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Hay Fever and Seasonal Allergies
Hay fever produces the symptoms the general public usually
associates with an allergy: sneezing, a runny nose and
red, itchy eyes. Although hay fever is generally
associated with pollen, it can be a reaction to many types
of airborne allergens: pollens, dust, animal dander, molds
and feathers.
Wind can spread tree and flower pollen over great
distances: you can have an allergic reaction to plants
hundreds of miles away. Needless to say, avoiding hay
fever allergens can be difficult, particularly on windy
days. People who react adversely to pollen often have
seasonal allergies: the amount of allergen present in the
environment varies according to the time of year. Animal
dander, dust and molds can cause reactions year-round.
Rhinitis
Rhinitis is a term describing the symptoms
produced by nasal irritation or inflammation. Symptoms of rhinitis include
runny nose, itching, sneezing and stuffy nose due to blockage or
congestion. These symptoms are the nose's natural response to inflammation
and irritation. Arbitrarily, rhinitis lasting less than six weeks is
called acute rhinitis, and persistent symptoms are called chronic
rhinitis. Acute rhinitis is usually caused by infections or chemical
irritation. Chronic rhinitis may be caused by allergy or a variety of
other factors.
The nose normally produces mucus, which traps
substances like dust, pollen, pollution, and germs such as bacteria and
viruses. Mucus flows from the front of the nose and drains down the back
of the throat. When mucus production is excessive, it can flow from the
front, as a runny nose, or become noticeable from the back, as post-nasal
drip. Nasal mucus, normally a thin, clear liquid, can become thick or
colored, perhaps due to dryness, infection or pollution. When post-nasal
drip is excessive, thick, or contains irritating substances, cough is the
natural response for clearing the throat. Itching and sneezing are also
natural responses to irritation caused by allergic reactions, chemical
exposures including cigarette smoke, or temperature changes, infections
and other factors.
What is sinusitis?
Sinusitis is inflammation or infection of any
of the four groups of sinus cavities in the skull, which open into the
nasal passages. Sinusitis is not the same as rhinitis, although the two
may be associated and their symptoms may be similar. The terms "sinus
trouble" or "sinus congestion" are sometimes wrongly used to mean
congestion of the nasal passage itself.
What is allergic rhinitis?
Known to most people as hay fever, allergic
rhinitis is a very common medical problem affecting more than 15 percent
of the population, both adults and children. Allergic rhinitis takes two
different forms seasonal and perennial. Symptoms of seasonal allergic
rhinitis occur in spring, summer and/or early fall and are usually caused
by allergic sensitivity to pollens from trees, grasses or weeds, or to
airborne mold spores. Other people experience symptoms year-round, a
condition called "perennial allergic rhinitis." It's generally caused by
sensitivity to house dust, house dust mites, and animal dander and/or mold
spores. Underlying or hidden food allergies are considered a possible
cause of perennial nasal symptoms. Some people may experience both types
of rhinitis, with perennial symptoms worsening during specific pollen
seasons. As will be discussed later, there are also other causes for
rhinitis.
What causes the sneezing, itchy eyes and other symptoms?
When a sensitive person inhales an allergen
(allergy-causing substance) like ragweed pollen, the body's immune system
reacts abnormally with the allergen. The allergen binds to allergic
antibodies (immunoglobulin E) that are attached to cells that produce
histamine and other chemicals. The pollen "triggers" these cells in the
nasal membranes, causing them to release histamine and the other
chemicals. Histamine dilates the small blood vessels of the nose and
fluids leak out into the surrounding tissues, causing runny noses, watery
eyes, itching, swelling and other allergy symptoms. Antibodies circulate
in the blood stream, but localize in the tissues of the nose and in the
skin. This makes it possible to show the presence of these antibodies by
skin testing, or less commonly, by a special blood test. A positive skin
test mirrors the type of reaction going on in the nose.
No hay, no fever so why "Hay Fever?"
"Hay fever" is a turn-of-the-century term
which has come to describe the symptoms of allergic rhinitis, especially
when it occurs in the late summer. However, the symptoms are not caused by
hay (ragweed is one of the main culprits) and are not accompanied by
fever. So physicians prefer the term "allergic rhinitis" because it's more
accurate. Similarly, springtime symptoms are sometimes called "rose
fever," but it's just coincidental that roses are in full-bloom during the
grass-pollinating season. Roses and other sweet-smelling, showy flowers
rely on bees, not the wind, for pollination, so not much of their pollen
gets into the air to cause allergies.
Is there any escape?
A common question from allergic rhinitis
sufferers is: Can I move someplace where my allergies will go away?
Allergist-immunologists seldom recommend moving to another locale as a
cure for allergies. A move may be of questionable value because a person
may escape one allergy to ragweed, for example only to develop sensitivity
to grasses or other allergens in the new location. Since moving can have a
disrupting effect on a family financially and emotionally, relocation
should be undertaken only after consultation with an
allergist-immunologist.
Is allergic rhinitis ever the cause of other problems?
Some known complications include ear
infections, sinusitis, recurrent sore throats, cough, headache, fatigue,
irritability, altered sleep patterns and poor school performance.
Occasionally, children may develop altered facial growth and orthodontic
problems. Allergy treatment can eliminate or alleviate most of these
problems.
Are all cases of rhinitis caused by allergies?
Rhinitis may result from many causes other
than allergic reaction. Not all rhinitis symptoms are the result of
allergies. The most common condition causing rhinitis is the common cold,
an example of infectious rhinitis. Most infections are relatively
short-lived, lasting from three to seven days. Colds can be caused by any
one of more than 200 viruses. Children, particularly young children in
school or day care centers, may have from eight to 12 colds each year.
Fortunately, the frequency of colds lessens after immunity has been
produced from exposure to many viruses. Colds usually begin with a
sensation of congestion, rapidly followed by runny nose and sneezing. Over
the next few days, congestion becomes more prominent, the nasal mucus may
become colored, and there may be a slight fever and cough. Cold symptoms
resolve within a couple of weeks, although a cough may sometimes persist.
Cold symptoms that last longer may be due to other causes, such as chronic
rhinitis or sinusitis.
What are other causes of rhinitis?
Not all symptoms in the nasal passage are
caused by allergy or infection. Similar symptoms can be caused by
mechanical blockage, use of certain medications, irritants, temperature
changes or other physical factors. Rhinitis can also be a feature of other
diseases and medical conditions. Drug-induced nasal congestion can be
caused by birth control pills and other female hormone preparations,
certain blood pressure medications and prolonged use of decongestant nasal
sprays. Decongestant nasal sprays work quickly and effectively, but they
alter how the nasal passages normally work. After a few weeks of use,
nasal tissues swell after the medication wears off. The only thing that
seems to relieve the obstruction is more of the medicine, and the
medication's effect lasts shorter lengths of time. Permanent damage to the
nasal tissues may result. Consultation with a physician to "get off" the
medication is often necessary. Cocaine also alters how the nasal passages
normally work, causing a condition identical to, or even more severe than
that produced by decongestant nasal sprays. If you use cocaine, it is
important to tell your physician so that appropriate therapy can be
prescribed. Irritant rhinitis, or "vasomotor rhinitis" describes a group
of poorly understood causes of rhinitis, with symptoms not caused by
infection or allergy. Many people have recurrent or chronic nasal
congestion, excess mucus production, itching, and other nasal symptoms
similar to those of allergic rhinitis, but the disorder is not caused by
allergy.
What triggers vasomotor rhinitis?
Irritants that can trigger vasomotor rhinitis
include cigarette smoke, strong odors and fumes including perfume, hair
spray, other cosmetics, laundry detergents, cleaning solutions, pool
chlorine, car exhaust and other air pollution. Other irritants are spices
used in cooking, alcoholic beverages (particularly beer and wine),
aspirin, and certain blood pressure medications. Some people are very
sensitive to abrupt changes in weather or temperature. Skiers often
develop a runny nose, but in some people any cold exposure may cause a
runny nose. Others start sneezing when leaving a cold, air conditioned
room. These agents are not allergens, do not induce formation of allergic
antibodies and do not produce positive skin test reactions. Occasionally,
one or two positive skin tests may be observed, but they do not match with
the history and are not relevant or significant. The cause of vasomotor
rhinitis is not well understood. In a sufficiently high concentration,
many odors will cause nasal irritation in almost anyone. Some people are
unusually sensitive to irritation and will have significant nasal symptoms
even when exposed to low concentrations of irritants. Thus, vasomotor
rhinitis seems to be an exaggeration of the normal nasal response to
irritation, occurring at levels of exposure which don't bother most
people. It occurs more often in smokers and older individuals. As is the
case with allergic rhinitis, vasomotor rhinitis often can't be cured.
Fortunately, symptoms can be kept under control by avoiding or reducing
exposure to substances that cause symptoms and by taking medication when
needed. Patients with vasomotor rhinitis should not smoke or permit
smoking in their homes. Dryness of the nasal tissues can be a normal
effect of aging, or a characteristic of a nasal condition associated with
a foul smelling nasal discharge. Rhinitis can also be a feature of
endocrine disease, like hypothyroidism, or can occur during pregnancy.
Rhinitis can be made worse or even improved during pregnancy. Alcoholic
beverages can cause the blood vessels in the nose to enlarge temporarily
and produce significant nasal congestion.
How do you know what kind of rhinitis you have?
Consult your physician. Sometimes several
conditions can coexist in the same person. In a single individual,
allergic rhinitis could be complicated by vasomotor rhinitis, septal
deviation (curvature of the bone separating the two sides of the nose) or
nasal polyps. Use of spray decongestants for chronic sinusitis, septal
deviation or vasomotor rhinitis may cause rhinitis medicamentosa. Any of
these conditions will be made worse by catching a cold. Nasal symptoms
caused by more than one problem can be difficult to treat, often requiring
the cooperation of an allergist-immunologist and an otolaryngologist (ear,
nose and throat specialist). How is allergic rhinitis diagnosed?
Your allergist-immunologist may begin by
taking a detailed history, looking for clues in your lifestyle that will
help pinpoint the cause of your symptoms. You'll be asked about your work
and home environments, your eating habits, your family's medical history,
the frequency and severity of your symptoms, and miscellaneous matters,
such as if you have pets. Then, you may require some tests. Your
allergist-immunologist may employ skin testing, in which small amounts of
suspected allergen are introduced into the skin. Skin-testing is the
easiest, most sensitive and generally least expensive way of making the
diagnosis. Another advantage is that results are available immediately. In
rare cases, it also may be necessary to do a special blood test for
allergens, using the RAST or other methods.
How is rhinitis treated?
When no specific cure is available, options
are ignoring your symptoms, avoiding or decreasing exposure to irritants
or allergens to the extent practical, and taking medications for symptom
relief. Once allergic rhinitis is diagnosed, treatment options include
avoidance, medication and immunotherapy (allergy shots).
Avoidance - A single ragweed plant may release one million pollen
grains in just one day. The pollen from ragweed, grasses and trees is so
small and buoyant that the wind may carry it miles from its source. Mold
spores, which grow outdoors in fields and on dead leaves, also are
everywhere and may outnumber pollen grains in the air even when the pollen
season is at its worst. While it's difficult to escape pollen and molds,
here are some ways to lessen exposure. Keep windows closed and use
air-conditioning in the summer, if possible. Automobile air conditioners
help, too. The outdoor air is most heavily saturated with pollen and mold
between 5 and 10 a.m., so early morning is a good time to limit outdoor
activities. Wear a dust mask when mowing the lawn, raking leaves or
gardening, and take appropriate medication beforehand.
Medication - When avoidance measures don't control symptoms,
medication may be the answer. Antihistamines and decongestants are the
most commonly used medications for allergic rhinitis. Nasal corticosteroid
sprays reduce the inflammation from the allergic trigger. Medications help
to alleviate nasal congestion, runny nose, sneezing and itching. They are
available in many forms, including tablets, nasal sprays, eye drops and
liquids. Some medications may cause side effects, so its best to consult
your allergist-immunologist if there's a problem.
Immunotherapy - Allergen
immunotherapy, known as "allergy shots," may be recommended for persons
who don't respond well to treatment with medications, experience
side-effects from medications or have allergen exposure which is
unavoidable. Immunotherapy does not cure allergies but can be very
effective in controlling allergic symptoms. Allergy injections are usually
given at variable intervals over a period of three to five years. An
immunotherapy treatment program consists of injections of a diluted
allergy extract, administered frequently in increasing doses until a
maintenance dose is reached. Then, the injection schedule is changed so
that the same dose is given with longer intervals between injections.
Immunotherapy helps the body build resistance to the effects of the
allergen, reduces the intensity of symptoms caused by allergen exposure,
and sometimes can actually make skin test reactions disappear. As
resistance develops, symptoms should improve, but the improvement from
immunotherapy will take several months to occur. Immunotherapy does not
help the symptoms produced by non-allergic rhinitis. There are many ways
of treating allergies, and each person's treatment must be individualized
based on the frequency, severity and duration of symptoms and on the
degree of allergic sensitivity. If you have more questions, your
allergist-immunologist will be happy to answer them.
About Antihistamines
Antihistamines are the most inexpensive and
commonly used treatment for rhinitis. These medications counter the
effects of histamine, the irritating chemical released within your body
when an allergic reaction takes place. Although other chemicals are
involved, histamine is primarily responsible for causing the symptoms.
Antihistamines do not cure, but help relieve: nasal allergy symptoms, such
as sneezing, itching and discharge; eye symptoms, such as itching,
burning, tearing, and clear discharge; skin conditions, such as hives,
eczema, itching and some rashes; and other allergic conditions as
determined by your physician. There are dozens of different antihistamines
and wide variations in how patients respond to them. Some are available
over-the-counter and others require a prescription. Generally, they work
well and produce only minor side effects. The body tends to build up
resistance to some antihistamines over time. This tendency varies from
individual to individual. If you find that an antihistamine loses its
"strength," notify your physician who may then recommend an antihistamine
of a different class or strength. Persons with nasal dryness or thick
nasal mucus should avoid taking antihistamines without consulting a
physician. Contact your physician for advice if an antihistamine causes
drowsiness or other side effects.
Proper use: Short-acting antihistamines can be taken every four to six
hours, while timed-release antihistamines are taken every 24 hours. The
short-acting antihistamines are often most helpful taken 30 minutes before
anticipated allergic exposure (picnic during ragweed season).
Timed-release antihistamines are better suited to chronic (long-term) use
for those who need daily medications. The most effective way to use them
is before symptoms develop. A dose taken early can eliminate the need for
many later to reduce established symptoms
Side effects: The most common side effect is sedation or drowsiness.
For this reason, it is important that you do not drive a car or work with
dangerous machinery the first time you take an antihistamine. You should
take the antihistamine for the first time at home, several hours before
bedtime. When you are sure that the medicine will not cause sedation, you
then can take it any time as prescribed during the day. In persons who
experience drowsiness, the sedation effect usually lessens over time. Some
of the newer antihistamines have no drowsiness side effects. Another
frequently encountered side effect is excessive dryness of the mouth,
nose, and eyes. Alcohol and tranquilizers increase the sedation side
effects of antihistamines. Important precautions: Do not use more than one
antihistamine at a time, unless prescribed. Keep these medications out of
the reach of children. Know the effect of the medication on you before
working with heavy machinery or driving. Follow your physician's
instructions. There have not been enough studies to determine absolute
safety of antihistamines in pregnancy. Again, consult your
allergist-immunologist or obstetrician if antihistamines must be taken.
What other medications are effective in
treating rhinitis?
Decongestants help relieve the stuffiness and
pressure caused by allergic, swollen nasal tissue. They do not contain
antihistamines, so do not cause antihistamine side effects. They do not
relieve the other symptoms of allergic rhinitis, such as runny nose,
post-nasal drip and sneezing. Decongestants are available as prescription
and non-prescription medications and are often seen in combination with
antihistamines or other medications. It is not uncommon for patients using
decongestants to experience insomnia if taking the medication in the
afternoon or evening. If this occurs, a dose reduction may be needed. At
times, men with prostate enlargement may encounter urinary problems while
on decongestants. Patients using medications for the management of
emotional or behavioral problems should discuss this with their physicians
before using decongestants. Pregnant patients should also check with their
physician before starting decongestants. Non-prescription decongestant
nasal sprays work within minutes and last for hours, but should not be
used for more than a few days at a time without a physician's order. Oral
decongestants are found in many over-the-counter and prescription
medications, and may be the treatment of choice for nasal congestion. They
don't cause rhinitis medicamentosa, but need to be avoided by some
patients with high blood pressure. If you have high blood pressure, you
should check with your physician before using them.
Non-prescription saline nasal sprays will help counteract symptoms of dry
nasal passages or thick nasal mucus. Unlike decongestant nose sprays, a
saline nose spray can be used as often as needed. Sometimes, your
physician may recommend washing (douching) of the nasal passage.
Corticosteroids counteract the inflammation caused by the body's release
of allergy-causing substances, as well as that caused by other
non-allergic factors. Thus, they generally work for many causes of
rhinitis symptoms and are sometimes useful for chronic sinusitis.
Corticosteroids are sometimes injected or taken orally, but usually on a
short-term basis for extremely severe symptoms. Physicians warn that
injected or oral steroids may produce severe side effects when used for
long periods or used repeatedly and, for this reason, they should be used
with extreme caution. In rhinitis, a corticosteroid is much safer when
used by spraying it into the nose. Side effects are less common, but may
include nasal ulceration, nasal fungal infection, or bleeding.
Cromolyn
is a medication that blocks the body's release of allergy-causing
substances. It does not work in all patients. The full dosage is four
times daily, and improvement may take several weeks to occur.
Atropine and the related drug ipratropium bromide are
sometimes used to relieve the runny nose of rhinitis; in fact, most
antihistamines have a slight atropine-like effect. Atropine can be taken
orally and as a nasal spray. It is a component of some antihistamine
decongestant preparations.
Antibiotics are for the treatment of bacterial infections. They do not
affect the course of uncomplicated common colds, and are of no benefit for
non-infectious rhinitis, including allergic rhinitis. In chronic
sinusitis, antibiotics may help only temporarily, and surgery may be
needed.
Eye
allergy preparations are used when the eyes are affected by the same
allergens that trigger rhinitis, causing redness, watery eyes and itching.
Eye preparations are available as prescription and non-prescription
medications. Check with your physician or pharmacist about these
medications.
Nasal surgery will usually cure or improve symptoms caused by mechanical
blockage or chronic sinusitis not responsive to prolonged antibiotics and
nasal steroid sprays. Stopping the use of offending medications will cure
rhinitis medicamentosa, providing that there is no underlying disorder.
Check with your physician or pharmacist if you are unsure about a specific
drug or formula. Medications for the Treatment of Rhinitis
Non-prescription antihistamines All of the non-prescription antihistamines
(combined with decongestants) are "first generation" antihistamines and
generally cause drowsiness, slowed reaction time and dry mouth in most
people. Actifed (and combination products) Alka Seltzer Plus Sinus Allergy
Medicine Allerest (and combination products) A.R.M. BC Cold Powder
Multi-Symptom Formula Benadryl (and combination products) Chlor-Trimeton
(and combination products) Comtrex Multi-Symptom Day/Night Contac Maximum
Strength Coricidin (and combination products) Dimetane Dimetapp (and
combination products) Drixoral (and combination products) PediaCare Night
Rest Cough-Cold Liquid Sinarest Sudafed Plus Tavist (and combination
products) Triaminic Allergy Tylenol Allergy Sinus/Tylenol PM Vicks NyQuil
(and combination products) Vicks Pediatric Formula 44M Cough & Cold Many
brand name and generic formulas are available without prescription. If you
are in doubt as to whether or not a product contains an antihistamine,
consult your physician or pharmacist. Prescription antihistamines The
following medications are "second generation" antihistamines and generally
do not cause the side effects of "first generation" antihistamines, such
as drowsiness, slowed reaction time and dry mouth. Allegra Claritin
Hismanal* Zyrtec** * Can cause cardiac problems when combined with certain
other medications. Check with your physician when taking this medication.
"Exposure to mold infestation can cause severe skin rashes, skin diseases,
and open skin wounds." Phillip Fry, mold expert
Allergy is a
hypersensitive reaction by the body to foreign substances (antigens) that in
similar amounts and circumstances are harmless within the bodies of other
people.
Since one of the most common cores of allergy, asthma and
sinusitis is fungal infections,
as well as polyps, reflux disease and bacteria, you have to
make sure that your home and real estate is free from molds and
mildew, which later may develop into molds, and prevent any of
their future growth.
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To eliminate molds and mildew from your home, office
or other real estate and property, follow the suggestions of the book Do It Yourself
Mold Prevention, Mold Inspection, Testing, & Remediation.
For more information, please visit: Mold
Book.
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To
visit the best internet mold website, please visit:
Mold Inspector.
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To find a
Certified Mold Inspector, Certified Mold Remediator or
Certified
Mold Contractor
in your area, please visit:
Certified Mold Inspector.
-
To find services of a mold lawyer or a
mold attorney,
please visit
Mold Lawyer.
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