Allergic Rhinitis

Question 1

What is allergic rhinitis?

Answer 1

Allergic rhinitis is a condition caused by an IgE-mediated type 1 hypersensitivity reaction. Environmental allergens cause an allergic inflammatory response in the nasal mucosa. It is very common and can significantly affect sleep, mood, hobbies, work and school performance and quality of life.

Question 2

What can cause allergic rhinitis?

Answer 2

Allergic rhinitis may be:

• Seasonal, for example hay fever
• Perennial (year round), for example house dust mite allergy
• Occupational, associated with the school or work environment

Question 3

How does allergic rhinitis present?

Answer 3

Allergic rhinitis typically causes:

• Runny, blocked and itchy nose
• Sneezing
• Itchy, red and swollen eyes

Allergic rhinitis is associated with a personal or family history of other allergic conditions (atopy).

Question 4

Briefly describe the diagnosis of allergic rhinitis

Answer 4

Diagnosis is usually made based on the history. Skin prick testing can be useful, particularly testing for pollen, animals and house dust mite allergy.

Question 5

Give examples of triggers of allergic rhinitis

Answer 5

• Tree pollen or grass allergy leads to seasonal symptoms (hay fever)
• House dust mites and pets can lead to persistent symptoms, often worse in dusty rooms at night. Pillows can be full of house dust mites.
• Pets can lead to persistent symptoms when the pet or their hair, skin or saliva is present
• Other allergens lead to symptoms after exposure (e.g. mould)

Question 6

Briefly describe the management of allergic rhinitis

Answer 6

Avoid the trigger. Hoovering and changing pillows regularly and allowing good ventilation of the home can help with house dust mite allergy. Staying indoors during high pollen counts can help with hay fever symptoms. Minimise contact with pets that are known to trigger allergies.

Oral antihistamines are taken prior to exposure to reduce allergic symptoms:

• Non-sedating antihistamines include cetirizine, loratadine and fexofenadine
• Sedating antihistamines include chlorphenamine (Piriton) and promethazine

Nasal corticosteroid sprays such as fluticasone and mometasone can be taken regularly to suppress local allergic symptoms.

Nasal antihistamines may be a good option for rapid onset symptoms in response to a trigger.

Referral to an immunologist may be necessary if symptoms are still unmanageable.

Question 7

Briefly describe the nasal spray technique

Answer 7

The aim when administering a nasal spray is to get a good coating throughout the nasal passage.

Hold the spray in the left hand when spraying into the right nostril and vice versa. Aim to spray slightly outward, away from the nasal septum.

Do not sniff at the same time as spraying, as this sends the mist straight to the back of the throat. The patient should not taste the spray at the back of the throat. If they do, that means it has gone too far.