«Mark E. Bubak, M.D. & Julie F. Nielsen, PA-C 2200 W. 49th St., Ste. 104 Sioux Falls, SD 57105 605-336-6385 YourAllergyRelief.com ALLERGIC RHINITIS ...»
Mark E. Bubak, M.D. &
Julie F. Nielsen, PA-C
2200 W. 49th St., Ste. 104
Sioux Falls, SD 57105
A runny nose, sneezing, and stuffiness are common problems. They can be caused by infections, allergies, nonallergic nasal
disease (vasomotor rhinitis), nasal polyps, deviated septum, chronic sinusitis and other difficulties.
This pamphlet supplements your doctor’s instructions to help you become more familiar with your condition and its treatment.
Allergic rhinitis, often referred to as hay or rose fever, can cause:
· Itchy eyes, nose and throat · Stuffy nose · Plugged ear · Watery eyes · Sneezing · Cough · Runny nose Hay fever does not cause a fever.
Allergic rhinitis can either be year-round or seasonal. Causes of year-round allergic rhinitis include animals, mold, house dust, and feathers.
In the Midwest, seasonal allergic rhinitis is caused by tree pollen in the spring (April and May), grass pollen in early and midsummer (late May, June, and early July) and weed pollen, primarily ragweed, in late summer and early fall (August and September). Molds, which can also cause hay fever, appear in the warm months, usually from early spring until later fall.
Nonallergic Rhinitis While having the same symptoms as allergic rhinitis, nonallergic rhinitis (vasomotor rhinitis) is not caused by allergies or sinus problems. Symptoms are more chronic (ongoing) and usually are present all year. However, they are often worse in the winter. At present, the cause of nonallergic rhinitis is not known.
Sneezing and a runny or stuffy nose may occur without a clear reason. However, symptoms are often brought on by irritants such as fumes, fresh newsprint, strong odors, smoke and all types of dust, including road dust, garage dust, and house dust. Alcoholic beverages also may cause nasal congestion.
Some people develop symptoms during changes in temperature or wind. Changes in body temperature also may bring on symptoms. People with nonallergic rhinitis may sneeze and become congested when they remove bedclothes or put their feet on a cold floor in the morning. Symptoms are sometimes worse in the morning when you first get up. In severe cases, you can lose your sense of taste and smell. One type of nonallergic rhinitis, nasal congestion during pregnancy, usually clears after delivery. Certain medications cause nasal congestion such as the blood pressure pill Hytrin. Nasal septal deviation and other structural nose problems also lead to nasal congestion.
Nasal polyps Small, benign (noncancerous) tumors in the nose can sometimes cause a runny nose and stuffiness. If nasal polyps grow large enough, they can block the nasal passages. A sinus infection can develop if the polyps obstruct sinus drainage. In rare cases. severe infection and large polyps can cause the bones surrounding the nose and sinuses to wear away.
TESTING FOR ALLERGIESThe Skin Tests An allergy skin test may help diagnose the cause of the allergy. Skin tests are done on the arms or back using either the prick or intradermal method.
In the prick technique, a drop of an allergy-producing substance (allergen) is applied to the skin. The skin is then scratched or pricked. In the intradermal method, a tiny amount of allergen is injected into the skin. Skin tests for most allergens are safe, and the results are available in 20 to 30 minutes. Antihistamine and antidepressant medications affect skin tests and must be stopped before tests are begun. Some antihistamines can interfere with allergy skin tests for weeks. Check with your physician about stopping medications.
Skin tests for tobacco smoke allergy are not useful because tobacco smoke is an irritant, not an allergen.
Blood Allergy Tests Allergies can also be diagnosed using a blood test. Examples include the radioallergosorbent test (RAST) or the ImmunoCap. They give information similar to the skin test. However, they are more expensive, may miss identifying some allergies, and also take longer to determine the results. The blood test can be used when a skin test would not be suitable.
For example, it can be used when a person has a skin disease which does not allow skin tests to be done, or when taking an antihistamine or other medication that might affect skin test results.
Both skin and blood allergy test results must be interpreted by a physician who is experienced in diagnosing and treating allergies and who is familiar with your medical history.
MANAGING YOUR NASAL CONDITION(s)Avoidance Avoid the causes of allergic rhinitis where possible. Avoidance is the most effective way to manage allergies.
If you are allergic to airborne pollens and molds, use air conditioning in your home, your car, and at work. Keeping doors and windows closed also is an effective way to keep out airborne pollens and molds. Dry your laundry inside during pollenation times. Clean up areas of obvious mold growth. Consider a dehumidifier for damp basements. If you have seasonal allergic rhinitis, it may help to leave the geographic area during the allergy season. For example, if you are allergic to ragweed, consider going to places such as the Rocky Mountains or northern Minnesota during the ragweed season.
If you are pet allergic, removing them from your home and cleaning the house thoroughly may give complete relief of symptoms. If you decide to keep your furry pets, wash them weekly. After washing your cat once a week for several weeks, you may reduce the amount of its allergen that floats in the air (airborne allergen). A special filter such as a HEPA can reduce the dander level in the air. Keep your pets outside as much as possible. Do not let them on your bed or even in your bedroom. Also, keep them out of other rooms in which you spend a lot of time. If you are allergic to animals, do not buy furniture or rugs that are made with animal hair.
For dust mite allergy, encase the mattresses and pillows in allergy control barriers, wash the blankets and sheets weekly, and keep the humidity down. Have the bedroom out of the basement and have smooth floors where possible. If you are allergic to cockroaches, use a roach control method to rid your home of these pests.
Avoid Irritants If you have any type of rhinitis, try to avoid things that irritate your nose and lungs, such as dust, smoke, and temperature change. Don’t smoke. Obviously, you cannot avoid all irritants, but you can take precautions. Avoid frequent nasal sniffing or blowing, and throat clearing. These actions can be irritating and can cause sensitive nasal and throat membranes to secrete more mucus.
Use the medication prescribed by your physician. Medications for allergic and nonallergic rhinitis fall into four categories:
Antihistamines These lessen symptoms of itchy, sneezy, and runny nose, and itchy watery eyes. Three families are available. The nonsedating forms are preferred and include Allegra® and Claritin®. Zyrtec® and Astelin® are minimally sedating.
Sedating antihistamines are commonly over-the-counter and include Benadryl® and chlorpheniramine. All can be used on an as needed basis as they start working in 30 to 60 minutes. Antihistamine eyedrops (Patanol®, Vasocon®, Decongestants Decongestants work by shrinking (decongesting) swollen nasal membranes. Various forms of pseudephedrine (Sudafed®) are the main products available. They are stimulant drugs and may aggravate high blood pressure. On rare occasions, decongestants may cause your heart to beat differently. Decongestants can cause difficulty with urination. This occurs most often in older men.
Avoid nasal decongestant sprays. Although these medications offer temporary relief, they can result in chronic obstruction of the nasal passage. They shrink the nasal mucous membranes briefly, and when the effect of the medication ends, the membranes once again swell. This swelling becomes greater with repeated use, and finally the nose becomes severely obstructed.
Many allergy medications contain both antihistamines and decongestants. Asthmatics can use antihistamines and decongestants for their nasal symptoms. These medications do not help the asthma symptoms.
Allergy Blocking Medications Allergy blocking medications inhibit the body’s mast cells from releasing histamine and other mediators that cause your allergic symptoms. Cromolyn (Nasalcrom®) is available as a nasal spray or eyedrop(Crolom®) that can relieve allergy symptoms. Lodoxamine (Alomide®) is another eyedrop. Both are preventive types of medication. To be most effective, they should be started before the beginning of the allergy season. In some people, they cause stinging or burning.
Corticosteroids These are effective in both allergic and nonallergic rhinitis (and nasal polyps) and can be given by injection, pill, or spray.
When used in pill form or by injection, cortisone may have serious side effects, particularly when used over long periods of time. The side effects of cortisone-containing drugs must always be weighed against the seriousness of the allergic symptoms.
Corticosteroid nasal sprays include beclomethasone (Beconase® or Beconase AQ®, Vancenase® or Vancenase AQ®), budesonide (Rhinocort® and Rhinocort Aqua®), flunisolide (Nasalide®, Nasarel®), fluticasone (Flonase®), mometasone (Nasonex®), and triamcinolone (Nasacort® or Nasacort AQ®). These nasal sprays usually do not cause the same serious side effects as the pills or injections. However, they can irritate the nose and cause stinging, burning, and minor nosebleeds. A small percentage of patients must stop the medication because of nosebleeds. They work best if started before your allergy season and if they are taken regularly.
Eye Drops These help with the itchy watery eyes of allergy. They can be antihistamines, decongestants, allergy blocking agents, or anti-inflammatory agents. Many can not be used with contacts.
New medications are being tested and put on the market continuously. Ask your physician about new medications for treating your condition.
Allergy Immunotherapy Allergy immunotherapy is also called desensitization, hyposensitization or allergy shots. It is a form of treatment that can make you less sensitive to allergens. It is helpful for allergic rhinitis, especially for allergies to trees, grasses, weeds,
cats, and dust mites. It can also help with mold or dog allergies. It is generally not helpful for nonallergic rhinitis or nasal polyps.
Allergy immunotherapy involves regular injections of the allergen(s) to which you are allergic. The injections start with a small dose once or twice weekly and gradually increase to the maximum dose determined by your allergist. Then the injections are extended gradually to monthly doses and continue year-round.
Approximately 70 to 80 percent of people who have allergic rhinitis benefit from allergy shots. The inconvenience and expense of going to the doctor for immunotherapy must be balanced against the severity of the symptoms, the cost of the other drugs, and the side effects of these other medications.
While it is uncommon, you can have an allergic reaction to the allergy immunotherapy injections. Lifethreatening reactions and deaths have occurred, but are extremely rare. You will be asked to wait in your physician’s office for 30 minutes following an injection so that if a reaction occurs, it can be properly treated.
After five years, if these injections provide relief from allergy symptoms, consideration can be given to stopping the injections. Most patients continue to enjoy relief for years after stopping the injections. If no benefit is seen after a year, a reevaluation of this therapy is suggested.
Nasal Surgery Surgery is not generally helpful for allergic and nonallergic rhinitis. However, surgery may help in some situations where another condition arises with allergic rhinitis. Surgery can often improve nasal breathing in people whose internal nose structures block air passage, such as a deviated nasal septum. Turbinate reduction procedures can reduce nasal congestion. Nasal polyps may need surgical treatment if they cause severe nasal obstruction, repeated sinus infections or erosion of the bone. Unfortunately, nasal polyps tend to return and may require additional surgery. Long term cortisone nasal sprays are often recommended to help reduce the regrowth of the polyps. Other proceedures can at times help with chronic sinusitis.
The nasal conditions discussed in this pamphlet are often chronic problems requiring some life adjustments. By using the correct combination of proven preventive measures, prescribed medications, allergy immunotherapy, and sometimes surgery we can usually find relief for your allergies and improve your life!