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Allergies

Allergic Rhinitis (Hay Fever)

Do you suffer from headaches, runny nose, and itching eyes? These symptoms may be the result of allergic rhinitis, or hay fever, an allergy that affects nearly 60 million people in the United States.

Mold spores, house dust mites, and grass and ragweed pollens can be present in the air we breathe. If a person who is sensitive to these particles - known as allergens - inhales them, they can trigger mucous membranes to swell in the eyes, ears, nose, throat, and sinuses. Allergic rhinitis occurs when a person becomes overly sensitive to allergens like these, a process that can take months or years. When a person is sensitized, this causes production of the allergic antibody, Immunoglobulin E (IgE), which is made specifically in response to each allergen.

Symptoms
Allergic rhinitis symptoms may include a runny nose, sneezing, and itching of the eyes, ears, nose, or throat. Other symptoms may include tearing of the eyes, nasal swelling, sinus headaches, and sinus infections. Allergic rhinitis is seasonal if symptoms occur during pollination periods in the spring, summer, or fall. When allergic rhinitis symptoms occur on a year round basis, they are known as perennial. In Cincinnati, tree pollens are spread in early March through April. Grass pollens are encountered from mid-May through June and ragweed pollens are found from mid-August through the first frost in early October. Some allergens responsible for year round rhinitis include dust mites, molds, and animal proteins.
Diagnosis
The evaluation and diagnosis of allergic rhinitis begins with a careful discussion of your past experiences (history) and physical examination by your health care provider. The history is directed toward the nature of the symptoms, the time of year they are worst and the triggers for symptoms. Skin testing with allergen solutions can confirm the suspected allergic factors. Skin testing should correlate with the patient's history of symptoms. These tests will be explained and administered by a trained allergy nurse. Local swelling and itching at the skin test site usually indicates that an allergic antibody is present in relation to the substance being tested.
Treatment
There is good news for people who suffer from the symptoms of allergic rhinitis. Doctors can treat this condition with a three-step approach:

  1. Avoidance -- If perennial allergens such as dust mites, animals, cockroach, and mold cause your allergic rhinitis, your health care provider may recommend that you avoid these allergens.

  2. Drug Therapy - There are hundreds of antihistamines and decongestants available over-the-counter or by prescription. Over the counter drugs include antihistamines (i.e. loratadine, Alavert, Claritin, benadryl, Chlor-trimeton), decongestants (i.e. pseudoephedrine), eye drops (naphazoline) and nose sprays such as cromolyn sodium (Nasalcrom).

    Prescription drugs include nasal corticosteroids (Beconase, Vancenase, Nasalide, Flonase, Nasonex, Nasalcort AQ and Rhinocort, topical antihistamines (Astelin), leukotriene modifying agents (Singulair), a number of eye drops and other low- or non-sedating antihistamines.

    All of these medications if prescribed appropriately and used properly can be effective in relieving symptoms. A suitable drug regimen will be recommended for you according to the severity of your symptoms while minimizing adverse side effects.
  3. Allergy Injections - These are used when avoidance and medications are not completely effective, do not work or cause intolerable side effects and/or symptoms are present several months out of the year. These injections may help reduce allergic symptoms and medication requirements. About 85% of people who receive allergy injections have improvement in their symptoms.

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Last Reviewed: Oct 19, 2010

David I Bernstein, MD David I Bernstein, MD
Professor of Medicine
College of Medicine
University of Cincinnati

I Leonard Bernstein, MD I Leonard Bernstein, MD
Clinical Professor Emeritus
College of Medicine
University of Cincinnati

Jonathan   Bernstein, MD Jonathan Bernstein, MD
Associate Professor of Medicine
College of Medicine
University of Cincinnati