Allergic rhinitis

What is allergic rhinitis?

Allergic rhinitis is a condition in which there are a group of symptoms that typically affect the nasal mucous membranes (these become itchy and inflamed) and also the eyes (these also become itchy and inflamed).

Allergic rhinitis is basically another name for hay fever.

Allergic rhinitis causes the body’s immune system to over-react and cause an allergic reaction to specific non-infecting particles such as:

• Animal fur and dander
• Certain foods
• Chemicals (any type)
• Dust mites
• Household chemicals
• Household dust
• Insect bites
• Medication
• Mould
• Perfume
• Plant pollens
• Tobacco smoke

Facts about allergic rhinitis

• Other conditions such as sinusitis, nasal polyps and asthma commonly occur alongside allergic rhinitis
• Blood levels of the antibody IgE are raised in people with allergic rhinitis
• Allergy testing can be done in a variety of ways but the most effective way is through skin prick testing, where a small amount of the allergen is placed on the skin and these areas are pricked or scratched to allow the allergen to go into the skin. If the skin develops a raised, itchy area (called a wheal) then there is a definite allergy to that substance – this test is normally done by a medical doctor
• Another type of allergy testing is the allergy blood test, which looks for antibodies to certain allergens to test if there is an allergy to them
• People with allergic rhinitis are advised to stay indoors on hot, dry, windy days when there is likely to be more pollen and other allergens in the air
• People with known allergens to certain substances should try to avoid them
• It is better to try to avoid the allergens in order to stop the symptoms from happening in the first place

Symptoms of allergic rhinitis

General symptoms

Allergic rhinitis is characterised by a number of general allergic symptoms that, while annoying, are generally not serious:

• Congestion – of the nose and sometimes the lungs, as they become clogged with all the mucous that is being produced in reaction to the allergic rhinitis
• Inflammation – includes redness of the nose and eyes especially, which are the main parts that are inflamed
• Itching – especially of the face, eyes, nose, soft and hard palate in the mouth
• Lethargy – the body becomes quickly exhausted if this condition goes on for a while
• Mucous production – the nasal mucous membranes are stimulated to produce a lot more mucous
• Sneezing – one of the most common symptoms of allergic rhinitis

Serious symptoms

There are more serious symptoms associated with allergic rhinitis (hay fever), which can even be life-threatening:

• Swelling – of any part of the body that is affected by the allergen
• Wheezing – if the lungs become congested with mucous it may be difficult to breath properly (similar to what occurs in people with asthma)
• Anaphylaxis – this is a serious allergic reaction, which involves severe restrictions on breathing and swelling of the throat and lungs. Anaphylaxis is very serious and it should be treated immediately with adrenaline

Causes of allergic rhinitis

Even with many years of research into this condition, scientists still do not know exactly what causes allergic rhinitis, other than the person having an overactive immune system that reacts improperly to a number of allergens. While science does understand how the allergies happen, they do not understand yet, why some people develop allergic rhinitis, while others do not.

When the susceptible person breathes in the allergen, the immune system mistakenly recognises it as a dangerous substance that needs to be expelled quickly and produces antibodies (IgE) against the allergen. The antibodies are stimulated to produce histamine which is part of the body’s inflammatory response to expel dangerous substances.

The histamine response causes symptoms such as itching, excessive mucous production, swelling and sometimes hives in more sensitive people, although symptoms vary for each person.

This is the reason that anti-histamines are sold as remedies for people with allergies – to stop the histamine response and stop the allergic reaction.

Nutritional deficiencies

Some research suggests that nutritional deficiencies may play a part in exacerbating some allergic rhinitis symptoms. There are a number of alternative / complementary treatment strategies for allergic rhinitis that can be used in the first instance to help alleviate symptoms.

Prevention of allergic rhinitis

Non-preventable risk factors

There is very little that can be done to prevent any of the known risk factors that are either genetic or in some other way unpreventable, which are known to be associated with the development of allergic rhinitis.

Some risk factors are unpreventable:

• Essential fatty acid metabolism – some people with allergic rhinitis may have a problem with the way their body metabolises omega 3 essential fatty acids (EFA), which can then result in a deficiency and this can display in the symptoms associated with allergic rhinitis
• Immune deficiencies – scientists think that some people with allergic rhinitis have a problem with the way their immune system reacts to possible allergens as invading pathogens (similar to a virus or bacteria) and specifically the IgA immunoglobulin, which is the antibody that deals with pathogens
• Severe viral infections – some scientists think that when some people have a number of recurrent and severe viral infections (such as mononucleosis, influenza, hepatitis), this can deplete the immune system to the point where it thinks any foreign body (dust, plants, chemicals, perfumes, cat fur, etc) is a potential pathogen that could cause harm to the body and reacts with an allergic reaction that is characterised by allergic rhinitis

Preventable risk factors

Ways to prevent allergic rhinitis in the first place (or at least reducing some of the symptoms associated with allergic rhinitis ). Research shows that there are some risk factors associated with the development of allergic rhinitis:

• Adequate vitamin D in pregnancy – studies show that when women do not get enough vitamin D in their diet while pregnant, this can increase the risk of a number of conditions in their child, including allergic rhinitis (as well as asthma), so to prevent this, pregnant women must get enough vitamin D in their diet
• Pregnant women need omega 3 – studies have shown that pregnant women who do not eat enough foods high in omega 3 fatty acids (such as salmon, mackerel, olives, walnuts) risk having a child that develops allergic rhinitis
• Breastfeeding women need omega 3 – studies have shown that pregnant women who do not eat enough foods high in omega 3 fatty acids (such as salmon, mackerel, olives, walnuts) risk having a child that develops allergic rhinitis
• Omega 3 in the baby’s diet – mothers should ensure there is adequate omega-3 fatty acids in their child’s diet so that they reduce their child’s risk of developing allergic rhinitis
• Not smoking while pregnant or breastfeeding – studies show that smoking is associated with a higher risk of the child developing allergic rhinitis (as well as allergies) in childhood. The studies suggested that when unborn foetus is exposed to cigarette smoke and the child is exposed to cigarette smoke after it is born, increases the risk of airway disorders in a child’s first 10 years

Complications of allergic rhinitis

While allergic rhinitis is not a terminal condition (it does not cause mortality in those who are sufferers), it can cause a number of serious symptoms which require immediate medical attention.

If you experience any of the following, ensure that you call an ambulance:

• Anaphylaxis – the condition anaphylaxis is a serious allergic condition, that can happen quite dramatically in people who are susceptible to having an acute allergic reaction – inability to breath properly, excessive mucous in the respiratory system and extreme wheezing. Anaphylaxis needs to be attended with the utmost urgency as it can ultimately lead to death
• Severe swelling – of the face and particularly the throat, where it feels very difficult to breath properly
• Wheezing – an ambulance should be called depending on the severity of the wheezing; if breathing is particularly difficult, then immediate medical attention must be sought

If allergic rhinitis is not diagnosed and treated early, it can continue to cause a whole range of unpleasant symptoms that may gradually get worse and worse.

While allergic rhinitis is not a terminal illness, it can cause a range of problems with quality of life, when symptoms become bad enough to interfere with life – inability to sleep due to constant itchiness, lack of proper sleep, inability to socialise due to possible allergic reactions, inability to keep pets.

There are a whole range of over-the-counter conventional medicines that are available, as well as prescription medication for allergic rhinitis, as well as number of alternative / complementary therapies and medicines also available to help treat the underlying cause of allergic rhinitis.

When to see a doctor about allergic rhinitis

A doctor should be consulted if symptoms of allergic rhinitis start to occur. It is much more preferable to see a doctor as soon as symptoms start to reduce discomfort and to prevent symptoms from getting worse.

The information on the alternative- complementary treatment of allergic rhinitis should be viewed as a first step in treating mild to medium allergic rhinitis without anaphylaxis, before strong medications are used.

A doctor (or other health professional) will usually suggest the simple and natural options first anyway.

Diagnosis of allergic rhinitis

Allergic rhinitis is diagnosed by the following:

• Medical history of symptoms – your doctor will take notes on the duration and severity of symptoms, when they started and will order other tests as necessary
• Physical examination – the doctor will perform a general physical examination of the throat, nose and ears to detect the severity of the condition

If necessary the following diagnostic tests can also be done (especially when symptoms are severe) to determine if there is any underlying problem with the respiratory system:

• CAT scan – the CAT scan test can provide a good view of the sinus and nasal passages and to determine if there are any nasal polyps which may be impairing breathing. If the sinuses appear to be adversely affected, swollen and inflamed, this can also be seen in this diagnostic tests
• X-ray – while an x-ray is not used to diagnose allergic rhinitis, it can show if there are any structural problems with the sinus and nasal passages that could be contributing to any problems or complications

There are also a number of other tests that can be performed to give an even better idea on the cause of the allergic rhinitis:

• Allergy testing – an allergy test is usually a test which can give a clear understanding on which allergens are most likely to prompt symptoms in people with allergic rhinitis. An allergy tests is also known as a”skin prick test” and it involves pricking the forearm with a very small needle and allowing some of the allergen into the skin. This is done many times with various allergens that the allergy specialist uses (including dust and pet hair brought from home) to determine if an allergy exists to a particular substance. Usually, if an allergy to the substance occurs, it will cause the skin pricked to form a welt, rash or lump. The allergy specialist (or immunologist) will have taken note of each substance used to enable determination of the substances that cause the allergic response
• Cytotoxic allergy tests – this is a simple blood test which exposes the white blood cells to a sample of the suspected allergens (food or other substance) to determine if there is any reaction (the IgA antibodies in the white blood cells will react to the food or substance if it is an allergen that the body recognises). Sometimes this test can give false positives and may not be as reliable as an allergy test
• Food sensitivity test – children with allergic rhinitis often have food allergies or sensitivities and much of their subsequent symptoms may be due to this sensitivity. An elimination diet needs to be followed to work out if this food is causing any of the symptoms. The most common food sensitivities that can cause behavioural problems are: cow’s milk, wheat (or gluten), oranges (and other citrus fruit), chocolate, peanuts, soy, eggs, corn, oats, apples, tomatoes. In order to test a food sensitivity, that food (and foods containing it) must be totally eliminated from the diet for two weeks (as must all foods with any artificial additives) and after that, the food can be re-introduced back into the diet to see if there are any reactions to it. This requires a lot of vigilance and strict monitoring and could be better accomplished with the help of a registered dietitian or naturopath

Conventional treatment of allergic rhinitis

Conventional treatment for allergic rhinitis involves a combination of strategies – using both prevention to remove yourself from contact with the allergen, together with medications that stem the allergic reaction:

Prevention – reduce exposure to allergen

• Avoid the allergen(s) – keep your home free from the allergic triggers (dust, animal fur, chemicals)
• If you have pollen/grass allergies and have to go outside, take a shower as soon as you get home to get rid of the allergens from your body
• Wear protective “wrap around” sunglasses, which wrap all the way around the eyes to prevent allergic eyes
• Keep windows closed during the day to keep out pollens, dust and other particles
• Try to stay home on days which are especially windy as this may exacerbate symptoms to a high level

Medication

There are a number of different types of medications used to remedy the different types of symptoms associated with allergic rhinitis:

• Antihistamine tablets – there are many non-sedating medications that control itching, sneezing, runny nose and itchy eyes. There are also older antihistamine medications which are sedating, but work equally as effectively as the non-sedating medication, but they can prevent you from operating machinery and driving
• Medicated eye drops – these types of eye drops help to stop the itchiness symptoms from the eyes
• Medicated nasal spray – there are nasal sprays which contain corticosteroid medication that decongests the nasal passages to be able to breath properly through the nose. These medications can only be taken for a short term, as they can cause reverse side effects – they can make the initial symptoms come back even worse than before if used for too long. The packaging of steroid nasal sprays now advises only short term use to prevent worsening of symptoms
• Oral decongestants – these medications, that contain the drug pseudoephedrine, open up the nasal blockages by deconstricting blood vessels in the nasal membranes, reduce inflammation in the nasal membranes and reduce congestion from mucous to help ease breathing
• Oral steroids – these medications are useful to control the symptoms of severe allergic rhinitis, especially in case of emergency, where life may be threatened due to severe symptoms (inability to breath properly, major mucous congestion), but should not be used for long periods. Common examples are: prednisone. This medication should be avoided in certain people and they cause a number of side effects

People intending to take any medications should be aware of the potential side effects of those medications.

Alternative / complementary treatment of allergic rhinitis

The following are the treatments advocated by alternative therapists.

Herbs

There are a number of herbs with anti-inflammatory and immune boosting effects that are used to treat allergic rhinitis:

• Echinacea – studies show this potent herb, echinacea has a positive effect on stimulating the immune system to work properly, which in turn can reduce the allergic rhinitis symptoms
• Fenugreek – the spice fenugreek is traditionally used to clear nasal congestion and prevent infection in the nasal passages associated with sinusitis
• Garlic – studies show this potent herb / food clears nasal congestion, reduces symptoms and prevents infection in the nasal passages associated with sinusitis
• Horseradish – the spice horseradish is traditionally used to clear nasal congestion and prevent infection in the nasal passages associated with sinusitis
• Olive leaf – studies show the olive leaf herb reduces inflammation and clears up congestion in the sinus passages, reducing symptoms

Vitamins

Studies show that there are several vitamins which could be beneficial for treating allergic rhinitis symptoms:

• Betacarotene – the vitamin betacarotene is the precursor to vitamin A, so has the same properties on the mucous membranes
• Bioflavonoids – the antioxidants bioflavonoids, together with vitamin C, support the immune system to function correctly and reduces the severity of symptoms associated with any allergic reaction
• Vitamin A – the antioxidant vitamin A is required to keep the mucous membranes soft, moist and healthy, in order to prevent allergens from entering the body and causing an allergic reaction in the first place
• Vitamin B complex – all of the B vitamins are needed to help the immune system to function properly and reduce symptoms overall, since allergic reaction is stemmed
• Vitamin C – the antioxidant vitamin C, together with bioflavonoids, support the immune system to function more normally, by reducing the overactive response and so reduce the duration and severity of symptoms
• Vitamin E – studies show the antioxidant vitamin E helps to reduce symptoms of nasal congestion by reducing inflammation associated with allergic rhinitis

Minerals

Studies show that there are several minerals which could be beneficial for treating allergic rhinitis symptoms:

• Magnesium – the mineral magnesium relaxes body tissues and may help with reduction of inflammation and anxiety associated with allergic rhinitis
• Selenium – studies show the powerful antioxidant selenium may reduce length and severity of symptoms
• Zinc – studies show that zinc can greatly reduce length and severity of symptoms and help to more quickly heal the inflamed nasal tissues in people with allergic rhinitis

Other nutrients

Studies show certain nutrients have a beneficial effect on reducing length and severity of symptoms

• Alpha-lipoic acid – the nutrient alpha-lipoic acid is a potent antioxidant which can boost the immune system to help it function more normally and this can help reduce symptoms
• Essential fatty acids – studies show that the omega 3 essential fatty acids especially, can greatly reduce inflammation in the nasal passages (sinuses especially), open the airways to enable better breathing capacity and thus greatly reduce severity of symptoms. Mothers should ensure children who have allergic rhinitis have adequate levels of essential fatty acids in their diet to at least greatly reduce symptoms, if not prevent them from occurring in the first place
• Quercetin – studies the antioxidant nutrient quercetin assists in reducing inflammation and also reducing severity of symptoms. Quercetin is even more effective when combined with vitamin C and bioflavonoids
• Grapefruit seed extract – studies show that the antioxidant effects of grapefruit seed extract may help reduce the inflammation in the nasal passage and reduce symptoms of allergic rhinitis (hayfever) without the rebound effects often experienced with conventional medicine

Dietary modifications

There are a number of dietary modifications which can help reduce severity and duration of symptoms:

• Avoid foods that are mucous forming – certain foods such as dairy, processed foods (high sugar and high fat foods) tend to cause more mucous to form which can make symptoms worse. Try to avoid all forms of dairy (except yoghurt) and all processed foods when symptoms are at their worst
• Drink more fluids – water helps to hydrate the body and moisten the mucous membranes to keep the allergens out and prevent them from causing symptoms
• Eat more garlic and onions – as much as can be tolerated either fresh, cooked or as garlic supplements; both have anti-inflammatory properties which help reduce symptoms. These are two power foods that should be eaten on a daily basis to assist with preventing symptoms (if able to be tolerated, as some people’s digestive system may not be able to handle them)
• Eat more oily fish – the fish such as salmon, mackerel, sardines, trout, tuna all contain omega 3 fatty acids which may reduce inflammation and severity of symptoms
• Eat more vegetables and fruit – they have a high content of vitamins, minerals and other nutrients such as antioxidants which may reduce severity and length of symptoms
• Eat more nuts – especially walnuts, as these foods contains essential fatty acids which may reduce inflammation associated with allergic rhinitis and so reduce severity of symptoms
• Eliminate food allergens – foods that trigger allergies should be avoided to reduce symptoms, such as cow’s milk products, artificial food additives (colours, flavours and preservatives), nuts, soy and other potential allergen

Lifestyle modifications

There are a number of lifestyle modifications that can be followed to reduce severity and duration of symptoms:

• Avoid the allergens – if you are allergic to dust mites, use a vacuum cleaner with an air filter, if you are allergic to certain foods, avoid them, if you are allergic to other substances, avoid them as much as possible, as this will help reduce symptoms
• Remove carpeting – having hardwood (or tiled floors) assists people with a great reduction in symptoms and prevent build-up of inflammation in sinuses. Carpets are great accumulators of dust, dust mites and any other particles that may cause an allergic reaction. People with allergic rhinitis have much less symptoms when they live in a home with hard flooring
• Rest properly – adequate amounts of sleep and rest gives the body the best chance of a quicker recovery and reduction in symptoms
• Shower after being outside – especially if it has been a very windy day, as this will remove any dust, pollens and other substances from your skin which could continue to cause allergies long after you have been inside

Alternative treatments

• Immunotherapy – this involves gradually increasing doses of the substance (allergen) to which the person is allergic over time, a little at a time. This has the effect of making the immune system less sensitive to that allergen and reducing symptoms
• Nasal douching – salt added to lukewarm water is added to a “neti pot” and used to wash over the eyes and into the nasal passages to help clear them and decongest them. This gets rid of the allergens in the eyes and nasal passages, reduces inflammation and opens up the nasal passages to enable better breathing (this can also be done with a bowl of lukewarm water and salt if the neti pot is not available)
• Nasal spray – there are two great nasal sprays that can be used to naturally treat inflammation in the nasal passages:
  • Saline nasal spray – this nasal spray is basically water and salt and does not contain any artificial preservatives. It helps to moisten the nasal passages, reduces inflammation and reduces severity and duration of symptoms (use as directed)
  • Herbal nasal spray – this type of nasal spray contains other beneficial nutrients such as eucalyptus and zinc, to provide relief of symptoms of nasal inflammation and so it reduces severity and duration of symptoms (use as directed)
• Steam inhalation – the steam breaks up the mucous in the nasal passages and lungs, so lessens nasal congestion and wheezing and also assists with better sleep. Children with allergic rhinitis should always be supervised when trying steam inhalation, as they could burn the skin on their face if they lean too closely to the hot water
• Vaseline – application of a little vaseline (or non perfumed, organic, natural lip balm) to the outside of the nostrils protects them by trapping pollen grains from entering the inner nasal passages and causing symptoms

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with allergic rhinitis

Management of allergic rhinitis should be more focused on determining what the triggers are and how much of an effect they have in order to reduce their effect.

General triggers that can cause symptoms are:

• Allergens – any type of allergies to foods, plants, pets and any other allergen can trigger symptoms and should be avoided
• Environmental toxins – pollution, cigarette smoke and other environmental chemicals, can all trigger symptoms
• Food additives – especially artificial colours, flavours and preservatives should be completely avoided as they can trigger symptoms in sensitive individuals

The triggers above should all be eliminated and then re-introduced one by one, a little at a time to determine if and what type of effect they have.

Nutritional supplementation should also be given and changes to lifestyle need to occur, to help provide a better quality of life.

Saline is an excellent way to wash out the possible allergens from the eyes and nasal passages and so should be used in the first instance to reduce symptoms.

Caring for someone with allergic rhinitis

Partner

There are a number of ways a partner of someone with allergic rhinitis can help:

• Dusting and cleaning – since many people with allergic rhinitis have an allergic reaction to dust, a partner should try to take on as much of the dusting and cleaning as possible to reduce triggering symptoms
• Natural cleaners – many people with allergic rhinitis often have a reaction to the chemicals in household cleaning products, so always buy natural ones to prevent triggering symptoms, including laundry liquid, which is a common trigger for causing symptoms associated with allergic rhinitis, due to the strong chemicals used in them
• No smoking – if your partner smokes, they should either quit or not smoke inside the home, as cigarette smoke is one of the most common allergens that causes the symptoms associated with allergic rhinitis
• Remove carpeting – if it is possible, remove all the carpeting inside the home. Carpets are full of dust, dust mites and other possible allergens and no matter how many times they are steam cleaned, they still contain possible allergens. Instead of carpet, use hardwood, tiles, ceramic or marble flooring which greatly reduce the amount of dust collected
• Support – providing love and support to a partner who has this irritating condition is very powerful in helping them relax and reducing symptoms

Friends

There are a number of ways that friends can help support someone who has allergic rhinitis:

• Less perfumes – if your friend is allergic to perfumes, then try to wear less when you see them, to prevent them having an allergic reaction
• Support – providing love and support to a friend who has this irritating condition is very powerful in helping them relax and reducing symptoms

Parents

There are a number of things parents can do for their children, to help reduce symptoms:

• Air out bed linen and pillows – all bed linen and pillows should be aired out on a regular basis (weekly or fortnightly) in full sunlight for at least 3-4 hours. This is an effective way to kill the dust mites that may be residing in the bed linen and pillows
• Dusting and cleaning – always do the dusting and cleaning when your child is not home, to prevent the dust (and dust mites) that are being released in the air from triggering their symptoms
• Natural cleaners – many people with allergic rhinitis often have a reaction to the chemicals in household cleaning products, so always buy natural ones to prevent triggering symptoms, including laundry liquid, which is a common trigger for causing symptoms associated with allergic rhinitis, due to the strong chemicals used in them
• No smoking – if you or your partner smokes and if quitting is not an option, then ensure neither of you smoke inside the home, as cigarette smoke is one of the most common allergens that causes the symptoms associated with allergic rhinitis
• Reduce chemical products in the home – any type of air fresheners, carpet or room deodorisers, perfumes, hair products, nail products and household cleaners, generally all have some type of synthetic chemicals which may be a trigger in causing symptoms in your child. Try to either use these products when your child is not home and air out the home so their symptoms are not triggered, or best of all, use organic, natural products which are made to be hypoallergenic and unlikely to cause an allergic reaction
• Remove carpeting – if it is possible, remove all the carpeting inside the home. Carpets are full of dust, dust mites and other possible allergens and no matter how many times they are steam cleaned, they still contain possible allergens. Instead of carpet, use hardwood, tiles, ceramic or marble flooring which greatly reduce the amount of dust collected
• Support – providing love and support to a child who has this irritating condition is very powerful in helping them relax and reducing symptoms

References

Last reviewed and updated: 14 May 2024