Ah, the beauty of spring.
Grass, flowers, trees, warm weather, late sunsets…and, for many of us, sneezing, itching and runny eyes. Whether you call it hay fever or allergic rhinitis, the seasonal attack on our immune systems is ready to launch.
Allergic rhinitis (AR) affects one in five of us. It is characterized by cold-like upper respiratory symptoms, particularly a runny nose, congestion, sneezing and swollen eyes. The condition is related to exposure to environmental proteins called allergens, which may be related to dust mites, mold spores, animal dander or pollen from trees and grasses. In sensitive patients, these allergens cause the body to release chemicals, including histamine. Depending upon an individual’s immune sensitivity, symptoms may be year round, or season-specific.
Sometimes it is difficult to differentiate AR from a common cold. Clues to the correct diagnosis include type of nasal discharge (AR thin and watery, common cold thick and yellow), onset (AR after exposure to allergens and common cold during an outbreak), and duration (AR may last a season or be continuous, common cold no longer than a week).
Patients with hay fever (AR caused by outdoor allergens) may notice their symptoms vary daily-this is likely in response to the amount of pollen in the air. Hot, dry and windy days are associated with an increased pollen count; cool, damp rainy days have lower counts.
A visit to your primary care physician can help establish the diagnosis. (S)he will ask several questions, including a query about other allergy related disorders such as asthma and eczema. If there is a suspicion of an allergic condition, the first step is to see if the patient can decrease the amount of allergen they are exposed to. This may be practical in indoor related situations related to pets or dust mites, but not so in cases of outdoor allergens.
The first line of therapy depends on the most prominent symptoms. Antihistamines have a long track record of safety and efficacy; more recently nasally inhaled steroids have played an important role in treating nasal symptoms.
In more severe cases, referral to an allergist may be warranted. This specialist in immune system function may test for the specific cause of AR through blood tests and/or skin testing. The latter consists of a series of “skin pricks” where the patient is exposed to small amount of allergen to see if there is an immediate reaction. If all other treatments fail, immunotherapy (or allergy shots) may be attempted over a 3-5 year period in an attempt to control the disease.
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