Allergic rhinitis can either be seasonal or perennial.

Seasonal rhinitis is due to the presence of plant pollens in the outdoor air.  The plants in bloom are responsible for the pollen and symptoms it causes.  The predominant seasonal antigens are three pollen (February – April), grass pollen (April – August), and wee pollen (September – October).  Flowers are usually not the culprits because they are pollinated by insects such as bees.

Perennial rhinitis is caused by allergens that are present in the air year round.  Examples of such allergens are dust mites, molds, animal dander and, in the years with no freezing winter temperatures, grass pollens.

Typical symptoms of allergic rhinitis include itchy watery eyes, sneezing, runny nose, nasal itching, congestion, post nasal drip, headaches, dry cough, ear fullness and ringing, decreased sense of smell, taste and fatigue.  Many people feel their symptoms are due to “sinus problems” or a “cold”.  Sinus infections and colds tend to be associated with fever and yellow to green mucous whereas allergic rhinitis is associated with clear mucous and tends to occur repeatedly throughout the year.  Other findings one might see are dark circles under the eyes called allergic shiners, and a crease across the top of the nose due to chronic nasal rubbing.  People with allergic rhinitis also tend to have bad breath due to the postnasal drip.  Common complications due to untreated allergic rhinitis include sinusitis, nasal polyps, and otitis media.

Allergic rhinitis responds to medical treatment and allergy shots.  The medications commonly used include antihistamines, decongestants, and steroid sprays.

Effective means of controlling allergic rhinitis include:

• Avoidance of allergens
• Medications
• Allergy shots

Allergic diseases occur in people who are genetically predisposed and have had prior exposure to an environmental antigen.  Antigens, or allergens, are usually protein molecules that are produced by plants or animals.  Common allergens include pet dander, plant pollens, insect droppings and insect venom.  Antigen exposure in genetically predisposed people, results in sensitization and eventually allergic symptoms.  Allergic symptoms include nasal congestion, sneezing, runny nose, itchy watery eyes, chest tightness, wheezing and shortness of breath, skin rashes and gastrointestinal complaints.  Food allergies are more common in children and can be severe.  Symptoms of food allergy can be as mild as nausea, vomiting, diarrhea and skin rashes or as severe as asthma and anaphylactic shock.

Most allergies individuals have family members who also have allergies.  If one parent has allergies, each child has a fifty percent chance of having allergies.  If both parents have allergies, each child has a seventy five percent chance of having allergies.  Children who develop skin problems (Eczema) at an early age are at a higher risk of developing allergic rhinitis and asthma as they grow up.  Early diagnosis and treatment can prevent development of asthma in children.  Allergy symptoms, and some of the medications used to treat allergies, can impair a child’s performance in school and an adult’s performance at work.

People who have developed sensitivities to environmental antigens (such as weed pollen, cat, dust mite, etc.) will have allergic reactions when they are exposed.  Reactions start within minutes of exposure and will continue until you treat the symptoms and avoid the causative antigen.  Allergic reactions have two phases, the first starting with the mast cells in your body releasing histamine.  Histamine dilates the blood vessels.  Dilating the blood vessels allows fluid to leak out of the blood into the tissue.  Leakage of fluid into the tissues causes swelling and increased mucous production in mucous membranes.

The second phase is triggered by histamine and other mediators recruiting inflammatory cells (T cells and others) into the local area.  Once enough inflammatory cells are present in the local area, these cells begin producing hormone like molecules called cytokines.  Cytokines allow the inflammatory cells to communicate with each other and perpetuate the inflammatory response.  It is this self-perpetuating inflammatory response which is responsible for the inability of antihistamines and decongestants to maintain long term control of allergic symptoms.  Anti-inflammatory medications are necessary to turn off the second phase of the allergic response.

Common allergic diseases are allergic rhinitis, asthma, urticaria, anaphylaxis, allergic eczema, and food allergies.

There are three ways to treat allergic problems: avoidance, medication and immunotherapy.

Avoidance

Avoidance of the things that cause your allergies is a very effective means of alleviating allergy symptoms.  However, this is not always possible.

Implementing environmental control measures can reduce your exposures thereby reducing your symptoms.

Allergic patients who respond well to environmental control are those typically allergic to dust mites, pets and mold.

Medication

There are two general categories of medications; those that relieve symptoms and those that prevent symptoms.  Medications are often available in pill form (systemic) or topical (local).  Systemic medications (pills, syrups or injections) are delivered by the bloodstream to the entire body.

Local medication (nasal sprays, eye drops, inhalers, lotions and creams) are applied directly to the area involved in the allergic reaction.  Generally speaking, local medications have fewer side effects than systemic medication.

Medications that are made to relieve symptoms include antihistamines and decongestants for allergic rhinitis, and bronchodilators (inhalers) for asthmatics.  Preventative medications are the anti-inflammatory steroids (topical and systemic).

Immunotherapy

Immunotherapy is a means of retraining your immune system to no longer react to the things you are allergic to.

The response to immunotherapy varies depending on your age, and the allergens to which you react.  People under the age of twenty years old respond more favorably (80-90% with remarkable improvement).  Individuals over the age of fifty five are less likely to respond (50%).

People who are allergic to dust mite, pet and pollen allergens respond better to immunotherapy than mold allergic individuals.  Food allergies do not respond to immunotherapy.  The only treatment for food allergy is avoidance.