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.

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 2

Presentation allergic rhinitis?
Diagnosis?

Answer 2

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).

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 3

Triggers allergic rhinitis?

Answer 3

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 4

Management of allergic rhinitis?

Answer 4

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 5

Nasal spray technique?

Answer 5

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.