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Allergic rhinitis

Definition

Allergic rhinitis is a diagnosis associated with a group of symptoms affecting the nose. These symptoms occur when you breathe in something you are allergic to, such as dust, animal dander, or pollen. Symptoms can also occur when you eat a food that you are allergic to.

This article focuses on allergic rhinitis due to plant pollens. This type of allergic rhinitis is commonly called hay fever or seasonal allergy.

Patient Education Video: Allergic rhinitis

Alternative Names

Hay fever; Nasal allergies; Seasonal allergy; Seasonal allergic rhinitis; Allergies - allergic rhinitis; Allergy - allergic rhinitis

Causes

An allergen is something that triggers an allergy. When a person with allergic rhinitis breathes in an allergen such as pollen, mold, animal dander, or dust, the body releases chemicals that cause allergy symptoms.

Allergy symptoms
The immune system normally responds to harmful substances such as bacteria, viruses and toxins by producing symptoms such as runny nose and congestion, post-nasal drip and sore throat, and itchy ears and eyes. An allergic reaction can produce the same symptoms in response to substances that are generally harmless, like dust, dander or pollen. The sensitized immune system produces antibodies to these allergens, which cause chemicals called histamines to be released into the bloodstream, causing itching, swelling of affected tissues, mucus production, hives, rashes, and other symptoms. Symptoms vary in severity from person to person.

Hay fever involves an allergic reaction to pollen.

Plants that cause hay fever are trees, grasses, and ragweed. Their pollen is carried by the wind. (Flower pollen is carried by insects and does not cause hay fever.) Types of plants that cause hay fever vary from person to person and from area to area.

The amount of pollen in the air can affect whether hay fever symptoms develop or not.

  • Hot, dry, windy days are more likely to have a lot of pollen in the air.
  • On cool, damp, rainy days, most pollen is washed to the ground.

Hay fever and allergies often run in families. If both of your parents have hay fever or other allergies, you are likely to have hay fever and allergies, too. The chance is higher if your mother has allergies.

Symptoms

Symptoms that occur shortly after you come into contact with the substance you are allergic to may include:

  • Itchy nose, mouth, eyes, throat, skin, or any area
  • Problems with smell
  • Runny nose
  • Sneezing
  • Watery eyes

Symptoms that may develop later include:

  • Stuffy nose (nasal congestion)
  • Coughing
  • Clogged ears and decreased sense of smell
  • Sore throat
  • Dark circles under the eyes
  • Puffiness under the eyes
  • Fatigue and irritability
  • Headache
Allergy symptoms
The immune system normally responds to harmful substances such as bacteria, viruses and toxins by producing symptoms such as runny nose and congestion, post-nasal drip and sore throat, and itchy ears and eyes. An allergic reaction can produce the same symptoms in response to substances that are generally harmless, like dust, dander or pollen. The sensitized immune system produces antibodies to these allergens, which cause chemicals called histamines to be released into the bloodstream, causing itching, swelling of affected tissues, mucus production, hives, rashes, and other symptoms. Symptoms vary in severity from person to person.

Exams and Tests

The health care provider will perform a physical exam and ask about your symptoms. You will be asked whether your symptoms vary by time of day or season, and exposure to pets or other allergens.

Allergy testing may reveal the pollen or other substances that trigger your symptoms. Skin testing is the most common method of allergy testing.

If your doctor determines you cannot have skin testing, special blood tests may help with the diagnosis. These tests, known as IgE RAST tests, can measure the levels of allergy-related substances.

A complete blood count (CBC) test, called the eosinophil count, may also help diagnose allergies.

Treatment

LIFESTYLE AND AVOIDING ALLERGENS

The best treatment is to avoid the pollens that cause your symptoms. It may be impossible to avoid all pollen. But you can often take steps to reduce your exposure.

You may be prescribed medicine to treat allergic rhinitis. The medicine your doctor prescribes depends on your symptoms and how severe they are. Your age and whether you have other medical conditions, such as asthma, will also be considered.

For mild allergic rhinitis, a nasal wash can help remove mucus from the nose. You can buy a saline solution at a drug store or make one at home using 1 cup (240 milliliters) of warm water, half a teaspoon (3 grams) of salt, and pinch of baking soda.

Patient Education Video: How to use nasal sprays

Treatments for allergic rhinitis include:

ANTIHISTAMINES

Medicines called antihistamines work well for treating allergy symptoms. They may be used when symptoms do not happen often or do not last long. Be aware of the following:

  • Many antihistamines taken by mouth can be bought without a prescription.
  • Some can cause sleepiness. You should not drive or operate machines after taking this type of medicine.
  • Others cause little or no sleepiness.
  • Antihistamine nasal sprays work well for treating allergic rhinitis. Ask your doctor if you should try these medicines first.

CORTICOSTEROIDS

  • Nasal corticosteroid sprays are the most effective treatment for allergic rhinitis. They work best when used nonstop, but they can also be helpful when used for shorter periods of time. They can even help when used intermittently.
  • Corticosteroid sprays are generally safe for children and adults.
  • Many brands are available. You can buy four brands without a prescription. For all other brands, you will need a prescription from your doctor.

DECONGESTANTS

  • Decongestants may also be helpful for reducing symptoms such as nasal stuffiness.
  • Do not use nasal spray decongestants for more than 3 days.

OTHER MEDICINES

  • Leukotriene inhibitors are prescription medicines that block leukotrienes. These are the chemicals the body releases in response to an allergen that also trigger symptoms.

ALLERGY SHOTS

Allergy shots (immunotherapy) are sometimes recommended if you cannot avoid the pollen and your symptoms are hard to control. This includes regular shots of the pollen you are allergic to. Each dose is slightly larger than the dose before it, until you reach the dose that helps control your symptoms. Allergy shots may help your body adjust to the pollen that is causing the reaction.

SUBLINGUAL IMMUNOTHERAPY TREATMENT (SLIT)

Instead of shots, medicine put under the tongue may help for grass and ragweed allergies.

Outlook (Prognosis)

Most symptoms of allergic rhinitis can be treated. More severe cases need allergy shots.

Some people, especially children, may outgrow an allergy as the immune system becomes less sensitive to the trigger. But once a substance such as pollen causes allergies, it often continues to have a long-term effect on the person.

When to Contact a Medical Professional

Contact your provider for an appointment if:

  • You have severe hay fever symptoms
  • Treatment that once worked for you no longer works
  • Your symptoms do not respond to treatment

Prevention

You can sometimes prevent symptoms by avoiding the pollen you are allergic to. During pollen season, you should stay indoors where it is air-conditioned, if possible. Sleep with the windows closed, and drive with the windows rolled up.

Gallery

Allergy symptoms
The immune system normally responds to harmful substances such as bacteria, viruses and toxins by producing symptoms such as runny nose and congestion, post-nasal drip and sore throat, and itchy ears and eyes. An allergic reaction can produce the same symptoms in response to substances that are generally harmless, like dust, dander or pollen. The sensitized immune system produces antibodies to these allergens, which cause chemicals called histamines to be released into the bloodstream, causing itching, swelling of affected tissues, mucus production, hives, rashes, and other symptoms. Symptoms vary in severity from person to person.
Eye
The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.
Allergy symptoms
The immune system normally responds to harmful substances such as bacteria, viruses and toxins by producing symptoms such as runny nose and congestion, post-nasal drip and sore throat, and itchy ears and eyes. An allergic reaction can produce the same symptoms in response to substances that are generally harmless, like dust, dander or pollen. The sensitized immune system produces antibodies to these allergens, which cause chemicals called histamines to be released into the bloodstream, causing itching, swelling of affected tissues, mucus production, hives, rashes, and other symptoms. Symptoms vary in severity from person to person.

References

Cox DR, Wise SK, Baroody FM. Allergy and immunology of the upper airway. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 35.

Milgrom H, Sicherer SH. Allergic rhinitis. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 168.

Wallace DV, Dykewicz MS, Oppenheimer J, Portnoy JM, Lang DM. Pharmacologic treatment of seasonal allergic rhinitis: synopsis of guidance from the 2017 joint task force on practice parameters. Ann Intern Med. 2017;167(12):876-881. PMID: 29181536 pubmed.ncbi.nlm.nih.gov/29181536/.

Last reviewed January 23, 2022 by Stuart I. Henochowicz, MD, FACP, Clinical Professor of Medicine, Division of Allergy, Immunology, and Rheumatology, Georgetown University Medical School, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

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