Your Nose Knows – Allergic Rhinitis

nose itching

Commonly referred to as ‘allergies’, allergic rhinitis is a common experience for a lot of people during the springtime and fall season in response to allergens in the air. In the US, 8% of adults and 7% of children were diagnosed with allergic rhinitis in 2018, according to the Asthma and Allergy Foundation of America[i]. It presents as nose itching and irritation, stuffy or runny nose, and excessive sneezing.

What is Allergic Rhinitis?

Rhinitis is an inflammation of the mucosal lining of the nasal cavities. Normally, a clear, thin layer of mucus covers the delicate skin inside our noses. Due to its sticky nature, it traps dirt, dust, and unwanted microorganisms and prevents them from entering our lungs. Throughout the day, mucus is drained from our noses via the throat and is harmlessly digested in the stomach.

Allergic rhinitis is the body’s allergic response to a particle that most people would not normally react to. In allergic rhinitis, this mucous layer can get inflamed when it is exposed to certain allergens, or when the mucus swallowing mechanism is impaired. The mode of action and cause of an allergic reaction are discussed in detail ahead.

Types of Allergic Rhinitis

The two types of allergic rhinitis are:

Seasonal Allergic Rhinitis

Seasonal allergic rhinitis is also known as hay fever. It occurs during spring and fall in response to pollen from trees, grass, and weeds in the air.

Perennial Allergic Rhinitis

Perennial rhinitis occurs due to allergens that are present throughout the year, like mold, dust mites, cockroach debris, and pet dander.

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Causes

Allergic rhinitis is a Type 1 hypersensitivity reaction that starts immediately after exposure to an allergen. These allergens are so tiny that large quantities can be inhaled straight through the nose or mouth.

The first time the allergen enters the nose, it binds to immune cells that set off a cascade of reactions, producing IgE antibodies and priming the body for further exposure to the irritant. In consequent situations of exposure, an inflammatory response is activated and immune cells release cytokines and histamine. Histamine is a powerful capillary dilator. When the capillaries are dilated, more fluid and immune cells are transported to the site of the allergic reaction.

Since the eyes and nose are vulnerable regions exposed to the external environment, a greater number of immune cells are present at these sites, resulting in allergic symptoms such as nose itching and irritation of the eyes.

The most widespread allergens that commonly result in nose and eye irritation are:

  • Pollen from plants and weeds
  • Cockroach saliva and waste products
  • Mold spores
  • Dust mites from carpets, furniture, curtains, and bedding
  • Dead skin flakes off your pet’s skin
  • Animal hair

Symptoms

The symptoms of allergic rhinitis can occur instantly after exposure to an allergen or can present over a longer period due to long-term exposure.

The symptoms of allergic rhinitis result from excess fluid in facial tissues due to the dilation of capillaries. The most common symptoms of allergic rhinitis are:

  • Nasal congestion due to excess mucus
  • Nose itching
  • Red, itchy eyes
  • Runny nose
  • Sneezing
  • Coughing,
  • Difficulty in breathing, wheezing
  • Stuffy sinuses and related headaches
  • Post nasal drip and sore throat

Diagnosis

There are three major methods of diagnosing allergies that help your doctor determine a suitable treatment and prevention plan.

General Examination

Your doctor may ask questions about your lifestyle and take a history of your symptoms. If you suspect that you have allergic rhinitis, you should keep a dated log of your symptoms to help your doctor determine whether your allergies are seasonal or perennial. For minor allergies, a physical exam may be sufficient to determine the nature of your condition.

Skin Prick Test

A skin-prick test is a safe and quick method of determining allergies. Your doctor will place a series of irritant substances on your skin in a grid and prick the skin to let the allergen invade the surface. This brings them in contact with the internal bodily environment. For each substance, if a red welt arises within the next 15-30 mins, your body is exhibiting a hypersensitive reaction to the allergen.

This method helps doctors determine most allergens that your body adversely reacts to within a span of half an hour.

Radioallergosorbent Test (RAST)

Another test that may be carried out is a RAST blood test that examines the IgE antibodies in your blood. Since antibodies are highly specific, this is the most comprehensive test that can accurately determine all your allergies, including food allergies.

Treatment

For symptoms like nose itching and irritation or red eyes, simply washing your face may suffice. Depending on the severity of your symptoms, your doctor may prescribe medications in the form of pills, syrups, nasal sprays, and drops. The kind of drug prescribed to you takes into account other health conditions such as pregnancy and asthma, so it is best to consult a physician instead of self-medicating.

Antihistamines

Since the release of histamine is the primary reason for allergic symptoms, the use of antihistamines is very effective in treating allergies. It can relieve nose itching, watering and redness of the eyes, and congestion. These are usually taken as pills or syrups, although nasal sprays have shown efficacy, too.

Side effects: Antihistamines can cause drowsiness so it is best to avoid driving and alcohol consumption.

Decongestants

Decongestants are prescribed to treat symptoms like congested nose and sinuses, and runny and irritated nose. However, decongestants must be used for less than 3 days. Over a period of prolonged use, a rebound effect is observed where the symptoms return once use of the medication is discontinued.

Side effects: Decongestants can raise your blood pressure, cause headaches, and can be addictive.

Corticosteroids

Corticosteroids are available in the form of nasal sprays and inhalers and are the most effective treatment option for symptoms of allergic rhinitis. They relieve nose and eye irritation and other common symptoms, without causing a rebound effect. Therefore, these are prescribed for long-term use for allergy management.

Others

Leukotriene inhibitors, immunotherapy, and sublingual immunotherapy treatment are also viable treatment options.

Prevention

Although you may not be able to wholly avoid allergens, you can take measures to reduce your exposure. You can abide by the following general guidelines to prevent irritating ENT symptoms.

  • Use an app to regularly check the air pollen count and stay indoors when pollen counts are high
  • Keep your windows closed in windy weather and during pollination season
  • Wash your hands after petting animals
  • Shower before going to bed to wash off allergens from your body and prevent transmitting pollen and dust to your bedding
  • When outdoors, opt to wear larger sunglasses to protect your eyes from allergens
  • Avoid rubbing your eyes and nose to prevent the transmission of allergens from your hands to your face
  • Don’t groom your pet indoors. Ask a non-allergic person for help when bathing or grooming your pet, preferably outdoors
  • Use dust- and mite-proof bedding and wash it regularly with warm water
  • If possible, apply filters in your air conditioner to reduce the allergens entering your house
  • Use a wet mop to clean floors and surfaces instead of dry sweeping, and use a vacuum cleaner with a HEPA filter

See Also: Shellfish Allergy Testing, Treatment, and Prognosis: A Guideline

Outlook

Allergic rhinitis is not life-threatening. Combined with asthma, rhinitis can get complicated. However, if managed well, your allergies can be a nuisance at worst.

At Family Medicine Austin, we offer top-notch diagnostic services to help you determine the cause, treatment, and prevention plan for your allergies. For more information, visit our website or contact us today!

Family Medicine Austin

Written by Jeannette

I am Jeannette, the medical writing specialist here at Family Medicine Austin. I have over five years of experience working with a range of medical and healthcare across the U.S.