Symptoms of allergic rhinitis are:
- thin mucous production/runny nose
- post nasal drip
- itchy/watery eyes
- nasal congestion
Typically allergic rhinitis symptoms come and go throughout the year depending on what you are allergic to, but can also be year round.
The first line treatment of allergic rhinitis are environmental controls to avoid exposure to allergens. This can include things like dust covers for bedding or a high efficient air filter (HEPA).
Second line treatments are medications to control your body’s response to allergens. Oral antihistamines are the most common medications used for this (ZyrtecⓇ, AllegraⓇ, ClaritinⓇ, BenadrylⓇ, etc.). These medications work by blocking histamine which is the primary mediator of inflammation in allergic responses. Leukotriene inhibitors are another class of medications (Singulair) that block another cause of inflammation in allergic patients. There effect is not as stong as antihistamines and are typically used in patients with asthma in addition to allergies.
Nasal steroids sprays (FlonaseⓇ, NasocortⓇ, NasonexⓇ, etc. ) are safe to use on a daily basis and are now largely over the counter. These sprays are non addictive and typically do not cause any long term changes to the nasal passages. Their most common side effect is nose bleeds which occur only in a small % of patients and often are due to improper spraying technique. Recent evidence has also shown that these sprays may increase the pressure inside of the eye and should be used with caution in patients with glaucoma.
Nasal antihistamine sprays (AstelineⓇ, PatanaseⓇ, DymistaⓇ, etc) are also safe to use on a daily basis and work by blocking the effects of allergens in the nasal lining. These sprays are most effective at improving sneezing and runny nose.
What if medications for allergies do not work?
For patients with moderate to severe allergies who do not respond to allergy medications an option is immunotherapy. Immunotherapy works by desensitizing your immune system to certain allergens (think pollens, dust, animal dander) by continually exposing you to those allergens. This sounds simple, but must be done is a very specific fashion and concentrations built up over time to have an effect.
The first step of immunotherapy is allergy skin testing – this is where small amounts of the most common allergens in our area are injected just under the skin to determine what you are allergic to and how severe is your reaction.
Once it is know what exactly you are allergic to, these allergens are either injected under your skin on a weekly basis (subcutaneous immunotherapy or SCIT) or made into drops to place under your tongue daily (sublingual immunotherapy or SLIT). Again, the concentrations are specifically controlled to each patient’s allergic reactions.
Immunotherapy is an advantageous form of treatment because after 3-5yrs of treatment, symptom control is often permanent.