Allergic Rhinitis and Seasonal Allergies

By Garry Kim, M.D.

The sniffling, sneezing, itchy symptoms of seasonal allergies are well known to many of us living in Los Angeles. National statistics state that on average 20% of Americans suffer from allergies, and some regions, including Los Angeles, are higher than others. Although people in their late teens and early twenties are usually affected, allergies can afflict people of all ages. What causes it, how do you know if you have it, and what can you do about it?

Definition

Allergies or hay fever, are caused by allergens. An allergen is any substance that sets off a chain reaction in our immune system that leads to the symptoms we often associate with allergies. There are millions of potential allergens in the environment. Most are probably familiar to you and they include: pollen from grass, trees and weeds, animal dander, house dust mites and molds. These allergens become airborne and come in contact with our nasal passageways, our eyes, our sinuses or the backs of our throats and cause all the typical symptoms of allergies. These include itchy and runny nose, sneezing, nasal congestion, itchy and watery eyes, scratchy throat, cough, pressure or fullness in the ear, difficulty hearing, poor sleep, irritability and loss of energy. All the symptoms can be worsened by irritating substances in the air such as cigarette smoke and strong scents from chemical compounds such as gasoline, paint and perfume. Polluted air does not cause allergies, but it can make the allergic response to allergens more severe.

Symptoms can be year round or can recur at specific times of the year. Seasonal allergies are usually caused by pollen from plants that flower during the spring or from trees whose leaves fall during the autumn months. People who suffer from year round allergies have sensitivities to household allergens such as dust mites or cockroaches and dander from pets. For these allergy sufferers, symptoms tend to be worse during the winter months when more time is spent indoors.

How is it diagnosed

A medical history and physical exam can establish the diagnosis of allergies in most cases. The seasonal recurrence of symptoms makes the diagnosis of allergies almost certain. The most common times for allergies are in the fall and spring/early summer. As mentioned above, this is when the pollen count is highest. Other conditions that are often mistaken for allergies are flu and colds. This is because all three conditions occur mostly in the early spring and late fall and can cause cough, runny nose, nasal congestion, scratchy and sore throats.

The medical history can also be helpful in identifying the causes of allergies. However, in cases when allergy symptoms are severe and unresponsive to most prescribed medications further testing to identify the allergen may be necessary. A special skin test or blood test called a radioallergosorbent test (RAST) can be performed to identify allergens. Treatments can then be targeted towards those specific allergens.

How is it treated

Allergen avoidance

The best way to treat allergies is, if at all possible, through allergen avoidance. For example, if you have an allergy to cats, you may want to reconsider adopting that cat from the pound. Traveling away on vacation during the months that your allergies are most severe is another approach. For those of you who have household or dust mite allergies there are a number of different ways to reduce your exposure. Carpets, curtains, upholstered furniture play host to dust mites. Frequent dusting and vacuuming can reduce exposure to these allergens. Your mattress and pillows are also hosts to dust mites and can be covered with hypoallergenic covers to provide a protective barrier between you and the mites.

Medications

First it is important to understand the two biggest categories of medications that are used to treat allergies: decongestants and antihistamines.

Decongestants (Sudafed, Actifed) — As a part of the allergic response, blood vessels in your nose, eyes and airways dilate, causing swelling and congestion. This then leads to watery eyes, stuffy and runny nose, headaches, pressure in the sinuses and ears. Decongestants act by diminishing the blood dilation response of the allergy cascade and help dry up those secretions and open up passageways. Some of the common side effects of decongestants are dry mouth, palpitations and insomnia when taken at night.

Antihistamines (Benadryl, Allegra, Claritin, Clarinex, Zyrtec) — Histamine is produced by a special type of white blood cell called masts cells. The histamine then reacts in different tissues such as the eye and nose causing burning and itching. It can also lead to scratchiness of the throat. For those with severe allergic reactions, it can also cause hives to break out on the skin. Antihistamines block the effects of histamine on tissues of the body and help prevent most, if not all, of those burning and itching symptoms. The most noticeable side effect from antihistamines is drowsiness. Prescription antihistamines such as Allegra, Claritin and Zyrtec have little to no drowsing side effects.

Antihistamines and decongestants can be purchased over the counter. They come in many forms including tablets, syrups, eye drops and nasal sprays. Most of the oral formulations come as combination medications that include both antihistamines and decongestants.

If you are mostly bothered by specific symptoms such as itching and burning eyes (allergic conjunctivitis) or runny and congested nose (allergic rhinitis), there are medications that can target these areas. For allergic conjunctivitis, many of the over the counter medications such as Visine and Clear Eyes provide some relief. For allergic rhinitis, salt water (or saline) nasal sprays are a good way to start. These sprays wash away allergens that are stuck to the cells within the nasal passageways. The saline sprays are often used in conjunction with other medications. Nasal decongestants that can be purchased over the counter such as Afrin can oftentimes provide immediate relief, but must be used only for a few days as continued use can sometimes worsen symptoms. Additional treatment options with inhaled nasal antihistamines and steroids are only available by prescription. When the over the counter options are unable to control symptoms, these medications provide the most effective relief.

Immunotherapy

A final treatment option is immunotherapy. Most people who suffer from moderate to severe allergies find adequate relief with prescribed antihistamines and decongestants. However, for those who do not respond to the usual treatments, immunotherapy is an option. Immunotherapy works by desensitizing your immune system to the provoking allergen. This type of therapy is performed by an allergy specialist and requires receiving multiple shots.