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Allergic rhinitis

What it is Allergic rhinitis

Allergic rhinitis is the medical term for “hayfever”. Technically, allergic rhinitis refers to a local allergic reaction in the nose. Hayfever is a symptom complex including a local allergic reaction in the nose, throat, and eye areas. Hayfever can be seasonal or perennial (occurring all year). Seasonal hayfever is caused by the wind-borne pollens of grass, trees, and weeds. During April and May, the pollen is from trees. Late May through mid-July, the pollen is from grass. From late August all the way through to the first frost, ragweed pollen is the culprit. Perennial hayfever is caused by allergens that are present in the daily environment such as dust mites, feathers, animal dander, and mold spores.

Allergic rhinitis symptoms

The symptoms of hayfever include sneezing, watery, profuse nasal discharge, nasal congestion, and itching of the nose, throat, and palate. Other symptoms include cough or throat clearing, snoring, and a popping sensation in the ears. Itching, redness, and tearing of the eyes may also occur.

You may also note particular mannerisms such as wrinkling of the nose (rabbit nose) or an upward rubbing of the nose (the salute sign). Many children who are chronically congested from nasal allergies will mouth breathe.

Fever is not associated with hayfever. If your child has fever, and is complaining of headache or facial pain, especially if the pain is in the forehead or around the eyes, you should see your child’s physician. These are signs of a sinusitis. A sinus infection can be a complication of allergic rhinitis due to the inflammation in the nasal passageways. Sinus infections should be treated with antibiotics.

Treatment

1. Avoidance of allergens

For seasonal allergies:

When in the car, keep the windows closed and the air-conditioner on Stay indoors when the pollen count is highIf your home has air-conditioning, keep the windows closed and the AC onIf your home does not have air-conditioning, consider getting a window AC for the bedroom of your child

For perennial allergies:

Avoid feather pillowsCover pillows and mattresses with plastic coversArea rugs are preferable to wall-to-wall carpeting, keep all carpets vacuumed Wash stuffed animals once a weekHEPA filters will help with animal dander, pollen and smoke, but will not help with dust mites or mold sporesAvoid allowing your children to play in a moldy basementWash moldy basement walls with a 1:10 dilution of household bleachUse a dehumidifier in the basement if neededHave your dogs and cats groomed every couple of months

2. Medications

Many medications are available to treat the symptoms of allergic rhinitis. There are oral medications that are available over-the counter as well as by prescription. Antihistamines are the main ingredient used to alleviate hayfever symptoms, although in many cases nasal congestion is so bothersome that using a medication with a decongestant is helpful. The most common side effect of antihistamine medications is sleepiness. There are several new non-sedating antihistamines now available by prescription and should be strongly considered in children who require daily therapy because drowsiness can interfere with learning.

Nasal sprays and eye drops are also used. Below is a list of some commonly used medications in each category. This list is by no means exhaustive, and this site does not endorse or favor any specific commercial product mentioned. Brand names are used only because they are considered essential in the context of the information reported herein.

Oral over-the-counter medications:

  • Antihistamines
  • diphenhydramine–in Benadryl, Tylenol Allergy Sinus, Unisom and others
  • chlorpheniramine–in Actifed, Alka-Seltzer Plus products, Chlor-Trimeton
  • Allergy, PediaCare products, Triaminic products and others
  • clemastine fumarate–in Tavist products

Oral prescription medications:

  • Antihistamines
  • fexofenadine–in Allegra (non-sedating)
  • brompheniramine–in Bromfed
  • hydroxyzine–in Atarax
  • loratadine–in Claritin (non-sedating)
  • cetirizine–in Zyrtec

Steroid nasal sprays:

Steroid nasal sprays are very effective in alleviating the nasal symptoms of allergic rhinitis. These are considered local therapy with very little systemic absorption, therefore extremely unlikely to cause the side effects seen with the use of oral steroids. The complications of nasal steroid sprays include local burning, irritation, and nasal bleeding.

  • beclomethasone–in Beconase, Vancenase
  • budesonide–in Rhinocort
  • flunisolide–in Nasalide
  • fluticasone–in Flonase
  • mometasone–in Nasonex

Mast Cell Stabilizer nasal sprays:

The mast cell stabilizer nasal sprays are used as preventive medications. They act by preventing the mast cells from bursting open and spilling out histamine and other mediators of hayfever when an allergen such as tree pollen comes into the nasal passageways. Because these are a preventive medications, they need to be used on a daily basis to be effective.

cromolyn sodium–in Nasalcrom

Eye drops:

  • Eye drops containing antihistamines are very effective for people who suffer from itchy, watery eyes as part of their hayfever symptoms.
  • olopatadine–in Patanol (prescription only)
  • cromolyn sodium–in Crolom ophthalmic solution (prescription only)
  • pheniramine–in Naphcon A (over-the-counter)
  • pheniramine–in Visine-A

Over-the-counter nose drops or sprays that contain phenylephrine such as Neo-synephrine or Afrin should be avoided except for short-term use–no longer than 3 days. If these medications are used for a prolonged time, they can result in the worsening of symptoms.