ALLERGIC RHINITIS
Allergic rhinitis (allergies, hay fever) is the most common chronic disease of the respiratory tract. Nearly 30% of Americans have some form of nasal/sinus/eye allergies (sometimes it seems like they all live in Kern County!), and for most allergy sufferers the symptoms are mild and short-lived or seasonal. However, some patients can have severe allergy symptoms, often year–round, and these symptoms can make it difficult or impossible for the patient to complete even the most simple daily activities.
A wide variety of substances can trigger allergy symptoms in patients, and for each patient the list is different. Although allergies run in families, not everyone in the same family will be allergic to the same substances. Classic "hay fever" (seasonal allergies) are commonly caused by pollens and grasses, and tend to occur in the spring and/or fall. However, in California, where many plants bloom year-round, even pollen allergies can occur in the winter and summer. Perennial allergies are also commonly due to dusts, molds and animal hair/dander.
Allergic symptoms include: nasal stuffiness and/or clear, watery discharge; itchy, watery eyes; post-nasal drip, often with morning sore throats; hoarse voice; sinus headaches; cough; fatigue; and sometimes wheezing. Allergy patients may have any or all of these symptoms.
Not all patients with allergy-like symptoms will have true allergic rhinitis. Symptoms may be due to sensitivities (pollutants, chemicals, cold), infection, medications/drugs, or obstruction (polyps, deviated nasal septum). If a patient has persistent nasal sinus or eye symptoms, an exam by a physician/nurse practitioner is always in order. Sometimes, lab tests and even allergy skin testing is needed to make the proper diagnosis.
Treatment of allergic rhinitis can take many forms, including:
Avoidance: If you are lucky enough to know what you are allergic to and it can be avoided, do it! Measures such as removal of offending pets, changing air conditioning and heating filters and plastic covers for mattresses and pillows can be helpful in many patients.
Anti-histamines: Many (but not all) allergic symptoms are due to the body’s release of histamine in response to the allergen. Anti-histamines can block the action of histamine in the airway and eyes, and are available both over-the-counter and by prescription. The most common side effect is drowsiness, although several of the newer, much more expensive prescription antihistamines (Claritin, Allegra, Zyrtec and others) cause little or no sedation. Nasal cortisone sprays: Cortisones block the allergic response before the cells release their histamines (the equivalent of the "keeping the horses in the barn" approach). The nasal spray cortisones can be quite beneficial with minimal side effects, but usually take some time (about 2 weeks commonly) to reach full effectiveness.
Nasal Cortisone sprays: Cortisones block the allergic response before the cells release their histamine and other allergy mediators. The nasal spray cortisones can be quite beneficial with minimal side effects, but usually take some time (about 1-2 weeks commonly) to reach full effectiveness.
Montelukast (Singulair): Singulair is a once daily (at bedtime) pill that blocks the inflammatory response associated with allergies. It is quite beneficial in asthma.
Immunotherapy (allergy shots): Some, but not all, severe allergy patients benefit from desensitization shots. However, shots are expensive, and often require 1-2 injections per week for years.
CSUB Student Health Services: (661) 654-2394 mjh 8/92, revised 2005