What is allergy?
- Foreign particles abound in our environment and many people are especially sensitive to them
- When these particles cause an inflammatory reaction they are referred to as allergens
- Allergens can evoke a chain of events at the cellular level which are responsible for the well-known symptoms of nasal allergy
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Hay fever symptoms
- These symptoms may be seasonal or year-long and can occur at any age
- Hay fever symptoms may include:
- Blocked nose
- Nasal congestion
- Watery “runny nose”
- Sneezing
- Itchy eyes, nose or throat
- Tearing
- Puffy eyes or “allergic shiners”
- Post nasal drip
- It is also important to know that these symptoms may not always be caused by allergies
- Other causes include rhinitis or pregnancy, the side effects of medications, mechanical irritation on the nasal mucosa, acute stress, and overuse of decongestant nasal spray
Hay fever causes?
- Common causes of nasal allergy include:
- Pollen
- Dust mites
- Molds
- Pet danders
- Note that food allergies do not usually cause nasal symptoms
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Hay fever treatment
- Non medical measures – hay fever remedies
- The first line treatment of nasal allergy is avoidance therapy – minimising exposure to irritants to the nose is very important
- Dust mites
- Dust mites are the basis for dust allergies
- These mites thrive in moist areas and feed off scales of human skin
- Animal dander
- Allergies to animal dander are a concern for pet owners and for those who work with animals
- If animals cannot be removed, they should be restricted from the bed, bedroom, and if possible, common living areas
- Pollen
- Pollen is difficult to completely avoid but masks may help patients allergic to pollens during grass mowing and gardening
- Appropriate filtration of air conditioning and heating systems can be helpful
- It is important to change filters on air conditioners often
- Dust mites
- Molds
- Molds are significant and are common in humid areas both indoors and outside
- Indoor molds are found year-round especially in damp, warm environments which include old shoes, books, luggage, old newspapers, carpets, behind refrigerators, showers and bathroom surfaces
- House plants and dried flowers are a major source of molds and should be kept out of bedrooms and major living areas
- Molds are also commonly found outdoors in compost bins, grass and leaf piles, and in flower and vegetable gardens
Hay fever remedies
- Further non medical measures to treat allergic rhinitis include:
- A saline nasal spray should be used to clean the nose and sinuses
- Minimizing exposure to non-specific irritants to the nasal mucosa
- Avoidance of tobacco smoke and irritating fumes
- Appropriate ambient humidity should be maintained indoors where air-conditioning or heating is used
- Nasal dryness is detrimental to nasal function but humidity over 50% allows molds and dust mites to flourish
Hay fever treatment – Medications for allergic rhinitis
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Antihistamines
- Options include: Aerius, Azep, Claratyne, Fexal, Lorapaed, Loratadine, Telfast, Zyrtec
- Block the release of histamine from cells and can prevent the classic allergic reaction and can be taken in tablet form or as nasal sprays
- Antihistamines are most effective when taken prior to allergen exposure
- They relieve the “wet” symptoms such as sneezing, itching and runny nose and watery eyes
- They have little effect on congestion unless a decongestant is added
- Prolonged use of one antihistamine may produce a tolerance necessitating a change to another type
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Decongestants
- Options include: Sudafed nasal, Drixine, Dimetapp nasal decongestant, Otrivin
- Cause “vasoconstriction” or shrinkage of swollen tissues in the passages of the nose
- Decongestant nasal sprays can cause an increase in congestion if used for longer than 3 days at a time – this is called rebound
- Therefore it is recommended the use of these sprays be limited and only taken for severe episodes of nasal congestion
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Intranasal mast cell stabilizers
- Options include: Cromolyn, Intal, Rynacrom
- These are effective therapy for allergic rhinitis in approximately 70-80% of patients
- Cromolyn works by stabilizing cellular membranes and preventing the release of histamine
- Because Cromolyn is expensive and requires dosing 4 to 5 times per day it is not widely used
- It is best used prior to exposure to irritants and allergens to prevent symptoms and is not particularly helpful once symptoms commence
- These products are now available over the counter
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Leukotriene inhibitors
- Eg. Montelukast (Singulair)
- Other substances released during an allergic reaction are leukotrienes, which can aggravate allergic conditions and asthma
- These drugs target leukotriene receptors to reduce allergic symptoms and are most useful in patients with both allergic rhinitis and asthma
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Corticosteroid nasal sprays
- Options include: Beconase, Flixonase, Flonase, Nasacort, Nasonex, Rhinocort
- The most effective first-line drug treatments for allergic rhinitis include oral antihistamines or nasal steroids with or without oral antihistamines
- Steroid nasal sprays do not prevent an allergic reaction but minimise symptoms
- Steroid sprays may take 2 weeks to start working so they must be used regularly as directed – these sprays are best used 1 to 2 weeks prior to the typical allergy season – and can be stopped when the allergy season is over
- Patients with year round allergies may also benefit from steroid sprays – however a 1 month “holiday” off the sprays ever 3 to 4 months is recommended to prevent nasal dryness
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Immunotherapy
- Immunotherapy may be more effective for seasonal than for allergic perennial rhinitis
- Patients whose symptoms are not easily controlled with other medications, those who are sensitive to allergens not easily avoided, those with year-long symptoms or severe symptoms and those who are willing to cooperate with the program are candidates for immunotherapy
Hay fever treatment – Surgery for allergic rhinitis
- Patient who have failure of medical management may be suitable for surgery which usually involves nasal septoplasty and turbinate reductions
- This surgery opens the nasal passages to improve breathing through the nose
- Nasal septoplasty and turbinate reduction surgery is safe and effective treatment for most patients with a blocked nose due to allergic rhinitis