Allergic Rhinitis in Otolaryngology

Introduction:

Allergic rhinitis, also known as “hay fever,” is caused due to irritation to the nose from natural or chemical irritants like pollens, dust mites, or molds while breathing. Exposure to these allergens releases natural chemical substances in the body called histamines. Histamines are the natural chemical substances that are released in the body after the body comes into contact with allergic substances. Allergic rhinitis does not spread on contact (non-contagious).

What Is the Prevalence of Allergic Rhinitis?

The prevalence of allergic rhinitis is 15 to 20 percent of the total population.

What Is the Incidence of Allergic Rhinitis?

The incidence of allergic rhinitis is more common in children in the age group of 7 to 13 years old.

What Are the Types of Allergic Rhinitis?

Allergic rhinitis is classified into two types:

• Seasonal (Intermittent): Around 20 percent of cases are seasonal. It is caused due to exposure to pollen or spores in the air.

• Perennial (Chronic): Around 40 percent of cases are perennial (long-lasting). It occurs due to exposure to dust mites or molds.

What Are the Causes of Allergic Rhinitis?

Allergic rhinitis occurs due to exposure to allergens like:

• Pollen.

• Dust mites.

• Molds.

• Pet dander (contact with fur, hairs, urine, or saliva of animals).

• Insects.

• Grass.

• Weeds.

• Latex.

• Food allergies.

What Are the Signs and Symptoms of Allergic Rhinitis?

Signs and symptoms associated with allergic rhinitis are:

• Irritation or itching in the nose.

• Runny nose.

• Nasal blockage.

• Watery eyes.

• Redness of the eye.

• Headaches.

• Sneezing.

• Fatigue.

• Body pain.

• Sore throat.

• Pain in the sinus (empty cavities within the skull bone).

• Fever.

• Difficulty in breathing.

• Swollen eyes.

• Coughing.

How Is Allergic Rhinitis Diagnosed?

Various diagnostic tests performed to rule out allergic rhinitis are:

• History and Clinical Examination: A detailed history of the patient for the presenting symptoms and previous history of allergies are recorded. Clinical examination is done by an ENT (ear, nose, and throat specialist) to check for mouth breathing in the patient due to difficulty in breathing from the nose, watery eyes, and scratchy throat due to postnasal drip (secretions from nose dripping down in the throat).

• Skin Prick Test: It is a painless test to identify the particular allergen causing allergic reactions. This test is done by placing the sample of the allergens on the forearm. Allergic reactions in response to the allergens present as redness and itching in the exposed area within 15 to 30 minutes if the person is allergic. It is one of the effective methods to identify the allergic substances causing allergic rhinitis.

• Serum Immunoglobulin Test: An allergen-specific serum IgE (immunoglobulin E) test helps to rule out allergies. Immunoglobulin E (IgE) is raised in the blood in response to allergens.

• Complete Blood Count (CBC): This test is the most common and simple. It shows increased eosinophil (white blood cells) cell count in the blood in response to allergens.

What Is the Treatment of Allergic Rhinitis?

Several methods are used to manage allergic rhinitis:

Conservative Management:

• Nasal Saline Rinses: Rinsing of the nose with saline solution (salt water) helps to clear the nasal blockage.

• Humidifier: Inhalation of hot water steams helps to clear nasal congestion and also improves breathing efficiency.

Medicinal Therapy:

• Steroid Therapy: Single therapy with intranasal corticosteroids or in combination with antihistamines is the first line of treatment for reducing the mild to severe symptoms of allergic rhinitis. Intranasal steroid therapy has been proven to be effective in reducing the swelling of the nose. Oral and injectable steroids are avoided due to their systemic side effects. Topical steroids drugs that are used in allergic rhinitis are:

1. Budesonide.

2. Beclomethasone.

3. Fluticasone propionate.

4. Triamcinolone acetonide.

• Antihistamines: These drugs are prescribed by the doctor to decrease histamine release and reduce the symptoms. Antihistamine drugs are given in the form of pills or intranasal sprays. The following are the Aantihistamines drugs that can be used:

1. Loratadine.

2. Cetirizine.

3. Diphenhydramine.

4. Chlorpheniramine.

5. Hydroxyzine.

6. Fexofenadine.

7. Azelastine (intranasal).

• Leukotrienes Receptors Antagonist (LTRA): It is also used to minimize the symptoms associated with allergic rhinitis. Drugs that are used are the following:

1. Montelukast.

2. Zafirlukast.

• Nasal Decongestants: Nasal decongestants are used to clear nasal blockage. The following intranasal decongestants are prescribed:

1. Xylometazoline.

2. Oxymetazoline.

Associated Risk: Intranasal decongestants are prescribed to the patient for one week. Prolonged use of nasal decongestants can result in rebound nasal congestion (rhinitis medicamentosa - The swelling of the nasal tissue due to intranasal drug abuse).

• Sublingual Immunotherapy (SLIT) or Subcutaneous Immunotherapy (SCIT): These therapies are indicated in patients in whom pharmacotherapy or medicinal therapy is ineffective.

Dose Schedule: These therapies are provided for six to eight months in weekly increasing doses. Maintenance doses are given for three to five years. Doses are then stopped once the patient starts feeling protected effectively.

• Oral Decongestants: It also helps to reduce the symptoms of allergic rhinitis. Oral decongestants like pseudoephedrine are prescribed to the patient. However, prolonged use of these drugs is also avoided due to their systemic side effects.

• Mast Cell Stabilizers: Drugs like Sodium Cromoglycate are prescribed to the patient to control symptoms like sneezing, runny nose, and nasal irritation or itching. Mast cell stabilizers act by blocking the release of histamine (chemical substances) across the cell membranes and inhibit degranulation (releasing of granules) of mast cells in the body.

• Eye Drops: It is prescribed by the doctor to treat itchy, watery, and swollen eyes.

How Can One Prevent Allergic Rhinitis?

Allergic rhinitis is not preventable; however, symptoms can be controlled by:

• Maintaining hand hygiene after coming in contact with animals.

• Avoid dust allergies by taking protective measures like masks and gloves while cleaning or dusting.

• Take showers before bed to keep yourself free from allergens.

• Wear eye protection glasses while going outside.

• Keep your bedsheets and bedcovers clean by washing them in hot water.

• Keep your windows closed in the spring or autumn seasons to avoid exposure to pollen.

Conclusion:

Allergic rhinitis is a common condition that affects the quality of life of the patient. It can result in symptoms like nasal irritation, nose blockage, watery eyes, sneezing, and breathing difficulties. Allergic rhinitis in patients with systemic diseases like bronchial asthma can cause worsened symptoms. Early diagnosis and management of the condition are important to prevent the worsening of the symptoms.