Many children and adults are affected by hay fever in the spring and summer months, when plants grow and bloom. Hay fever is caused by higher amounts of pollen in the air. A lot of people who have allergies and asthma have more asthma attacks around this time of year too.
If someone has an allergic reaction to substances such as pollen or animal fur and it affects their upper respiratory tract (upper airways), it is called “allergic rhinitis."
People who have allergic rhinitis sneeze a lot and have a runny or stuffy nose. If their symptoms are more severe, they might also feel weak and tired. Sometimes people have watery and itchy eyes too, and their eyelids become swollen. The medical term for this is allergic rhinoconjunctivitis (allergic rhinitis combined with conjunctivitis). Further possible hay fever symptoms include itching and asthma symptoms like coughing, wheezing and shortness of breath.
Causes and risk factors
Allergy symptoms arise when your body overreacts to particular substances that are usually harmless, such as pollen. These substances (allergens) trigger a chain reaction in the immune system. First, antibodies to the allergen are made, and they bind to specific cells. If these cells come into contact with the allergen again, they are then able to “respond” by releasing chemical substances, including a substance known as histamine. These substances then lead to allergic reactions such as sneezing, coughing and skin rashes.
Allergic rhinitis can be triggered by things like dust mites, animal fur, pollen and mold.
Sometimes a higher risk of allergies runs in families. Environmental factors such as air pollution and cigarette smoke can make allergies more likely too.
Allergies are quite common nowadays. This may be partly due to higher standards of hygiene and the fact that some infections have become less common in childhood. As a result, our immune systems are often not as “well trained” as they might have been in the past.
Prevalence and outlook
Allergic rhinitis affects about 1 out of 4 people in industrialized countries like Germany. It usually first arises before the age of 20.
Allergic rhinitis might develop into allergic asthma after several years. Sometimes people who are allergic to pollen, for instance, become allergic to certain foods too after a while. This is known as cross-reactivity.
Severe symptoms may increase the likelihood of developing other medical conditions such as sinusitis (inflammation of the sinuses). Allergic rhinitis makes mucous membranes overly sensitive in a lot of people too. As a result, their nose reacts more strongly to irritants like dry air in heated rooms and cigarette smoke.
If you see a doctor, he or she will first ask you about your symptoms, everyday life, and medical history. The doctor can then do a skin prick test to find out whether you are allergic to particular substances. This involves placing small drops of various allergens on the skin of your forearm, leaving enough space between them, and then pricking the surface of your skin where the allergens are, so the substances go into the skin. If the skin becomes red and swollen, like a big mosquito bite, it’s a sign that you’re allergic to that substance.
You might also need a blood test or something known as a nasal provocation test. This is where the membranes lining the nose are exposed to extracts of the potential allergen using a nasal spray or drops. If the lining of your nose becomes swollen, you sneeze and your nose starts running, you are likely to have allergic rhinitis.
The most effective way to prevent allergy symptoms is to avoid the substances that trigger the allergy. How well this works will mainly depend on the type of trigger. It’s quite easy to avoid contact with things like animal fur or chemical substances. But it’s almost impossible to avoid pollen. If you’re allergic to dust mites, it may be helpful to combine a number of different approaches: wiping the bedroom floor with a damp cloth, using mite-proof mattress covers, removing “dust traps” such as upholstered furniture and curtains, and regularly washing your bedding at temperatures above 55°C (130°F). But it isn’t possible to completely avoid contact with dust mites.
Various medications are available for the treatment of the symptoms:
- Steroids (corticosteroids)
- Leukotriene receptor antagonists
- Decongestant nasal drops and sprays
There are also non-drug alternatives such as saline (salt water) nasal sprays and nasal washes (nasal irrigation).
Allergen-specific immunotherapy (also known as desensitization) can reduce your sensitivity to allergens over the long term. Like with vaccines, this treatment approach involves exposing people to small amounts of the allergen. Here it is done at regular intervals by either injecting the allergen into your skin or placing it under your tongue. Allergen-specific immunotherapy takes about three years to complete.
Sometimes surgery is done too, to make it easier to breathe through your nose – for instance, if the symptoms are very severe and medication or other treatment approaches aren’t effective enough. Surgery doesn’t make the allergy go away, though.
Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 2010; 126(3): 466-476.
Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet 2011; 378(9809): 2112-2122.
Sheikh A, Panesar SS, Salvilla S, Dhami S. Hay fever in adolescents and adults. BMJ Clin Evid 2009.
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