What is Allergic Rhinitis?
Nearly one in five Australians suffer from allergic rhinitis - that is almost 4.5 million people Chances are that you or someone you know suffers from this troublesome condition.
Allergic rhinitis occurs when something from the environment that we are sensitive to - an “allergen” - comes into contact with your eyes or nose. Normally your body recognises these substances as harmless, however, in the case of allergic rhinitis your body will see this substance as an irritant and will trigger inflammation. We experience this inflammation as allergic symptoms such as itchy and watery eyes, a runny nose, or sneezing. Depending on the allergen, you may have seasonal allergic rhinitis (from pollens and grass), or persistent allergic rhinitis (from dust mites and animal hairs).
Untreated allergic rhinitis can lead to complications such as headaches, sleep disturbance and excessive daytime tiredness, poor concentration, recurrent ear and sinus infections as well as poorer asthma control. If you experience any of these symptoms, your GP can assist you in making the diagnosis and starting treatment.
What Tests Are Available?
Many tests are available and easy to access with the help of your doctor. They can look for individual triggers that you may be sensitive to such as house dust mites, animal dander, mould spores, pollen, grass, trees, foods, insects and some medicines.
The two main ways of testing are either a skin prick test or a blood test, which can show which allergens your body is reacting to. Both of these tests are covered by a Medicare rebate.. Occasionally, you may be referred to a clinical immunologist for further testing.
Skin Prick Test
In skin prick testing a small prick is made into the skin to allow a very small amount of an allergen to enter. The skin prick is normally performed somewhere inconspicuous such as your forearm or back. If you are sensitive to the allergen, a small red and itchy lump will appear around the pricked site within 20 minutes. This will normally resolve in 1-2 hours. A severe reaction from skin prick testing is very rare.
Allergen Specific Blood Test
Blood tests are another option for diagnosis that is readily available. These tests are quick and convenient and can be used in situations where skin prick testing is impractical or has failed.
The blood tests will look for a certain type of antibody produced during an allergic process. This antibody is called “IgE”, and if your levels of IgE are high, it may indicate that you suffer from allergies. We can now look for specific subtypes of IgE which allows us to differentiate exactly which allergen your body is reacting to.
How Can We Treat Allergic Rhinitis?
Many strategies are available for the treatment of allergic rhinitis – and most are available over the counter or with a prescription from your GP. In more severe cases you may be required to be referred to an immunologist who can organise immunotherapy.
Once you have identified what allergen is causing your symptoms it is important to do your best to minimise exposure to it. For example if you are allergic to dust, you may want to avoid working in a dusty environment and regularly vacuum your home.
For practical advice on how to minimise exposure to various allergens, see here.
There are many medications available. There are three main groups – antihistamines, anti-inflammatory medications (corticosteroids), decongestants, or some combination of these. These medications are generally available as tablets, nasal sprays or eye drops.
- Antihistamines work to stop a cellular signal in your body for allergy – histamine - which often causes symptoms of runny and itchy nose, watery eyes and sneezing. Using an antihistamine can relieve these symptoms quickly.
- Antihistamines come in many forms including tablets, syrups, nasal sprays and eye drops. They can be used on an as needed basis, such as for seasonal allergic rhinitis. Antihistamine tablets may cause drowsiness, although non-drowsy preparations available.
- Intranasal corticosteroid sprays: Corticosteroids are potent anti-inflammatory medications. For allergic rhinitis we often spray this medicine directly where the symptoms are taking place – into the nose. The sprays reduce inflammation inside the nose – leading to clearer breathing and a less runny nose. Corticosteroid sprays need to be used regularly for their best effect. As the sprays are used directly on the part of the body as needed, their effect to the rest of the body is minimal.
- Antihistamine and corticosteroid nasal sprays: Combination sprays are available if one type of medication is not effective in controlling your symptoms.
- Decongestants: Decongestants are quick acting medicines which rapidly relieve the symptoms of allergy. These most often come as nasal sprays or tablets. These medicines are quick acting and potent, however, they should not be used for longer than a few days at a time as they may have a rebound effect when you stop using it.
These medications are not recommended to those who are pregnant or have high blood pressure, glaucoma and thyroid disease due to their side effects. Decongestants are a good short-term measure for symptom control; however, if you find you need them very often please speak to your GP about achieving better long-term control.
Nasal Spray Technique
It is our experience that many patients find nasal sprays to be ineffective. More often than not this is due to poor technique as nasal sprays can be difficult to use well. There are many resources available (see here ), but if you are still unsure your GP can help you check you are using it correctly.
Immunotherapy is reserved for those who have severe symptoms which cannot be controlled with simple measures. Immunotherapy is a long term treatment in which your body is progressively desensitised to an allergen. A small amount of allergen is given to you regularly, either by injections, tablets or drops under the tongue. The amount of allergen taken is incrementally increased until your body develops a tolerance to it, and no longer reacts to it with an allergic response. Allergen immunotherapy is not to be undertaken lightly as treatment duration can last up to 5 years. Your GP can refer you to an immunologist for consideration of this treatment method if you think you may benefit from it.