Allergic rhinitis or “hayfever” is a condition characterised by inflammation of the nasal lining, induced by exposure to an inhaled allergen and mediated by the allergic pathway of the immune system.

What are the symptoms?

The main symptoms are nasal blockage or congestion, a runny nose, sneezing and nasal itching. Postnasal drip (mucus dripping into the throat from the back of the nose) may also be present. Symptoms may be intermittent or persistent.

What causes allergic rhinitis?

If a person’s immune system is sensitive to certain substances, inhaling these particular substances (or “allergens”) leads to allergic symptoms. Indoor allergens, such as dust mites, mould spores, cockroaches, cats and dogs, often cause persistent symptoms, whereas outdoor allergens such as pollens, often cause intermittent symptoms. Sometimes patients are sensitive to both types of allergens. Other factors, such as the season, weather, travel and pollution may contribute to symptoms.

How is it treated?

Unfortunately, there is no cure for allergic rhinitis but there are effective treatment options. Generally, medical treatment is given first. If troublesome symptoms persist, a combination of medical and surgical treatment may be offered.

What medical treatment would you recommend?

a) Medications for prevention
The mainstay is treatment with a steroid nasal spray, such as Nasonex and a Saline rinse or spray daily. Rynacrom spray may also be used. For patients with pollen allergy and asthma, a Montelukast tablet may be given from August to January to prevent symptoms.

b) Medications for symptom relief
Antihistamines may be taken as tablets or nasal sprays, such as Azepor or Livostin. They help to reduce symptoms of sneezing, itching, runny nose and nasal blockage. Atrovent nasal spray helps to reduce runny nose and postnasal drip. Decongestant tablets may be used but their side effects can be problematic.

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What do the medications do?

Saline rinses help to wash the allergens out of the nose, thereby reducing inflammation. The steroid sprays reduce the abnormal immune response to allergens. Rynacrom reduces the immune response by a different mechanism. Atrovent spray reduces the nasal mucus secretion.

Are there any side effects?

Nasal sprays are generally well tolerated. They may dry the nose and lead to some bleeding, irritate the nose and throat or leave a bad taste. Some can worsen glaucoma.

What is immunotherapy?

Immunotherapy may be given by injection (subcutaneous or SCIT) or a spray or tablet under the tongue (sublingual or SLIT). The allergen responsible for driving the symptoms is administered to the patient in a small dose to desensitise them over time – often about 3 years. For outdoor allergens, SLIT is given every day of the year, but for pollens it may be given every day for 6 months, before and during the pollen season.

What does immunotherapy do?

By prolonged, low-dose exposure to the allergen, the immune system gradually reduces its reaction, producing less severe symptoms when allergen exposure occurs naturally. In most patients, the effect appears to last several years after stopping the immunotherapy, but it is usually not permanent. Most patients are able to reduce or even stop medications after several months of immunotherapy, but this is not the case for everyone.

Are there any side effects of immunotherapy?

SLIT can lead to some irritation or swelling of the lips, mouth, tongue and throat. SCIT can lead to local skin irritation, exacerbations of asthma and very rarely can produce shock.

What about surgical treatment?

Surgical treatment aims to improve blockage of the nose, reduce symptoms and to let the steroid spray and saline rinse penetrate the nose more effectively. This allows more effective topical medical treatment of the inflammation causing the symptoms. Surgery is not a substitute to medical treatment: it is important to continue the topical nasal sprays after surgery.

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