Medications for Allergy

Allergic rhinitis is an inflammation or swelling of the mucous membranes that line the nose.

This condition can either be seasonal or year-round. Seasonal allergic rhinitis is also commonly known as “hay fever.” In most people, a single allergen — something that triggers an allergy — sets their symptoms off at about the same time each year. Spring attacks are usually due to tree pollen, while grass pollens dominate in the summer and weed pollens in the autumn.

Perennial allergic rhinitis often causes year-round symptoms. This condition isn’t always caused by an allergy, but it’s most common in people with allergies to things that are present all year. Naturally, people who are allergic to house dust mites, their own pets, or feathers tend to suffer no matter the season.

Causes

Allergic rhinitis is an atopic disease like asthma, meaning that the body tends to ‘overreact’ to certain types of outside substances, also called allergens. One way the body overreacts is by releasing histamine, a chemical present in almost every cell in the body. Histamine, when released in the nasal passages or the airways, causes inflammation or swelling. The inflammation and swelling makes the nasal passages more narrow . Histamine also can cause sneezing and coughing.

Allergic rhinitis, like asthma, can be inherited, but you probably don’t inherit particular allergies. Instead, you just inherit the tendency to be allergic. Whatever you’re most exposed to will probably become the allergen that bothers you.

Symptoms and Complications

The most common symptoms of allergic rhinitis include a stuffy (congested) and/or runny nose, sneezing, and itching of your eyes, nose and throat. Other symptoms include watery eyes, coughing, headache, and poor appetite.

You can usually tell seasonal rhinitis from perennial rhinitis by the fact that it appears regularly at the same time each year. Another difference is that seasonal rhinitis often causes red eyes and perennial rhinitis does not.

Making the Diagnosis

It is important to remember exactly when your symptoms of allergic rhinitis appear and disappear. Knowing specific dates will give your doctor or allergist vital clues as to what may be causing your symptoms.

In some cases, doctors and allergists test for allergies by gently scraping the skin with substances that commonly cause allergies. If a small rash develops, the individual is allergic to that substance.

If none of the skin tests produce a small rash, it’s probably some other kind of rhinitis. These other kinds of rhinitis include:

• Vasomotor rhinitis — the nasal mucus membrane swells up with increased bloodflow, causing a stuffy and runny nose, but typically no itching. There’s no specific cause — patients aren’t allergic to anything — although smoke, dry air, temperature change (like coming in from the cold) and odours can trigger symptoms.
• Chronic rhinitis — may be prolonged symptoms of a common cold, or another disease like syphilis or tuberculosis.
• Rhinitis medicamentosa — caused by overusing nasal spray decongestants, which actually increase congestion (stuffiness) if used for more than 3-7 days.

Treatment and Prevention

The best treatment for allergic rhinitis is to avoid the allergen. This may mean changing your habits, or even giving away a pet or moving to another house if the symptoms are unbearable and don’t respond to medications.

If the allergen is something you can’t completely avoid, like dust mites, here are some steps you can take to help:

• If possible, remove furniture that collects dust, like carpets, draperies, and stuffed chairs
• Frequently clean blinds, curtains, bedding and carpets
• Put plastic covers on mattresses
• Wash floors frequently with a wet mop
• Reduce air humidity with a dehumidifier
• Install a high-efficiency air filter, called a HEPA filter
• Avoid sweeping— use a vacuum

If these measures do not control your symptoms, medications can usually help. The best medication for you can only be determined by you, your doctor, and your pharmacist. You may have to try several medications before you find the one that is best for you.

Some of the medications used to treat allergic rhinitis include:

1. Antihistamines block the action of histamine and are considered the “mainstay of treatment”. However, antihistamines are not very good at relieving nasal stuffiness or congestion. Antihistamines can be taken as needed when symptoms are bothersome or on a regular basis to prevent symptoms. Some antihistamines can cause drowsiness, but some newer antihistamines do not cause this side effect.
2. Decongestants relieve nasal stuffiness or congestion. Decongestants are best used on a short-term or occasional basis. Nasal sprays that contain decongestants should only be used for 3-7 days. If used longer, they actually can make congestion worse and harder to treat.
3. Corticosteroids are the “mainstay of treatment” for chronic rhinitis symptoms. These medications are usually given via a nasal spray and help by preventing the body from reacting to histamine. Very few side effects have been reported with these nasal sprays.
4. Cromolyn sodium helps to prevent the release of histamine after you have been exposed to an allergen. There are few, if any, side effects with this medication, but it does not work for everyone.

If antihistamines aren’t helping, and you can’t avoid the allergen, your doctor may suggest desensitization, sometimes called hyposensitization or allergen immunotherapy. With immunotherapy, small amounts of the allergen are injected regularly, slowly increasing the dosage with the hope of getting the body “used to it.” The immune reaction eventually gets weaker and weaker, even disappearing in some people. The injections are needed every 4-6 weeks, and the treatment works best if used year-round.

Desensitization isn’t risk-free, however. Very occasionally, the patient has a severe allergic reaction called anaphylactic shock. You’ll usually have to wait around for half an hour after each shot, to make sure you don’t have this reaction.