Allergic rhinitis

Diagnosis

To diagnose allergic rhinitis, your doctor typically performs a physical examination, inquiries about your medical history, symptoms, and possible triggers. Your doctor may recommend one or both of the following tests:

• Skin prick test. Allergy skin tests are performed by allergy specialists to identify allergies by pricking small amounts of allergens into the skin on the arm or upper back, then observing for any allergic reactions such as a hive or raised bump within 15 to 20 minutes. The test involves scratching or pricking the skin with a needle to allow the allergen to enter the skin’s surface. If allergic, the area becomes red, itchy, and irritated with raised welts known as wheals, indicating the allergen causing the symptoms, making the skin prick test a safe and effective method for determining allergies.
• Allergy blood test. To determine how your immune system reacts to a particular allergen, a blood sample is forwarded to a laboratory. This test counts the number of immunoglobulin E (IgE) antibodies, which are responsible for allergies, in your circulation.

Treatment

Developing a treatment plan with a healthcare provider can help reduce or eliminate hay fever symptoms once allergens have been identified. Limiting exposure to substances that cause hay fever is the best approach, and over-the-counter medications may suffice for mild symptoms. Prescription medications may be necessary for more severe symptoms. Combining allergy medications may provide the best relief, and multiple options may need to be tried before finding the most effective one.

If a child has hay fever, it is important to discuss treatment options with their healthcare provider since not all medications are suitable for children. It is crucial to read medication labels carefully. Treatment methods for hay fever may involve medications, immunotherapy, and nasal saline rinses.

Medications for hay fever

Nasal corticosteroids. These nasal sprays aid in the prevention and treatment of hay fever’s itchy, runny nose, and nasal congestion. Nasal sprays are frequently the first form of drug suggested because they are the most efficient hay fever treatment for many people.

• Nonprescription nasal sprays such as mometasone, budesonide, fluticasone and triamcinolone.
• Prescription nasal sprays that combine an antihistamine with a steroid such as azelastine with fluticasone and mometasone with olopatadine

Most individuals can safely use nasal corticosteroids as a long-term treatment option. Although some people may experience nose irritation, an unpleasant taste or smell, adverse effects from steroid nasal sprays are infrequent.

Antihistamines. This function by preventing the production of histamine, a substance that causes symptoms when your immune system responds to an allergen. Antihistamines have a limited impact on congestion, although they can aid with itchiness, sneezing, and runny nose. Typically, these medications are taken orally as pills. Antihistamine nasal sprays are another option for treating nasal issues. Antihistamine eye drops can ease itching and irritation in the eyes.

• Oral antihistamines available over-the-counter such as fexofenadine, cetirizine and loratadine.
• Nonprescription nasal sprays such as azelastine.
• Nonprescription eye drops such as ketotifen fumarate and olopatadine.
• Prescription nasal sprays such as olopatadine.

Antihistamines can cause some common side effects such as dryness in the mouth, nose, and eyes. Some oral antihistamines can also cause drowsiness. Additionally, these medications may lead to restlessness, headaches, changes in appetite, sleeping difficulties, and issues related to blood pressure and urination. It is advisable to consult with a healthcare professional before taking antihistamines, especially during pregnancy or breastfeeding, or if you have an enlarged prostate or glaucoma.

Decongestants. Decongestants lessen nasal congestion and swelling-related pressure. They are occasionally taken in combination with other drugs, such as antihistamines, because they do not treat other hay fever symptoms.
There are liquid, pill, and nasal spray forms of decongestants. Additionally, they are offered both with and without a prescription.

• Nasal decongestant sprays such as oxymetazoline and phenylephrine hydrochloride.
• Oral decongestants such as pseudoephedrine.

Increased blood pressure, sleeplessness, irritability, and headache are just a few of the negative effects that oral decongestants can produce. If you have an enlarged prostate, decongestant drugs may make it difficult to urinate. If you have heart disease, high blood pressure, are pregnant, or any of the aforementioned conditions, consult your doctor before taking decongestants.

A decongestant nasal spray shouldn’t be used for longer than 2 to 3 days at a time because prolonged use can exacerbate symptoms (rebound edema).

Cromolyn sodium. Cromolyn sodium is a medication that can alleviate the symptoms of hay fever by inhibiting the release of histamine. For optimal results, it should be used prior to the onset of symptoms. Non-prescription nasal spray formulations of Cromolyn sodium are available, which require multiple daily applications. Additionally, a prescription is needed for the eye drop form. Fortunately, Cromolyn sodium is associated with minimal side effects.

Leukotriene modifier. Montelukast (Singulair) is a prescription tablet that is commonly used to treat allergy-induced asthma by blocking the action of leukotrienes. Leukotrienes are immune system chemicals that cause allergy symptoms like irritation in the nose and excess mucus. This medication is a good alternative to nasal sprays when they can’t be tolerated or for mild asthma. However, one of its side effects is headaches, and in rare cases, it may cause psychological reactions like insomnia, anxiety, depression, and suicidal thoughts. If you experience any unusual psychological symptoms, seek medical advice immediately.

Nasal ipratropium. Ipratropium is a medication that can be obtained as a nasal spray with a prescription. It works by stopping the nose glands from producing excess mucus, thereby providing relief from severe runny nose. However, it is not useful for treating symptoms such as sneezing, itching or congestion.

The drug may cause mild side effects, such as dry nose, nosebleeds, sore throat, and dry and irritated eyes. Occasionally, it can result in more severe side effects like dizziness, blurred vision and difficulties with urination. It is not advisable to use this medication if you have an enlarged prostate or glaucoma.

Oral corticosteroids. Prednisone, a type of corticosteroid medication, may be employed to alleviate severe allergy symptoms. However, as prolonged use of corticosteroids can result in significant adverse effects like cataracts, osteoporosis, and muscle weakness, they are typically administered for only brief durations.

Immunotherapy

Allergy shots. Allergy shots, also known as immunotherapy or desensitization therapy, can change the way your immune system reacts to allergens. If medications are not effective or cause too many side effects for your hay fever symptoms, allergy shots may be recommended. Over a period of 3 to 5 years, regular injections of small amounts of allergens aim to help your body become accustomed to the allergens that cause your symptoms and potentially reduce your reliance on medications. Immunotherapy may be particularly useful for those allergic to animal dander, dust mites, or pollen from trees, grass, or weeds. Additionally, in children, it may help prevent asthma.

Sublingual allergy tablets. Instead of receiving injections, sublingual allergy tablets are taken that dissolve in the mouth and contain very small amounts of the allergen. The tablets are usually taken on a daily basis. While sublingual allergy tablets may not be effective for all types of allergens, they can be helpful for those allergic to dust mites, grass, and ragweed pollen.

Nasal saline rinses

Saline nasal spray. Nasal sprays with saltwater help thin nasal mucus and moisten dry nasal passages. They are non-prescription and may be used as often as required.
Nasal irrigation. Nasal irrigation, or rinsing your nasal passages with saline, is a rapid and efficient technique to clear nasal congestion. Mucus and allergens are flushed from your nose when you rinse. A water-based solution called saline irrigation includes other substances as well as a small amount of salt (sodium).