Allergic rhinitis, commonly referred to as hay fever, is a very common condition affecting more than 20% of people living in the United States. It is an allergic inflammation of the nasal airways. Allergic rhinitis is caused by exposure to substances in the air called allergens. Allergens are usually substances, such as pollen, dust mites, pet dander or mold that the immune system typically ignores. However, in people with allergic rhinitis, the immune system mistakenly identifies these allergens as ‘intruders’ and generates a reaction against them. In allergic individuals, the immune system produces a specific type of antibody call IgE (the ‘allergy antibody’) against the allergen (e.g. cat dander). The IgE antibody coats immune cells called mast cells. Mast cells exist everywhere the body comes in contact with the outside environment (the skin, respiratory tract, gastrointestinal tract) and contain a number of chemicals , such as histamine, that cause allergic symptoms. On exposure to an allergen, the IgE molecules bind to it and this triggers the mast cell to burst and release its histamine and other chemicals that contribute to the symptoms of allergic rhinits.
The histamine and other chemicals released from Mast cells causes many of the common symptoms of allergic rhinitis – sneezing, runny nose, and nasal congestion. Eye symptoms include itchy, watery, red and, at times, swollen eyes. The ears and roof of the mouth may itch as well. In asthmatic patients, allergen exposure can trigger cough, wheeze, and shortness of breath. Importantly, up to 70% of asthmatics have underlying allergies. People with allergies are also more prone to ear and sinus infections.
A careful history, physical exam and detailed knowledge of the area’s native plants and pollination patterns are key elements in the proper diagnosis of allergic rhinitis. Identification of allergens is best done with allergen skin prick testing. In skin testing, a small drop of highly purified allergen extract is placed on the skin and the skin is ‘pricked’ with a small plastic device. If the person is allergic to say cat dander, a prick test to cat dander will cause the mast cells in the skin to release histamine and a small hive will develop within 15 minutes. Blood based allergy tests (commonly called RAST tests) measure IgE antibody in the bloodstream and can also be used to diagnose allergy triggers. Such testing, however, has limitations and skin testing remains the preferred method to identify allergic triggers.
The cornerstone in the treatment of allergic rhinitis it to avoid allergens that trigger symptoms (Click here to see Allergy Partners Environmental Control Handbook). A variety of medications are useful in treating symptoms. Antihistamines are useful for alleviating itching and sneezing, while decongestants alleviate congestion. Nasal sprays (both steroid and antihistamine) effectively treat many nasal symptoms while a variety of antihistamine eye drops are available for eye symptoms. Immunotherapy is a very effective treatment for allergic rhinitis, allergic conjunctivitis, and asthma. Unlike medications that treat symptoms only, immunotherapy truly modifies the immune system and prevents symptoms from developing in the first place. Immunotherapy is effective in approximately 85% of patients and reduces symptoms, need for medications and may prevent asthma in young children.
How We Can Help
As Columbus's largest and oldest single specialty allergy practice, all of our physicians have expert training in the diagnosis management and treatment of allergic diseases, such as allergic rhinitis and asthma. Dr. Petry and Dr. Singhal will work to develop a comprehensive, personalized and cost effective treatment program designed to alleviate symptoms and improve quality of life.
For more information on this condition, visit:
American College of Allergy, Asthma, and Immunology