Allergic rhinitis From Wikipedia, the free encyclopedia Jump to: navigation, search For the play, see

Hay Fever.

Allergic rhinitis, pollenosis or hay fever is an allergic inflammation of the nasal airways. It occurs when an allergen such as pollen or dust is inhaled by an individual with a sensitized immune system, and triggers antibody production. The specific antibody is immunoglobulin E (IgE) which binds to mast cells and basophils containing histamine. IgE bound to mast cells are stimulated by pollen and dust, causing the release of inflammatory mediators such as histamine (and other chemicals).[1] This causes itching, swelling, and mucus production. Symptoms vary in severity between individuals. Very sensitive individuals can experience hives or other rashes. Particulate matter in polluted air and chemicals such as chlorine and detergents, which can normally be tolerated, can greatly aggravate the condition. The first description of hay fever was by John Bostock in 1819. Contents [hide]

1 Classification 2 Signs and symptoms 3 Cause 4 Management

o o o o o

4.1 Antihistamines 4.2 Steroids 4.3 Decongestants 4.4 Desensitization 4.5 Alternative treatments

4.5.1 Dietary

5 Epidemiology 6 References 7 External links

Classification The two categories of allergic rhinitis include:

Seasonaloccurs particularly during pollen seasons. Seasonal allergic rhinitis does not usually develop until after 6 years of age. Perennialoccurs throughout the year. This type of allergic rhinitis is commonly seen in younger children.[2]

Allergic Rhinitis may also be classified as Mild-Intermittent, Moderate-Severe intermittent, Mild-Persistent, and Moderate-Severe Persistent. Intermittent is when the symptoms occurs <4 days per week or <4 consecutive weeks. Persistent is when the symptoms occurs >4 days/week and >4 consecutive weeks. The symptoms are considered mild with normal sleep, no impairment of daily activities, no impairment of work or school, and symptoms is not troublesome. Severe is when it results in sleep disturbance, impairment of daily activities, impairment of school or work, and troublesome symptoms.[3]

Signs and symptoms The early phase of the reaction begins minutes after exposure causing vasodilation, increase vascular permeability, production of nasal secretions, rhinorrhea, itching, sneezing, nasal obstruction. The late phase of the reaction occurs 48 hours after exposure and mainly causes nasal congestion.[4] Characteristic physical findings in individuals who have allergic rhinitis include conjunctival swelling and erythema, eyelid swelling, lower eyelid venous stasis, lateral crease on the nose, swollen nasal turbinates, and middle ear effusion.[5] Sufferers might also find that cross-reactivity occurs.[6] For example, someone allergic to birch pollen may also find that they have an allergic reaction to the skin of apples or potatoes.[7] A clear sign of this is the occurrence of an itchy throat after eating an apple or sneezing when peeling potatoes or apples. This occurs because of similarities in the proteins of the pollen and the food. [8] There are many cross-reacting substances. Some disorders may be associated with allergies: Comorbidities include eczema, asthma, depression and migraine.[9]

Cause Allergies are common. Heredity and environmental exposures may contribute to a predisposition to allergies. It is roughly estimated that one in three people have an active allergy at any given time and at least three in four people develop an allergic reaction at least once in their lives. Allergic rhinitis triggered by the pollens of specific seasonal plants is commonly known as "hay fever", because it is most prevalent during haying season. However, it is possible to suffer from hay fever throughout the year. The pollen which causes hay fever varies between individuals and from region to region; generally speaking, the tiny, hardly visible pollens of wind-pollinated plants are the predominant cause. Pollens of insect-pollinated plants are too large to remain airborne and pose no risk. Examples of plants commonly responsible for hay fever include:

Trees: such as pine, birch (Betula), alder (Alnus), cedar, hazel, hornbeam (Carpinus), horse chestnut (Aesculus), willow (Salix), poplar, plane (Platanus), linden/lime (Tilia) and olive (Olea). In northern latitudes birch is considered to be the most important allergenic tree pollen, with an estimated 1520% of hay fever sufferers sensitive to birch pollen grains. Olive pollen is most predominant in Mediterranean regions. Grasses (Family Poaceae): especially ryegrass (Lolium sp.) and timothy (Phleum pratense). An estimated 90% of hay fever sufferers are allergic to grass pollen. Weeds: ragweed (Ambrosia), plantain (Plantago), nettle/parietaria (Urticaceae), mugwort (Artemisia), Fat hen (Chenopodium) and sorrel/dock (Rumex)

Allergy testing may reveal the specific allergens an individual is sensitive to. Skin testing is the most common method of allergy testing. This may include intradermal, scratch, patch, or other tests. Less commonly, the suspected allergen is dissolved and dropped onto the lower eyelid as a means of testing for allergies. (This test should only be done by a physician, never the patient, since it can be harmful if done improperly). In some individuals who cannot undergo skin testing

(as determined by the doctor), the RAST blood test may be helpful in determining specific allergen sensitivity. Management The goal of rhinitis treatment is to prevent or reduce the symptoms caused by the inflammation of affected tissues. In cases of allergic rhinitis, the most effective way to decrease allergic symptoms is to completely avoid the allergen. [10][11] Vasomotor rhinitis can be brought under a measure of control through avoidance of irritants, though many irritants, such as weather changes, are uncontrollable. Allergic rhinitis can typically be treated much like any other allergic condition. Eliminating exposure to allergens is the most effective preventive measure, but requires consistent effort. Many people with pollen allergies reduce their exposure by remaining indoors during hay fever season, particularly in the morning and evening, when outdoor pollen levels are at their highest. Closing all the windows and doors prevents wind-borne pollen from entering the home or office. When traveling in a vehicle, closing all the windows reduces exposure. Air conditioners are reasonably effective filters, and special pollen filters can be fitted to both home and vehicle air conditioning systems.[12] Rinsing is very often recommended as part of the healing process after sinus or nasal surgery. For this rinse, boiled or distilled water is only necessary during recovery from surgery, as the entire contents of the bottle is used.[13] Antihistamines Several antagonistic drugs are used to block the action of allergic mediators, or to prevent activation of cells and degranulation processes. These include antihistamines, cortisone, dexamethasone, hydrocortisone, epinephrine (adrenaline), theophylline and cromolyn sodium. Anti-leukotrienes, such as montelukast, are FDA approved for treatment of allergic diseases.[14] One antihistamine, azelastine, is available as a nasal spray. Antihistamine drugs can have undesirable side-effects, most notably drowsiness. First generation Antihistamine drugs such as Benadryl cause drowsiness but second generation antihistamine such as Zyrtec and Claritin cause less drowsiness.
[15]

Antihistamine drugs can be taken orally to control symptoms such as sneezing, rhinorrhea, itching and conjunctivitis. It is best to take the medication before exposure, especially for seasonal allergic rhinitis. Ophthalmic antihistamines (such as ketotifen) are used for conjunctivitis; intranasal forms are used for sneezing, rhinorrhea and nasal pruritus.[15] A case-control study found "symptomatic allergic rhinitis and rhinitis medication use are associated with a significantly increased risk of unexpectedly dropping a grade in summer examinations".[16] Another study suggests that drivers who need antihistamine drugs should avoid those that act centrally because they greatly impaired driving behaviour [17] Steroids Systemic steroids such as prednisone are effective at reducing nasal inflammation, but their use is limited by their short duration of effect and the side effects of prolonged steroid therapy. Steroid nasal sprays are effective and safe, and may be effective without oral antihistamines. They take several days to act and so need be taken continually for several weeks as their therapeutic effect builds up with time.

Intranasal corticosteroids are used to control symptoms associated with sneezing, rhinorrhea, itching and nasal congestion. It is an excellent choice for perennial rhinitis.[18] Decongestants Pseudoephedrine is also indicated for vasomotor rhinitis. It is only used when nasal congestion is present and can be used with antihistamines. Oral decongestants containing pseudoephedrine must be purchased behind the pharmacy counter by law to combat the making of methamphetamine.[19] Topical decongestants: may also be helpful in reducing symptoms such as nasal congestion, but should not be used for long periods as stopping them after protracted use can lead to a rebound nasal congestion (Rhinitis medicamentosa). Desensitization More severe cases of allergic rhinitis require immunotherapy (allergy shots) or removal of tissue in the nose (e.g., nasal polyps) or sinuses. Alternative treatments Therapeutic efficacy of complementary-alternative treatments is not supported by currently available evidence.[20][21] Some evidence shows that acupuncture is effective for rhinitis while other evidence does not. The overall quality of evidence, however, is poor.[22] Dietary It is postulated that allergic rhinitis (and other allergies) are the result of immune disorders and in some cases autoimmune disorders.[23] While the cause of these disorders is not discovered in most patients, clinical experience suggests a dietary root cause, led by chronic tissue inflammation.[24] Significant clinical evidence to suggest that diets high in carbohydrate (especially in individuals with concomitant high blood glucose levels),[25] high in omega-6 fatty acids (due to metabolism via eicosanoid pathways) [26] and high in gluten contribute directly to autoimmune disorders.[27] In patients where the dietary autoimmune disorder is addressed, the immune reaction to pollen and other allergens weakens or disappears.[citation needed] There is a growing movement supporting paleolithic diets to address dietary based immune disorders and autoimmune disorders. Diet plans such as PNu [28] attempt to minimize the intake and effect of these common dietary items. Positive experiences are common[citation needed] with low carbohydrate (lowering or eliminating dietary starch and sugars, especially sucrose, fructose and lactose), zero gluten diets. Elimination of inflammation leading to autoimmune disorder is a major effect of a properly designed diet. Significant reduction or elimination of allergic rhinitis can be seen in as little as one or two months following a strict dietary regimen.
[citation needed]

Epidemiology In Western countries between 1025% of people annually are affected by allergic rhinitis.[29] References
1. ^ May JR, Smith PH. Allergic Rhinitis. In: Dipiro JT, Talbert RL, Yee GC, et al

eds.Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York, NY: The McGraw-Hill Companies, Inc; 2008:1565-1575.)
2. ^

"Rush University Medical Center". http://www.rush.edu/rumc/page1098987384061.html. Retrieved 2008-03-05.

3. ^ Bousquet J, Reid J, van Weel C, et al. Allergic rhinitis management pocket

reference 2008. Allergy 2008 Aug; 63 (8):990-996

4. ^ Hansen I, Klimek L, Mosges R, Hormann K. Mediators of inflammation in

the early and the late phase of allergic rhinitis. Curr Opin Allergy Clin Immunol. Jun 2004;4(3):159-63. [Medline]
5. ^ Valet RS, Fahrenholz JM. Allergic rhinitis: update on diagnosis. Consultant.

2009;49:610-613
6. ^ Czaja-Bulsa G, Bachrska J (1998). "[Food allergy in children with pollinosis

in the Western sea coast region]". Pol Merkur Lekarski 5 (30): 33840. PMID 10101519.
7. ^ Yamamoto T, Asakura K, Shirasaki H, Himi T, Ogasawara H, Narita S,

Kataura A (2005). "[Relationship between pollen allergy and oral allergy syndrome]". Nippon Jibiinkoka Gakkai Kaiho 108 (10): 9719. PMID 16285612.
8. ^ Malandain H (2003). "[Allergies associated with both food and pollen]".

Allerg Immunol (Paris) 35 (7): 2536. PMID 14626714.

9. ^ "Allergists Explore Rising Prevalence and Unmet Needs Attributed to

Allergic Rhinitis". ACAAI. November 12, 2006. http://www.acaai.org/public/linkpages/NR+Rising+Prevalence+and+Unmet+ Needs+of+Allergic+Rhinitis.htm. Retrieved 2008-10-01.
10. ^ "The Facts about Hay Fever". Healthlink. University of Wisconsin.

http://healthlink.mcw.edu/article/1031002426.html. Retrieved 2007-06-19.

11. ^ 12. ^

"NHS advice on hayfever". http://www.nhs.uk/Conditions/Hayfever/Pages/Prevention.aspx?url=Pages/Lifestyle.aspx. Steven Jay Weiss. "Seasonal Allergic http://www.suggestadoctor.com/health_article_28.htm. Retrieved 28. Rhinitis". 2009-01-

13. ^ Australian Society of Clinical Immunology and Allergy 14. ^ eMedicine Health Hay Fever Causes, Symptoms, and Treatment on

eMedicineHealth.com
15. ^

May JR, Smith PH. Allergic Rhinitis. In: Dipiro JT, Talbert RL, Yee GC, et al eds.Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York, NY: The McGraw-HillCompanies, Inc; 2008:1565-1575.)
a b

16. ^ Walker S, Khan-Wasti S, Fletcher M, Cullinan P, Harris J, Sheikh A (2007).

"Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study". J. Allergy Clin. Immunol. 120 (2): 3817. doi:10.1016/j.jaci.2007.03.034. PMID 17560637.
17. ^ T Betts, D Markman, S Debenham, D Mortiboy, and T McKevitt.. "Effects of

two antihistamine drugs on actual driving performance.". http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1444070/. Retrieved 1984-0128.

18. ^ May JR, Smith PH. Allergic Rhinitis. In: Dipiro JT, Talbert RL, Yee GC, et al

eds.Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York, NY: The McGraw-HillCompanies, Inc; 2008:1565-1575.
19. ^ May JR, Smith PH. Allergic Rhinitis. In: Dipiro JT, Talbert RL, Yee GC, et al

eds.Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York, NY: The McGraw-HillCompanies, Inc; 2008:1565-1575
20. ^ Passalacqua G, Bousquet PJ, Carlsen KH, Kemp J, Lockey RF, Niggemann B,

Pawankar R, Price D, Bousquet J (2006). "ARIA update: I--Systematic review of complementary and alternative medicine for rhinitis and asthma". J. Allergy Clin. Immunol. 117 (5): 105462. doi:10.1016/j.jaci.2005.12.1308. PMID 16675332.

21. ^ Terr A (2004). "Unproven and controversial forms of immunotherapy". Clin

Allergy Immunol. 18 (1): 70310. PMID 15042943.

22. ^ Witt CM, Brinkhaus B (July 2010). "Efficacy, effectiveness and cost-

effectiveness of acupuncture for allergic rhinitis - An overview about previous and ongoing studies". Auton Neurosci. doi:10.1016/j.autneu.2010.06.006. PMID 20609633.
23. ^ Prevalence of autoimmune thyroid disease in chronic rhinitis 24. ^ Mild adrenocortical deficiency, chronic allergies, autoimmune disorders

and the chronic fatigue syndrome: a continuation of the cortisone story

25. ^ Inflammation and insulin resistance 26. ^ Omega-3 fatty acids in inflammation and autoimmune diseases 27. ^ Celiac disease as a model of gastrointestinal inflammation 28. ^ PNu 29. ^ Dykewicz MS, Hamilos DL (February 2010). "Rhinitis and sinusitis". J.

Allergy Clin. Immunol. 125 (2 doi:10.1016/j.jaci.2009.12.989. PMID 20176255. Definition of Allergic Rhinitis

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S10315.

Allergic rhinitis is an inflammation of the nasal passages, usually associated with watery nasal discharge and itching of the nose and eyes. Description of Allergic Rhinitis Allergic rhinitis affects about 20 percent of the American population and ranks as one of the most common illnesses in the U.S. The symptoms occur in the nose and eyes and usually occur after exposure to dust, danders, or certain seasonal pollens in people that are allergic to these substances. Two-thirds of all patients have symptoms of allergic rhinitis before the age of 30, but onset can occur at any age. Allergic rhinitis has no sexual predilection, although boys up to the age of 10 are twice as likely to have symptoms as girls. There is strong genetic predisposition to allergic rhinitis. One parent with a history of allergic rhinitis has about a 30 percent chance of producing offspring with the disorder; the risk increases to 50 percent if both parents have a history of allergies. Patients can be severely restricted in their daily activities, resulting in excessive time away from school or work. Millions of dollars are spent each year on physician services and medication for treatment of this chronic illness. Causes and Risk Factors of Allergic Rhinitis Many perennial and seasonal allergens cause allergic rhinitis. Dust mites, cockroaches, molds and animal dander, are examples of year-around allergens. Tree, grass and ragweed pollens are primarily seasonal outdoor allergens. Seasonal pollens depend on wind for cross-pollination. Plants that depend on insect pollination, such as goldenrod and dandelions, do not usually cause allergic rhinitis. Mold spores grow in warm, damp environments. The highest mold spore counts occur in early spring, late summer and early fall, but mold spores can be measured indoors year-around.

Animal allergens are also important indoor allergens. The major cat allergen is secreted through the sebaceous glands of the animal's skin. These small, light proteins are capable of staying suspended in the air for up to six hours and can be measured for several months after a cat is removed from an indoor environment. Symptoms of Allergic Rhinitis Characteristic symptoms include repetitive sneezing; rhinorrhea (runny nose); post-nasal drip; nasal congestion; pruritic (itchy) eyes, ears, nose or throat; and generalized fatigue. Symptoms can also include wheezing, eye tearing, sore throat, and impaired smell. A chronic cough may be secondary to postnasal drip, but should not be mistaken for asthma. Sinus headaches and ear plugging are also common Diagnosis of Allergic Rhinitis After a medical history, your physician will perform a physical exam. Often, the nasal mucosa (lining of the nose) is pale or violaceous because of the engorged veins. Nasal polyps may be seen. Classic signs of allergic rhinitis may include swelling of the eyelids, injected sclerae (the whites of the eyes may be red), allergic shiners (darkened areas under the lower eyelids thought to result from venous pooling of blood), and extra skin folds in the lower eyelids. Skin testing may confirm the diagnosis of allergic rhinitis. Initial skin testing is performed by the prick method. Intradermal testing is performed if results of prick testing are negative. Treatment of Allergic Rhinitis (see also SELF-CARE) The goal of treatment is to reduce the allergy symptoms. Avoidance of the allergen or minimization of contact with it is the best treatment, but some relief may be found with the following medications. Antihistamines and Decongestants Oral decongestants alone may be helpful, including pseudoephedrine. Antihistamines are available as tablets, capsules and liquids, and may or may not be combined with decongestants. Common antihistamines include brompheniramine or chlorpheniramine, and clemastine. Non-sedating (less likely to cause drowsiness) long-acting antihistamines include loratidine and fexofenadine. Nasal sprays For rhinorrhea, a nasal spray of cromolyn sodium (Nasalcrom) or a steroid nasal spray, such as flunisolide (Nasalide), beclomethasone dipropionate (Beconase, Vancenase), triamcinolone acetonide (Nasacort), and fluticasone (Flonase), may work so well that additional antihistamines or decongestants are unnecessary. It is important to remember that improvement may not occur for one to two weeks after starting therapy with steroid nasal sprays. Short courses of oral corticosteroids may usually be indicated when severe nasal symptoms prevent the adequate delivery of topical agents. Immunotherapy (Allergy shots) Immunotherapy involves giving gradually increasing doses of the substance (or allergen) to which the person is allergic. This works by making the immune system less sensitive to that substance, probably by causing production of a particular "blocking" antibody, which reduces the symptoms of allergy when the substance is encountered in the future.

Before starting treatment, the physician and patient try to identify trigger factors for allergic symptoms. Skin or sometimes blood tests are performed to confirm the specific allergens to which the person has antibodies. Immunotherapy may be indicated for patients who are:

Unresponsive to medical therapy Have side effects from medications Have recurrent sinusitis or otitis (an ear infection) Are unwilling or unable to use medication Prefer not to use medication on a long-term basis

RAST (a kind of allergy test) testing or skin testing to identify the offending allergens is often a prerequisite to immunotherapy. Immunotherapy is initiated with weekly injections of small amounts of antigen (allergen). The amount of antigen and the length of time between injections are slowly increased. Maintenance injections are usually given once every three to four weeks. The principal side effect of immunotherapy is a local reaction at the injection site, but the risk of anaphylaxis warrants caution. Immunotherapy is not a cure for allergic rhinitis. Approximately 85 percent of all patients obtain long-lasting symptom relief from immunotherapy. After three to five seasons of adequate symptom relief, it may be possible to discontinue immunotherapy. Sixty percent of all patients continue to derive symptomatic benefit, with reduced need for medications after immunotherapy is discontinued. Environmental modification should be maintained during immunotherapy.

Self Care Avoidance measures Seasonal allergens (such as tree, grass and ragweed pollens) are difficult to avoid outdoors, but can be controlled by closing windows and running air conditioners. Excessive exposure to allergens, such as outdoor molds, can be prevented by avoiding lawn mowing and other activities likely to stir these up. Maintaining an allergen-free environment also includes covering pillows and mattresses with plastic covers, substituting synthetic materials (such as foam mattresses or acrylics) for animal products (such as wool or horsehair) and removing dust-collecting household fixtures (like carpets, drapes and bedspreads). Allergic rhinitis is a collection of symptoms, mostly in the nose and eyes, which occur when you breathe in something you are allergic to, such as dust, dander, or pollen. This article focuses on allergic rhinitis due to outdoor triggers, such as plant pollen. This type of allergic rhinitis is commonly called hay fever. For information on other types of allergies, see:

Allergies Allergy to mold, dander, dust Asthma

Back to TopCauses An allergen is something that triggers an allergy. When a person with allergic rhinitis breathes in an allergen such as pollen or dust, the body releases chemicals, including histamine. This causes allergy symptoms such as itching, swelling, and mucus production. Hay fever involves an allergic reaction to pollen. (A similar reaction occurs with allergy to mold, animal dander, dust, and similar inhaled allergens.) The pollens that cause hay fever vary from person to person and from region to region. Large, visible pollens are seldom responsible for hay fever. Tiny, hard to see pollens more often cause hay fever. Examples of plants commonly responsible for hay fever include:

Trees (deciduous and evergreen) Grasses Ragweed

The amount of pollen in the air can play a role in whether hay fever symptoms develop. Hot, dry, windy days are more likely to have increased amounts of pollen in the air than cool, damp, rainy days when most pollen is washed to the ground. Some disorders may be associated with allergies. These include eczema and asthma. Allergies are common. Your genes and environment may make you more prone to allergies. Whether or not you are likely to develop allergies is often passed down through families. If both your parents have allergies, you are likely to have allergies. The chance is greater if your mother has allergies. In-Depth Causes Back to TopSymptoms Symptoms that occur shortly after you come into contact with the substance you are allergic to may include:

Itchy nose, mouth, eyes, throat, skin, or any area Problems with smell Runny nose Sneezing Tearing eyes

Symptoms that may develop later include:

Stuffy nose (nasal congestion) Coughing Clogged ears and decreased sense of smell Sore throat Dark circles under the eyes Puffiness under the eyes Fatigue and irritability

Headache Memory problems and slowed thinking

In-Depth Symptoms Back to TopExams and Tests The health care provider will perform a physical exam and ask you questions about your symptoms. Your history of symptoms is important in diagnosing allergic rhinitis, including whether the symptoms vary according to time of day or the season, exposure to pets or other allergens, and diet changes. Allergy testing may reveal the specific substances that trigger your symptoms. Skin testing is the most common method of allergy testing. See the article on allergy testing for detailed information. If your doctor determines you cannot undergo skin testing, special blood tests may help with the diagnosis. These tests can measure the levels of specific allergyrelated substances, especially one called immunoglobulin E (IgE). A complete blood count (CBC), specifically the eosinophil white blood cell count, may also help reveal allergies. In-Depth Diagnosis Back to TopTreatment The best treatment is to avoid what causes your allergic symptoms in the first place. It may be impossible to completely avoid all your triggers, but you can often take steps to reduce exposure. There are many different medications available to treat allergic rhinitis. Which one your doctor prescribes depends on the type and severity of your symptoms, your age, and whether you have other medical conditions (such as asthma). For mild allergic rhinitis, a nasal wash can be helpful for removing mucus from the nose. You can purchase a saline solution at a drug store or make one at home using one cup of warm water, half a teaspoon of salt, and pinch of baking soda. Treatments for allergic rhinitis include: ANTIHISTAMINES Antihistamines work well for treating allergy symptoms, especially when symptoms do not happen very often or do not last very long. Antihistamines taken by mouth can relieve mild to moderate symptoms, but can cause sleepiness. Many may be bought without a prescription. Talk to your doctor before giving these medicines to a child, as they may affect learning.

Newer antihistamines cause little or no sleepiness. Some are available over the counter. They usually do not interfere with learning. These medications include fexofenadine (Allegra), and cetirizine (Zyrtec).

Azelastine (Astelin) is a antihistamine nasal spray that is used to treat allergic rhinitis.

CORTICOSTEROIDS

Nasal corticosteroid sprays are the most effective treatment for allergic rhinitis.

They work best when used nonstop, but they can also be helpful when used for shorter periods of time. Many brands are available. They are safe for children and adults.

DECONGESTANTS Decongestants may also be helpful in reducing symptoms such as nasal congestion.

Nasal spray decongestants should not be used for more than 3 days.

Be careful when using over-the-counter saline nasal sprays that contain benzalkonium chloride. These may actually worsen symptoms and cause infection. OTHER TREATMENTS The leukotriene inhibitor Singulair is a prescription medicine approved to help control asthma and to help relieve the symptoms of seasonal allergies.

Specific illnesses that are caused by allergies (such as asthma and eczema) may require other treatments. ALLERGY SHOTS Allergy shots (immunotherapy) are occasionally recommended if the allergen cannot be avoided and if symptoms are hard to control. This includes regular injections of the allergen, given in increasing doses (each dose is slightly larger than the previous dose) that may help the body adjust to the antigen. In-Depth Treatment Back to TopOutlook (Prognosis) Most symptoms of allergic rhinitis can be treated. More severe cases require allergy shots. Some people (particularly children) may outgrow an allergy as the immune system becomes less sensitive to the allergen. However, as a general rule, once a substance causes allergies for an individual, it can continue to affect the person over the long term. Back to TopPossible Complications

Sinusitis

Back to TopWhen to Contact a Medical Professional Call for an appointment with your health care provider if severe symptoms of allergies or hay fever occur, if previously successful treatment has become ineffective, or if your symptoms do not respond to treatment. Back to TopPrevention Symptoms can sometimes be prevented by avoiding known allergens. During the pollen season, people with hay fever should remain indoors in an air-conditioned atmosphere whenever possible:

Most trees produce pollen in the spring.

Grasses usually produce pollen during the late spring and summer.

Ragweed and other late-blooming plants produce pollen during late summer and early autumn. Back to TopReferences Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008 Aug:122(2).