**By David Jeong, MD**
Although many think of spring as the time of year when most people are bothered by allergic rhinitis, or hay fever, the condition can affect folks year round depending on what an individual is allergic to at any given time.
As an allergist, I see and treat children and adults with allergic rhinitis 12 months out of the year.
What is allergic rhinitis?
Hay fever is the group of uncomfortable symptoms that occur when your body is exposed to a specific allergen. An allergen is a typically harmless substance that causes an allergic reaction.
When your body comes into contact with an allergen, the immune system recognizes it and signals the release of histamine, among other natural chemicals, from the body. Unfortunately, an excess of histamine can cause uncomfortable symptoms.
As a result, it is important to seek treatment since this condition can interfere with your everyday quality of life.
Types of allergens
Common allergens that can cause this condition include:
- Grasses and weeds
- Dust mites
- Animal dander (old skin) and saliva
- Pollens (Pollens are the biggest allergen culprit during certain seasons – trees during early and mid-spring, grasses during summer and weeds in fall)
Risk factors for allergic rhinitis
Although allergies can affect anyone, they are often genetic. You are more likely to develop allergic rhinitis if your family has a history of allergies.
Other risk factors for developing hay fever include:
- Being male
- Born during pollen season
- Being the firstborn in your family
- Early use of antibiotics
- Maternal smoking exposure in the first year of life
- Exposure to indoor allergens, such as dust mites
Hay fever symptoms
The most common symptoms of allergic rhinitis include:
- Runny nose
- Itchy nose (also eyes, ears and throat)
- Stuffy nose
- Postnasal drip
- Dark circles under eyes
- Eczema-type symptoms (e.g., extremely dry, itchy skin)
- Excessive fatigue
- Frequent headaches
Allergic rhinitis is often associated with asthma, eczema (atopic dermatitis), allergic conjunctivitis, repeated sinus infections and chronic ear congestion (Eustachian tube dysfunction).
Diagnosing allergic rhinitis
Minor allergies usually only require a health history and physical exam. However, your primary care provider may refer you to an allergist for allergy testing to identify your triggers and develop an individualized treatment plan.
Skin prick testing is the most reliable and fastest testing method available. During this test, your doctor uses a prick method to introduce individual allergens onto the surface of your skin (usually the arms and/or back) and watches for a skin reaction at the test site. A small red bump develops if you are allergic to something.
Another often used allergy test is a blood test, which measures the amount of immunoglobin E antibodies (the allergic antibody) to particular allergens in your blood. This blood test is slightly less accurate than the skin test, but is often used when a skin test cannot be done for certain reasons.
When it is diagnosed, allergic rhinitis may be classified as seasonal and/or perennial (year-round).
Treating hay fever
Allergic rhinitis is treated with one or more of the following items:
- Eye drops
- Nasal sprays (various types)
- Antileukotrienes (help block inflammatory response)
- Immunotherapy (allergy shots)
Antihistamines can effectively treat allergies. They can also help prevent allergic symptoms. Most antihistamines are available over the counter.
Oral decongestants are used over a short period to help with sinus pressure and stuffy nose. If you have high blood pressure or heart disease, be sure to ask your physician before taking a decongestant.
Nasal corticosteroid sprays are the single most effective therapy in treating allergic rhinitis. Some have moved to over the counter in the last couple of years, but the rest are still only available through a prescription. Nasal antihistamine sprays can also be very helpful. Over-the-counter nasal decongestants (e.g., oxymetazoline, Afrin, Zicam, etc.) can be immediately effective but cause physiologic dependence when used over extended periods. These should not be used long term.
If you have severe allergies, your physician may recommend immunotherapy. This treatment plan, which is usually referred to as allergy shots, is used to desensitize you or decrease your immune response to specific allergens over time.
Deciding which allergy medications and treatments are the most effective and safest can be overwhelming. Make sure to speak with your health care provider and/or allergist to find the most appropriate treatment for you.
As the saying goes, “Prevention is the best medicine.” This is especially true when it comes to allergies. The best way to avoid allergy symptoms is to manage allergies before your body has a chance to negatively react to substances.
In fact, the American Academy of Allergy, Asthma and Immunology recommends beginning medications ahead of seasonal allergy attacks. For example, if you are affected by tree pollen in the spring, you might want to start taking your allergy medications just before the season hits and the allergic reaction has a chance of happening.
Another way to prevent hay fever is to avoid allergens that prompt your symptoms. For example, change the clothes you have been wearing outdoors when you come back inside and shower to remove pollen from your skin. In addition, consider implementing proper avoidance precautions for dust mites, pets and molds if you are allergic to any one of these triggers.
Prognosis for people with allergic rhinitis
As with much of medicine, the treatment outcome for hay fever is dependent on a person’s unique condition. Allergic rhinitis has a tendency to be a chronic condition and can significantly disrupt quality of life. The good news is that it can be managed and well-controlled with the right treatment plan.
David Jeong, MD, is board certified in allergy, immunology and pediatrics. He specializes in allergy and asthma and practices at Virginia Mason University Village Medical Center, Virginia Mason Hospital & Seattle Medical Center, Virginia Mason Issaquah Medical Center and Virginia Mason Lynnwood Medical Center.