Allergic Rhinitis is a chronic illness that occurs as a result of a set of reactions that the nasal mucus membrane has when exposed to certain external agents; this causes nasal hyperactivity that affects both the eyes and the nose and leads to common allergic rhinitis symptoms.
These reactions are the body’s principal defense mechanism against the IgE antibodies. Also known as Immunoglobulin E, IgE antibodies stimulate the release of chemical mediators in the cells that have the predisposition to certain antigens that balance infections.
Meanwhile, the antigens or immunoglobulins (Ig) are toxic substances that produce antibodies. So, that is why they have a defensive response to them. Because of this chemical process, the body enters a state of immediate hyper sensibility that presents itself with slow inflammatory responses.
Allergic Rhinitis Symptoms
The symptoms can vary according to each person. However, it isn’t necessary that the symptoms present themselves completely for the patient to be diagnosed with allergic rhinitis. As we continue, we will present the most common symptoms related to allergic rhinitis:
- Daytime fatigue
- Head pain
- Nasal obstruction
- Granular oropharynx
- Changes in sleep
- Nasal and Pharyngeal itch
- Runny nose
- Irregularities in nasal alignment
- Continuous sneezing
- Allergic stigmas (eye bags, Dennie lines, nasal grooves)
- Conjunctivitis symptoms (red eyes, itchy eyes, teary eyes)
- Expression of disinterest, absent gaze, half open mouth, breathing from mouth
- Pale nasal mucous or congestive hyaline mucous (transparent and watery)
There are factors that are related to the development of allergic rhinitis symptoms. Among them you can find:
- Genetic predisposition
- Being born in risk zones
- Early exposure to allergens
- Indiscriminate use of antibiotics in childhood
- Family history of atopy (allergic disorders)
- Exposure to adverse environments (tabacco, dust mites, animal fur)
Types of allergic rhinitis
There are two types of allergic rhinitis: seasonal and perrenial.
Seasonal allergic rhinitis
Also known as pollinic, it makes up close to 75% of allergic rhinitis cases. It tends to show up between winter and spring (in the northern hemisphere) because of the pollination of the plants.
The characteristic symptoms of this type of allergic rhinitis include: acute itchiness in the ears, eyes and oropharynx. This can become more intense with prolonged exposure to fresh air, especially during pollination hours (5:00-10:00 and 19:00-22:00) and can decrease on humid and rainy days.
Perennial allergic rhinitis
This type of rhinitis is triggered mainly by factors like dust, fungal spores (Alternia and Cladosporium) and skin particles from animals like cats, dogs and rodents.
The allergic rhinitis symptoms can appear to be the same as seasonal rhinitis; however, the ear itch is lighter and the nasal obstruction is more watery. As a result, the patient has to breath from her mouth, has a nasally voice, loses her sense of smell and taste, among other symptoms that are easier to identify.
A large amount of allergens exist, but the most common tend to be the following:
- Materials (latex, gloves, probes)
- Animal epithelium (hair, urine, saliva)
- Fungal spores (penicillium, cladosporium, alternaria and aspergillus)
- Mites (dermatophagoides pteronysinus, dermatophagoides farinae, dermatophagoides microceras)
Controlling allergic rhinitis usually consists of combining pharmacological treatment and environmental treatment to control allergic reactions and to remove allergens.
Environmental treatment consists of a series of measures that should usually be done before starting medications. By doing this, the patient can create an environment that will make recuperation easier. The measures included in the environmental treatment are:
- Avoid drastic changes in temperature
- Keep the windows closed at night
- Wash your nasal passages with sterile saline solution
- Keep a balanced diet avoiding foods with allergens and drink water
- Decrease your time outside (during pollination times, windy days, peak allergen periods)
- Use air conditioning with a filter in the house and in your car
- Avoid contact with chemical irritants, from tobacco to chlorine
- Exercise in a way that promotes the narrowing of the blood vessels through the contraction of the muscle fibers (vasoconstriction)
- You can use tools like masks to limit your contact with allergens and nose strips to reduce nasal congestion
Currently, there is a broad range of of medications available the help to control allergic rhinitis symptoms. Among them are: decongestants, antihistamines, chromones and topical nasal decongestants.
They are recommended to help with itching, sneezing and runny nose. However, their ability to improve nasal congestion and eliminate allergic rhinitis symptoms is limited. Oral medications that are more useful for this are: cetirizine and loratadine.
It should be stated that, first generation antihistamines can produce side effects like sleepiness and decreased abilities. When it comes to second generation antihistamines, there are no side effects and you get relief almost instantly, but it only lasts a short amount of time.
Decongestants for allergic rhinitis
They are long lasting medications, don’t cause local irritation, or rebound congestion or rhinitis medication. However, they have side effects like drowsiness, dizziness, anxiety and urinary retention. They can also increase your blood pressure.
If you are using topical nasal decongestants for more than two or three days, it will decrease its effectiveness, cause a relapse and worsen chronic rhinitis. Because of that, you should use oral decongestants instead.
These medications are effective for relieving these symptoms of rhinitis: nasal congestion, runny nose, itching and sneezing, especially in both types of allergic rhinitis and non allergic rhinitis.
Intranasal corticoids are metabolized quickly and last for a long time. However, you should be careful when using them since they have significant side effects when used for prolonged periods of time: growth stunts, behavior issues, suppression of the hypothalamus axis, etc.
Among the most recommended intranasal corticoids are:
- Mometasone furoate
- Fluticasone propionate
- Beclomethasone dipriopionate
Immunotherapy consists of the progressive administration of gradual concentrations of certain extracts of allergens according to the condition of the patient. This produces an immune tolerance to the allergen.
This is the pillar of treatments for allergic rhinitis because it is very effective. However, in many countries, the only way to apply it is subcutaneous. For that reason, patients have to think about factors such as the frequency of the injections, the duration of the treatment, risks and the disposition of the patient to continue with the therapy.
Mendoza Amatller, Alfredo, & Mansilla Canelas, Gonzalo. (2002). Rinitis alérgica. Revista de la Sociedad Boliviana de Pediatría, 41(1), 50-53. Recuperado en 11 de octubre de 2017, de http://www.scielo.org.bo/scielo.php?script=sci_arttext&pid=S1024-06752002000100017&lng=es&tlng=es.
Balziskueta, E., Encabo, B., Gaminde, M., Gutiérrez, A., Gracia, L., Gurrutxaga, A. and Sakona, L. (2017). Rinitis alérgica.Recuperado en 11 de octubre de 2017, de http://www.elsevier.es/es-revista-farmacia-profesional-3-articulo-rinitis-alergica-13028023
Instituto Mexicano del Seguro Social, IMSS. (2009). Guía de Práctica clínica para el Diagnóstico y Tratamiento de Rinitis Alérgica. Recuperado en 11 de octubre de 2017, de http://www.imss.gob.mx/sites/all/statics/guiasclinicas/041GER.pdf
Instituto Mexicano del Seguro Social, IMSS. (2009). Guía de Práctica clínica para el Diagnóstico y Tratamiento de Rinitis Alérgica. Recuperado en 11 de octubre de 2017, de http://www.cenetec-difusion.com/CMGPC/IMSS-041-08/ER.pdf
U.S. Food and Drug Administration, FDA. (2017). Alivio para la alergia de su hijo. Recuperado en 11 de octubre de 2017, de https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm317182.htm