My son has allergic rhinitis and asthma. How to manage both?

Question

Hello doctor,

My son, aged 22, suffers from allergic rhinitis every change of season. His IgE level was 325 IU/mL last week. He keeps sneezing, has a blocked nose, and itchy eyes.

Currently, we are using Levocetrizine and a nasal steroid spray, but still not improving fully. So, my concerns are:

Could he be allergic to dust mites or pollen specifically?
Should we consider allergy testing or immunotherapy shots now?
Does long-term nasal spray use have any side effects?
He has mild asthma too, so are these conditions connected in some way, or need different treatment plans for each?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your son's symptoms of sneezing, blocked nose, and itchy eyes during seasonal changes, with a high IgE (immunoglobulin E) level, suggest allergic rhinitis, which commonly involves allergens like dust mites and pollen.

Both dust mites (perennial allergens found indoors) and pollens (seasonal outdoor allergens) can cause such symptoms.

Allergy testing, especially skin prick tests or specific IgE blood tests, is recommended to identify the precise allergens and guide treatment decisions.

Considering immunotherapy (allergy shots) is appropriate when symptoms persist despite standard treatments like antihistamines and nasal steroids, immunotherapy can reduce symptoms and induce long-term tolerance.

To confirm whether your son is specifically allergic to dust mites or pollen, the following tests are commonly used:

Skin prick test (SPT) is the most commonly used, first-line test. Small amounts of specific allergens (such as dust mite extracts and various pollen) are pricked into the skin, usually on the forearm or back. A positive reaction shows as a raised bump (wheal) and redness, typically within 15 to 20 minutes, indicating an allergy to that specific allergen.
Specific IgE blood test, also called ImmunoCAP or RAST (radioallergosorbent test), measures the level of IgE antibodies in the blood against individual allergens like dust mite species (Dermatophagoides farinae, Dermatophagoides pteronyssinus) or various pollens (grass pollen, tree pollen, weed pollen). It is useful when skin testing is contraindicated or inconclusive.
Nasal allergen provocation test is occasionally used to confirm nasal allergy to a particular allergen by applying it directly to the nasal mucosa and observing symptoms.

Long-term use of nasal steroid sprays is generally safe but may cause side effects such as nasal dryness, irritation, nosebleeds, and, rarely, systemic effects like eye issues or hormonal changes. These side effects are uncommon if used as prescribed.

Allergic rhinitis and asthma are interconnected. They share similar inflammatory pathways and may require coordinated treatment.

Medications such as inhaled corticosteroids and leukotriene receptor antagonists can help manage both conditions. Treatment to address both is important, often involving allergen avoidance, pharmacotherapy, and possibly immunotherapy.

I hope you find this helpful.

Thank you.