Allergic rhinitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 29, 2016
StartDiseasesAllergic rhinitis

In the United States alone, researchers estimate over 24 million people suffer with allergies affecting the nose. The most recognizable allergic condition is allergic rhinitis, also known as hay fever or simply allergies.


Definition & Facts

Allergic rhinitis describes a group of symptoms affecting the nasal cavity when a person breathes in an allergen. The normal immune system sees these substances as harmless and ignores them. However, in people with overreacting immune systems, the allergen enters the nasal cavity and the body recognizes it as a foreign substance. It attacks the allergen by producing a substance called histamine. The resulting battle between the allergen and the immune system creates unpleasant symptoms.

Symptoms & Complaints

While the term rhinitis refers primarily to an inflammation of the nose, allergic responses vary in severity. Allergy sufferers commonly complain of sneezing, itchy eyes, and a runny nose. These symptoms are likely to occur soon after contact with the allergen. However, some reactions also affect the ears, eyes, throat and roof of the mouth.

Nasal secretions can build up in the ears and nose, causing sinus and ear infections. This often causes drainage and frequent coughing. If the immune system rages long enough, rashes on the skin such as hives or eczema are also possible.

Some people overlook such symptoms as headaches, dark circles under eyes and extreme fatigue. These types of reactions are more likely to occur later than the immediate exposure. If a food or medication introduced the allergen, anaphylaxis is possible. This is a severe reaction which can cause the throat to swell and limit breathing to the point of death.


People with a family history of allergies are more prone to allergic rhinitis. Common allergens that induce symptoms are pollen, mold, pet dander, dust and grass. If pollen is the only irritant which produces a reaction, a person’s allergies may only affect him seasonally. Molds are particularly difficult to identify since they are not always visible. Often a mold is not discovered until toxic byproducts form in a moist environment and become visible.

Food allergies are more complex. Some foods and medications are relatively new to the food supply and may not be recognizable to the body, triggering the same types of reactions as a harmless natural substance does.

Researchers cannot pinpoint exactly why one person suffers with allergies and another does not, but certain conditions do seem to trigger allergies and exacerbate symptoms. An environment containing many chemicals, perfumes, cigarette smoke or fumes increases the risk factors for allergies significantly.

Diagnosis & Tests

Doctors diagnose most cases of allergic rhinitis with a simple review of symptoms. A trained medical professional can spot the correlation between a person’s environment and their symptoms especially when the reactions occur seasonally. However, a doctor may order diagnostic aids such as skin testing or blood tests.

In skin testing, the most common tool used, the medical provider injects possible allergic substances into the skin and watches for a reaction over a short period of time. If the allergies are very severe and skin testing is not advisable, lab tests such as a CBC (complete blood count) or an IgE RAST test can identify allergic responses in the blood.

The RAST test measures the ratio of immunoglobin E antibodies and different allergens in the blood. When concentrations are high, a person is likely allergic to those substances. If treatments are not effective or symptoms are very severe, a doctor may order additional tests such as imaging tests to check for inflammation, structural defects or even cancer. Endoscopy can find polyps in the nose which may be blocking the nasal cavity.

Treatment & Therapy

Symptom management is the main treatment for allergic rhinitis. Cleaning out the nasal passages can be effective for flushing out allergens and treating mild symptoms. More often, allergy sufferers use over-the-counter medications to reduce histamine or decrease congestion. Doctors prescribe medications for more severe allergies, but they are typically just stronger antihistamines or decongestants.

The most effective prescription symptom management is a nasal spray corticosteroid. These generally must be used preventively to work effectively. Immunotherapy is another option gaining in popularity. This is a process which reduces the allergy response over time by exposing the patient to small amounts of the allergen in pill form or by way of a shot. The aim is to help the body get used to the substance so it no longer recognizes the allergen as a foreign invader in need of attack.

In rare cases, a person’s nose or sinuses may need surgical intervention to make allergy treatments more effective. However, surgery should truly be a last resort and not considered a curative procedure. Natural remedies are gaining in popularity as well. While these have yet to be fully proven, anecdotal accounts of reducing or eliminating symptoms through remedies such as local raw honey, herbs, and probiotics abound.

Prevention & Prophylaxis

The most obvious way to prevent allergic rhinitis is to avoid allergens. In cases where pollen is an irritant, a person is often able to stay in an air-conditioned building during the height of its season and escape allergic reactions. Careful attention to cleaning can lessen reactions to dust and mold.

Restricting pets from the home and staying away from close contact with other animals is necessary for those with allergies to pet dander. While many would do well to reduce the chemical burden in their environments, it is an essential component in the lifestyle of a person suffering from allergic rhinitis.

Other preventive measures are medications taken before the allergy symptoms occur. Those in favor of less intervention suggest that altering the diet can shift the immune system to avoid allergies entirely.