Pass the tissues: Combating allergic rhinitis
What is allergic rhinitis?
Rhinitis is a term describing the symptoms produced by nasal irritation or inflammation. Allergic rhinitis is an allergic reaction that occurs mainly in the nasal passages. It can occur seasonally (seasonal allergic rhinitis or “hay fever”) or all year long (perennial allergic rhinitis). Symptoms of rhinitis include runny nose, itching, sneezing and stuffy nose due to blockage or congestion.
What causes the sneezing, itchy eyes and other symptoms?
When a sensitive person inhales an allergen (allergy-causing substance) like ragweed pollen, the body’s immune system reacts abnormally to the allergen. The pollen triggers cells in nasal membranes, causing them to release histamine and other chemicals. Histamine dilates the small blood vessels of the nose. Fluids leak out into surrounding tissue, causing runny noses, watery eyes, itching, swelling and other allergy symptoms.
Is there any escape?
A common question is: Can I move someplace where my allergies will go away? Some allergens are tough to escape, and allergists seldom recommend moving to another locale as a cure for allergies. Ragweed, which bothers 75% of allergic rhinitis sufferers, blankets most of the United States. Although less ragweed is found in a band along the West Coast, the southern-most tip of Florida and northern Maine, it is still present.
Are all cases of rhinitis caused by allergies?
Rhinitis symptoms may result from many causes other than allergy, as shown in the table below.
| rhinitis type | common name | allergic sensitivity |
causes | duration of symptoms |
| allergic | hay fever | yes | dust mites, animals, pollens, molds, foods | perennial and/or seasonal |
| infectious | colds or flu | no | viruses | three to seven days, sometimes longer |
| non-allergic | irritant | no | smoke, air pollution, exhaust fumes, aerosol sprays, fragrance, paint fumes | perennial and/or following exposure |
Can I outgrow my allergy?
Although allergies can sometimes become dormant and symptoms may disappear, most people do not actually outgrow allergies. Allergic conditions can return after dormancy or even have an initial onset later in life.
How is allergic rhinitis treated?
Once your clinician has diagnosed allergic rhinitis, treatment options include avoidance, medication and immunotherapy (allergy shots).
Avoidance: A single ragweed plant may release one million pollen grains in just one day. The pollen from ragweed, grasses and trees is so small and buoyant that the wind may carry it miles from its source. Mold spores, which grow outdoors in fields and on dead leaves, also are everywhere. While escaping pollen and molds may be difficult, you can reduce exposure by following these tips.
Keep windows closed and use air-conditioning in the summer, if possible. A HEPA (high energy particulate air) filter may help clean pollen and mold from the indoor air.
Don’t hang clothing outdoors to dry. Pollen may cling to towels and sheets.
Limit outdoor activities between 5:00 and 10:00 a.m., when the outdoor air is most heavily saturated with pollen and mold.
Wear a dust mask when mowing the lawn, raking leaves or gardening, and take appropriate medications beforehand.
Medications: When avoidance measures don’t control symptoms, medication may be the answer. Antihistamines and decongestants are the most commonly used medications for allergic rhinitis. Nasal corticosteroid sprays may also be used to help alleviate nasal congestion, runny nose, sneezing and itching.
Oral Antihistamines: These drugs are the most common treatment for allergic rhinitis. They counter the effects of histamine, the irritating chemical released within your body during an allergic reaction. Dozens of different antihistamine drugs are available. Antihistamines are generally separated as sedating antihistamines (i.e. diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton)) and non-sedating antihistamines (i.e. fexofenadine (Allegra), loratadine (Claritin, Alavert)).
Recently, loratadine (Claritin, Alavert) became available in the United States without a prescription. The recommended dose of loratadine is 10mg once daily as needed to relieve symptoms. Supplies of loratadine (Alavert, Claritin) tablets can be purchased without a prescription at the YHP Pharmacy or any other pharmacy.
Oral and nasal decongestants: These drugs help relieve the stuffiness and pressure caused by swollen nasal tissue. They do not relieve the other symptoms of allergic rhinitis, such as runny nose, post-nasal drip and sneezing. Decongestants (e.g. pseudo ephedrine (Sudafed), oxymetazoline (Afrin)) are available as prescription medications at higher doses and non-prescription at lower doses and are often seen in combination with antihistamines or other medications.
In some patients, oral decongestants (i.e. pseudo ephedrine (Sudafed)) may cause sleep problems, appetite loss and irritability, which can contribute to allergy problems. If you have any of these symptoms, discuss them with your clinician.
Non-prescription decongestant nasal sprays (i.e. oxymetazoline (Afrin)) work within minutes and last for hours, but should not be used for more than 3-4 days.
Non-prescription saline nasal spray: Saline solution will help counteract dry nasal passages or thick nasal mucus. Unlike decongestant nose sprays, a saline nose spray can be used as often as needed. Saline solution is available without a prescription at the YHP Pharmacy or any other pharmacy.
Nasal corticosteroids: These drugs counteract inflammation caused by the body’s release of allergy-causing substances, as well as that caused by other non-allergic factors. Nasal corticosteroids (e.g. fluticasone (Flonase), budesonide (Rhinocort AQ) require prescriptions and are indicated for patients with moderate to severe allergic rhinitis symptoms lasting more than 1 to 2 weeks. While generally well-tolerated, nasal corticosteroids may cause nasal drying, nasal fungal infection or bleeding.
Immunotherapy: Allergen immunotherapy, known as “allergy shots,” can be very effective and may be recommended for persons who don’t respond well to medications, experience side effects from medications, or have unavoidable allergen exposure. Allergy injections are usually given at variable intervals over a period of three to five years. Over time symptoms should improve, but the improvement from immunotherapy will take several months to occur. Immunotherapy does not help the symptoms produced by non-allergic rhinitis.
Summary
There are many treatments for allergic rhinitis. Each person’s treatment must be individualized based on the frequency, severity and duration of symptoms and on the degree of allergic sensitivity. If you have more questions, your clinician or a YHP pharmacist will be happy to answer them.
Antibiotics decrease the effectiveness of oral contraceptives
Many antibiotics (including penicillin, tetracycline, rifampin) and some seizure medications (such as Dilantin and Tegretol) increase the metabolism of oral contraceptives; the concentration of the oral contraceptive in the body is decreased, leading to diminished effectiveness. If you are taking oral contraceptives, ask your pharmacist whether your other medications will interact with your oral contraceptive. Another form of contraception should be used while you are taking an antibiotic.
Your bathroom medicine chest is the worst place to store medications
Steam from the shower may cause the active chemicals to degrade, decreasing the effectiveness of the medication and possibly compromising your health. Store medications in a cool, dry, place away from children and animals.
