Allergic Rhinitis: The Year of El Nino

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Spring is here! And for those people who suffer from allergic rhinitis, the heavy rains from El Nino is likely to create much more than a runny nose. The fall-out from pervasive pollens and rampant airborne grass shoots are likely to make sufferers tired and irritable, and set the stage for more serious ailments, including chronic ear or sinus infections.

Allergic rhinitis means, literally, an inflammation of the nose caused by allergies. The symptoms of allergic rhinitis—a stuffed-up nose, frequent sniffling and sneezing, and red, watery, swollen eyes—can be almost impossible to distinguish from those of a common cold. But unlike a cold, allergic rhinitis symptoms are brought on by an allergic reaction to pollens, pets, or some other allergy-provoking substance. Such non-allergy triggers as cold air or strong odors can also bring on symptoms in some people with allergic rhinitis.

The sniffling, sneezing disorder afflicts at least 15 percent of the North American population. But the true incidence of this common nasal misery may be much higher. Because so many people mislabel their stuffed-up, runny noses as symptoms of a cold or sinus problem, allergic rhinitis is undoubtedly under-diagnosed.

Allergic rhinitis can occur at any age. If symptoms appear only at certain times of the year, the disorder is usually called „hay fever.” If symptoms occur year-round, it is known as perennial rhinitis.

While allergic rhinitis is usually fairly mild and easy to control, it leaves many people feeling as though they have a constant bad head cold. Fatigue and irritability are common complaints. Allergic rhinitis can also predispose sufferers to the development of sinus infections, middle ear infections, or nasal polyps, benign growths that can block normal drainage from the nasal and sinus passages. In addition, rhinitis can trigger asthma attacks in people with asthma.

Diagnosis

If you suspect your runny nose may be more than an ordinary head cold, consult your doctor. With proper treatment, allergic rhinitis can be well-controlled—and more serious problems can be averted.

Your doctor will begin by asking you a series of questions about your symptoms, and will examine your nose, throat, and eyes for clues of allergic rhinitis, including swollen, watery eyes; „allergic shiners,” or dark circles under the eyes; and a „nasal crease,” or horizontal line just below the bridge of the nose caused by the „allergic salute,” in which an allergic rhinitis sufferer’s hand repeatedly pushes up on the nose to open nasal passages while wiping away nasal secretions. In addition, your doctor may recommend skin testing for allergies.

Avoidance

If you have allergic rhinitis, the best way to control your symptoms is to discover what you are allergic to, and then eliminate or minimize your contact with that substance. For example, if you are allergic to dust mites—microscopic insects present in ordinary household dust—encasing your mattress and bed pillows in allergen-proof covers can improve your symptoms. Washing your sheets in hot water once a week and removing carpets and drapes from your bedroom are other effective strategies for reducing dust mite exposure. If you allergic to cats, finding another home for your cat may cure your runny nose.

Wetting Agents

Rinsing your nose with a saline solution is a simple but effective way to reduce nasal stuffiness, sneezing, and congestion, to relieve irritation or dryness of the nasal passages, and to dislodge encrusted or thickened mucus from inside the nose.

Antihistamines

If avoidance and wetting agents alone are not enough to relieve your symptoms, antihistamine medication can be valuable. Drugs such as Claritin can be very effective at relieving sneezing, a runny nose, and itching eyes.

Terfenadine (Seldane) and astemizole (Hismanal), two nonsedating prescription antihistamines, have been associated with a heart rhythm abnormality known as Torsades de Points when used in combination with certain other medications such as ketoconazole, an antifungal agent, or erythromycin, an antibiotic, or when taken by people with heart disease. However, these antihistamines pose minimal risks for people without heart disease who take them in recommended doses.

To date, loratadine (Claritin), another nonsedating prescription antihistamine, and cetirizine (Zyrtec) have not been associated with cardiovascular problems. The most common side effect of cetirizine is drowsiness.

Although there may be a place for the „sedating,” over-the-counter antihistamines in helping people to sleep at night, these drugs can cause drowsiness and compromise performance if taken during the day. Over-the-counter antihistamines are typically combined with a decongestant to help relieve nasal congestion.

Decongestants

Common oral decongestants include pseudoephedrine, phenylpropanolamine and phenylephrine. These agents help to relieve nasal stuffiness and reduce nasal secretions. Possible side effects include high blood pressure, rapid or irregular heart beat, restlessness, insomnia and headache. Combining phenylpropanolamine with caffeine—in the amount present in two to three cups of coffee—may significantly raise blood pressure. In addition, decongestant medications may cause hyperactivity in children.

Decongestant nasal sprays are also effective at drying up runny noses. But these products should be used only for a limited period of time, as they are associated with a „rebound” effect with overuse. If they are used for too many days at a stretch and then stopped, nasal congestion can return even worse than before.

Anticholinergic Agents

Anticholinergic agents can be helpful for people who have significant nasal secretions, or suffer from certain specific conditions such as „gustatory rhinitis,” which usually accompanies a spicy meal. These agents also have been studied for their beneficial effects on the common cold. Ipratropium nasal spray is a newly released medication indicated only for the treatment of runny nose in allergic rhinitis and the common cold.

Intranasal Cromolyn

Cromolyn has an excellent safety record and is especially effective if used on a regular basis. Administered via nasal spray, cromolyn can be effective in reducing sneezing, runny nose, and nasal itching. Although side effects are unusual, sometimes the spray will cause sneezing, transient headache, or nasal burning.

Topical Corticosteroids

Corticosteroid nasal sprays such as Nasonex are very effective agents in the prevention and treatment of allergic rhinitis, especially for symptoms of stuffiness, sneezing, and runny nose. They, too, must be used on a regular basis in order to be effective. Depending on the preparation, corticosteroid nose sprays may cause irritation, stinging, burning, or sneezing. The sprays also may cause local bleeding, and can even create a small hole in the septum, the stiff cartilage that divides the two sides of the nose—especially if the sprays are not aimed in the proper direction. Corticosteroid nasal sprays should be aimed up and away from the septum. Topical steroids generally are more effective than cromolyn sodium.

Oral Corticosteroids

These agents can be highly effective in reducing the symptoms of allergic rhinitis, but side effects limit their usefulness except for temporary therapy in patients with severe symptoms. These agents are particularly useful in shrinking nasal polyps when corticosteroid nasal sprays have been unsuccessful.

Immunotherapy

Allergy shots, or immunotherapy, often can provide substantial benefits for people with allergic rhinitis, especially for those who experience side effects from other medications, or do not get adequate relief from other medications. Although immunotherapy is expensive and inconvenient, it can reduce or eliminate allergic reactions to a number of common allergy-provoking substances, from pollens and weeds to dust mites.

Allergic rhinitis can be both annoying and frustrating. But it can be controlled. A number of safe, effective treatments can help to prevent problems, minimize symptoms, and restore quality of life.

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