers. The client’s doctor will need to narrow down the likely suspects before testing, otherwise this can be an expensive exercise.

TREATMENT

There are fortunately many options for the treatment of allergic rhinitis. Always check which treatments your client has previously used or is currently using before recommending an additional measure.

Nasal irrigation and saline sprays

Rinsing the nose with a salt-water (saline) solution is called nasal irrigation or nasal lavage. Saline is also available in a standard nasal spray, although this is not as effective as using larger amounts of water in an irrigation. Nasal irrigation is particularly useful for treating drainage down the back of the throat, sneezing, nasal dryness, and congestion. The treatment helps by rinsing out allergens and irritants from the nose. Saline rinses also clean the nasal lining and can be used before applying sprays containing medications, to get a better effect from the medication.

You can recommend your patient tries nasal irrigation once or twice per day using sterilised water and salt. Saline nasal sprays and irrigation kits can be purchased over-the-counter (OTC) and include a variety of devices, such as bulb syringes and bottle sprayers. At least 200ml of fluid (salt solution made with distilled or boiled water or sterile saline, not tap water) is recommended for each nostril.

Nasal glucocorticoids

Nasal glucocorticoids (steroids delivered by a nasal spray) are the first-line treatment for the symptoms of allergic rhinitis. These drugs have few side effects and dramatically relieve symptoms in most people. Studies have shown that nasal glucocorticoids are more effective than oral antihistamines for symptom relief.  While certain nasal glucocorticoids require prescription, others are now OTC medications which you can recommend. Make sure to advise your patient it may take up to two weeks before they experience relief from symptoms. For this reason, it’s important that they use their spray daily or twice daily as prescribed.

Antihistamines

Antihistamines relieve the itching, sneezing, and runny nose of allergic rhinitis, but they do not relieve nasal congestion. Combined treatment with nasal steroids or decongestants may provide greater symptom relief than use of either alone. As most antihistamines cause drowsiness encourage patients to use them in the evening.

Decongestants

These medications are designed for controlling symptoms of colds or flu and should not be used on an ongoing basis to control allergic rhinitis. You can recommend them for a few days while a client starts nasal glucocorticoids or antihistamines. Used for more than one or two weeks at a time, they can cause rebound sinusitis.

Allergy shots

A course of histaglobulin injections can help to significantly reduce allergies in adults. The course consists of four injections four days apart, repeated after a month. This needs to be followed by a monthly injection for four months and annual booster shots. Injections are expensive and reserved only for those not controlled on standard treatment.

Leukotriene modifiers

Leukotriene modifiers (leukotriene antagonists) are medicines used to manage allergic rhinitis or allergies, as well as prevent asthma. If your patient doesn’t have asthma these drugs are usually only used where nasal glucocorticoids are not effective.

DON’T SNIFF AT ALLERGIC RHINITIS

While allergic sinusitis is not a life-threatening condition, for many of your patients it’s a chronic unpleasant condition leading to frequent respiratory tract infections, tiredness, congestion, and loss of smell and taste. Most clients don’t realise what their symptoms mean and often go poorly treated – using decongestants – for years without any real success. By starting them on nasal glucocorticoids and an antihistamine you can give relief to a multitude of symptoms and improve their lives.