Ask a Doctor: Allergic Rhinitis

Introducing: Ask a Doctor

At UTHSC ENT, we understand that patients need clear, helpful answers to their questions. We also know that a flood of new information can be overwhelming.

That’s why our department’s introducing Ask a Doctor: an ongoing series of posts that tackle Frequently Asked Questions about common issues. We hope these articles give you a better understanding of your situation and an easy path to treatment.

Today, we discuss a common problem, especially in the mid-south: allergic rhinitis.

Prepared by: Patrick Williamson
Reviewed by: Dr. Sanjeet Rangarajan

What is allergic rhinitis?

Allergic rhinitis is the activation of the body’s immune system in response to contact with an allergen. An allergen is defined as any substance that can cause someone to experience an allergic reaction. Often allergens are common inhaled substances such as pollen, dust mites, or animal dander, and the exact allergen can vary from person to person.

When you come into contact with an allergen, your immune system mistakes the substance as harmful and overreacts to defend against it. This hypersensitive immune response produces natural chemicals such as histamine, which lead to inflammation.

In fact, the word “rhinitis” refers to inflammation of the nasal passages. Histamine release and inflammation result in an allergic reaction that causes a variety of symptoms, such as nasal congestion, runny nose, and sneeze, among others.

What are its symptoms?

Allergic rhinitis symptoms vary from person to person. Many people experience symptoms that not only affect their nose (nasal), but also their eyes, ears, throat, and ability to sleep (non-nasal).

Common symptoms of allergic rhinitis include:

• Nose: Sneezing, runny nose, itchy nose, congestion
• Eyes: Itchy or red eyes
• Ears: Popping or congestion of the ears
• Throat: Sore throat, hoarseness or itching of the throat
• Sleep: Difficulty breathing at night, which can lead to tiredness and daytime fatigue
• Other: Headache, facial pressure

What simple solutions can I try at home?

Lifestyle modifications:
Allergen avoidance is one primary way to help control the symptoms of allergic rhinitis (see “Treatment”). This begins identifying those allergens that are specific to the patient. Once the patient’s specificities have been identified, a plan can be put in place to help control the both the patient’s environment and reduce allergen exposure. Similarly, practicing good hygiene can also help reduce the symptoms of allergic rhinitis. Periodically washing your hands and avoiding touching your face, nose, or eyes can prevent exposure to triggers and allergens.

Nasal irrigation:
Nasal irrigation involves rinsing the nose with salt water solution and can help remove mucus from the nose. This can be done with a variety of devices including Neti pots. Nasal irrigation can improve mucus flow and remove allergens and irritants from the nasal cavities and sinuses, which can improve symptoms. Saline nasal sprays are also available; however, they are not as effective as higher volume rinses. Your doctor may decide to recommend that special medications be added to your rinses to help achieve an improvement in your symptoms.

When should I see my doctor?

Allergic rhinitis causes symptoms that may be similar to other respiratory diseases like the flu or the cold.

Contact your provider if you experience any of the following:

• Severe symptoms such as difficulty breathing
• Treatment that once worked for you no longer works
• Symptoms are not responding to treatment

How will my doctor know I have allergic rhinitis?

Your doctor can diagnose allergic rhinitis in their office with a medical history and physical exam. This will include reviewing your symptoms and looking for characteristic physical changes that accompany allergic rhinitis.

Common symptoms review questions can include the following:

• Remembering where you were and what you were doing when the symptoms began?
• Recalling the time of year where you noticed symptoms?
• Noticing anything about your home and work environments that you may be allergic to?

Allergy testing can confirm the diagnosis and help to identify your specific triggers. Skin testing may be suggested if the cause of your symptoms is not clear. Skin testing is done by an Allergist and involves putting small amounts of different potential allergens in your skin and seeing if any result in a reaction.

Also, nasal endoscopy is a special procedure where a small, flexible telescope is inserted into your nose to examine your nasal and sinus passages. Your doctor may be able to determine if allergies are affecting your nose/sinuses with this procedure.

What are my treatment options?

Treatment of allergic rhinitis includes trying to avoid the allergens that cause your symptoms. Providing a detailed history or undergoing skin testing can help you and your doctor identify troublesome allergens.

Reducing exposure can be through regular washing of bedding, adequate household cleaning, and avoidance of pets can help control symptoms. If it is impossible to avoid the allergen all together, it is still important to try to take steps to reduce exposure, such as using air-conditioning instead of open air during pollen season.

It is common to be prescribed medication to help treat allergic rhinitis. The medicine that your doctor prescribes will depend on several factors, including the symptoms you are experiencing, how severe they are, your age, and if you have other medical conditions such as asthma.

Medical treatment for allergic rhinitis includes:

Corticosteroids: nasal steroid sprays have been shown to reduce symptoms of allergic rhinitis. Some sprays are available over the counter and readily available in your local pharmacy. It is important to talk to your doctor before using these because it may worsen conditions like diabetes, uncontrolled hypertension, and peptic ulcer disease, among others.

Antihistamines: these medications can help relieve itching, sneezing, and runny nose of allergic rhinitis, but they do not relieve nasal congestion. Using them along with nasal steroids may provide the greater relief than using antihistamine medications alone.

Allergy shots: also known as “allergen immunotherapy,” are only available for common allergens, including pollens, animal dander, dust mites, and some molds. These shots adjust your immune response to the allergens over time. As a result, being exposed to the allergen causes fewer symptoms and may even eliminate symptoms altogether.

In addition to medical treatments, there are many new treatments and clinical trials on going which you may be eligible for.

The best treatment(s) will depend on your symptoms and personal preferences. At UTHSC, we strive to develop a personalized treatment plan for each patient we meet.

How can our Dream Team help?

UTHSC ENT’s Dream Team provides world class treatment in your hometown, and we’re only a call away!

Dr. Rangarajan and Dr. Sansoni are the only fellowship-trained sinus specialists in the area. If you experience allergy issues, they should be your first call!

We’d love to hear from you: (901) 866-8384