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Allergic Rhinitis

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Allergic Rhinitis

In the United States, there are more than 3 million cases of Allergic Rhinitis a year.

Allergic rhinitis, often called hay fever, is a condition that affects 40 to 60 million Americans. Allergies occur because the body overreacts to certain substances that are not actually harmful, signaling the immune system to release histamine and other inflammatory chemicals.

Allergic Rhinitis Causes:

Allergies can happen to anyone at any time at any age. However, you are more likely to develop allergic rhinitis if you have a family history of allergies. Families share the same genetics and environments and tend to eat the same foods.

Allergic rhinitis is often categorized into two types, but they often overlap:

  • Seasonal: Seasonal allergic rhinitis occurs during seasonal changes-in spring, summer and early fall. It is usually caused by allergic sensitivity to airborne mold spores or to pollens from grass, trees and weeds.
  • Perennial: Perennial allergic rhinitis causes symptoms year-round. It is generally caused by dust mites, pet hair or dander, cockroaches or mold.

Equally, if not more commonly, sensitivities to foods and food additives and yeast overgrowth create symptoms very similar to traditional allergic rhinitis. Allergy testing, which is specific for an IgE or histamine type response, is often negative in these cases, hence the term, nonallergic rhinitis.

Allergic Rhinitis Symptoms:

Typical symptoms of allergic rhinitis are sneezing, itching, watery eyes, postnasal drip, sinus headaches, nasal congestion, nasal obstruction, thick phlegm, throat clearing, and hoarseness. Allergies can also cause migraine headaches, snoring, chronic fatigue, ear infections, sinus infections and asthma. People who suffer from chronic allergic rhinitis conditions can become depressed and incapacitated if their symptoms are not controlled.

Allergic Rhinitis Diagnosis:

Diagnostic testing is done primarily by two methods: scratch testing (or subcutaneous injections) or blood testing (RAST). Both tests have about a 50% sensitivity rate in terms of allergic rhinitis, because they are indirectly testing the skin and blood (IgE) to see if it correlates with a mucosal allergic response (IgA). If these tests are positive, they are accurate, but if they are negative it does not mean you do not have allergies. Sometimes you can have allergic symptoms, but they are not happening from IgE specific pathways. Food sensitivities are an example of this.

There is more involved blood testing depending on symptoms and history. Even with these tests (ALCAT, Genova diagnostic, etc) which can be expensive and generally not covered by insurance, the cause of your symptoms is not easily identified. Keeping a food diary or symptom diary related to your environment can be quite helpful.

Allergic Rhinitis Treatments:

Treatments are aimed at resolving the symptoms as well as the cause.

For treatment of symptoms, options are:

  • Nasal irrigation – This can be done with a Neti pot or squeeze bottle purchased over the counter with pre-made saline packets. If you want to make your own irrigation you can use this recipe:
      • 16 oz boiled or distilled water with ¼ tsp sea or kosher salt
      • You can also use additives, such as a drop of oregano oil, a drop of baby shampoo, a few drops of hydrogen peroxide, or probiotics.
  • Oral supplements – such as bromelain, quercetin, oregano oil, probiotics, berberine, arnica, fish oil, etc, to decrease mucous production and reduce inflammation.
  • Medicated nasals prays – These can be over the counter or prescribed. They are effective in treating symptoms but do not address the cause.
      • Corticosteroids (i.e. Flonase, Nasonex, Nasocort, etc)
      • Antihistamines (i.e Astelin, Patanase, Astepro)
      • Combination sprays (i.e.Dymista)
      • Vasoconstrictors (i.e. Afrin, Vicks, Mucinex) – These spray are addictive after a few days, so should be used sparingly.
  • Decongestants – These can help relieve a stuffy nose, but they shouldn’t be used regularly because they are drying and can cause high blood pressure and anxiety. (pseudoephedrine or  phenylephrine)
  • Antihistamines – These can ease your symptoms, but they work best preventatively, before you feel a reaction. They are also often sedating. (i.e. Benadryl, Claritin, Allegra, Clarinex, Zyrtec, Xyzal, etc)

For treatments of causes, options are:

  • Immunotherapy – This is a treatment to desensitize your body’s reaction to allergens by introducing small amount of the allergen into your body and increasing that amount very slowly, over the course of 1-3 years.
  • Allergy shots – Allergens are administered with injections into the muscle (allergy shots). They require weekly, biweekly or monthly office visits and have a risk of anaphylaxis.
  • Sublingual Immunotherapy, or SLIT – Allergens are administered as drops under the tongue and represent true homeopathy. They have similar efficacy to shots without the risk of anaphylaxis. Although they require minimal office visits, but you must remember to administer the drops yourself every day. SLIT is ideal for patients who travel often or have an erratic schedule.
  • Cleansing diets – These treatments remove foods that are most commonly allergenic to see if your symptoms improve. You can then add foods back in one by one to  identify causative factors.

Air filters and environmental changes – Often, the source of your symptoms comes from something you are breathing in every day. If you take a lot of allergy medications and your symptoms do not improve, it may be because you are constantly exposed to allergens in your home or office. Black mold is very common in New York City apartments and old houses, as are environmental toxins. Air filters, such as a the Venta Airwasher and Winix Plasmawave, can help clean your immediate environment if you place them near your bed when you sleep or near your desk at work. In cases of black or toxic mold, professional cleaning is usually required.

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Linda D. Dahl, MD