Allergic Rhinitis

Achoo! It’s about that time for allergies, and anywhere from 15-30% of people have them. But you say, “I’ve never had allergies.”

We are self-repairing beings. It is a beauty of our design. However, since that fruit-eating incident in the Garden of Eden a few thousand years ago, aging wears out the body’s ability to self-repair. Do not be surprised if, for the first time in your life, you are diagnosed with allergic rhinitis. Why is that?

Since that fruit-eating incident in the Garden of Eden a few thousand years ago, aging wears out the body’s ability to self-repair.

Though not very clear, it may partly be that allergic rhinitis is similar to arthritis, which develops as joints wear down faster than the body’s ability to self-repair. Immune systems wear down like joints do and can become hypersensitive or decreased in their ability to self-repair or defend the body. Suddenly, you can no longer manage the allergen assaults of spring, fall, or household agents.

Allergic rhinitis is a group of symptoms similar to those of a cold, such as a runny nose, congestion, sore throat, itchy nose, throat clearing, watery eyes, and sneezing caused by an allergic reaction to an allergen such as dust, plant pollens, or animal dander. Fever is not a symptom of allergic rhinitis.

Developing an allergy is usually a two-step process. First is sensitization, when you are exposed to a harmless substance, and your body mistakenly starts making allergic antibodies, called IgE antibodies, to fight that substance. Those antibodies do not do anything until there is a repeat exposure to the triggering substance or allergen. When that occurs, the allergen binds to the IgE antibodies. This action starts a cascade of immune reactions in your body that results in allergy symptoms.

Common triggers include tree and grass pollen (spring and summer), ragweed and other weed pollens (fall), spores from fungi and molds (warm weather months), and dust mites and other house allergens (any time and can be affected by humidity).

Typical approaches to treatment include nasal irrigation, antihistamines, and nasal steroids. Nasal irrigation works by flushing allergens and allergic debris (mucus, snot) from the sinuses with a saline solution. Examples include neti pots, nasal rinse bottles, or nasal lavage machines.

Nasal steroids are typically the most effective medical treatment, e.g., fluticasone (Flonase, Veramyst), mometasone (Nasonex), and triamcinolone (Nasacort), when used properly. For some people, oral medicines are preferred or more effective.

Not all that sniffles or congests is allergic rhinitis. Other things to consider include vasomotor rhinitis, chemical rhinitis, non-allergic rhinitis with eosinophilia syndrome (NARES), infectious rhinitis, drug-induced rhinitis, rhinitis of pregnancy, and hormonally-induced rhinitis.

Dr. Stephen A. Wilson, MD, MPH, FAAFP, is Chair of Family Medicine at Boston University Chobanian and Avedisian School of Medicine and Chief of Family Medicine for Boston Medical Center.

Note: Therapies named do not imply endorsement or suggestions to use. Please consult your family physician for specific care designed for your circumstance.