Allergic Rhinitis

A common type of chronic inflammation of the nasal mucosa is Allergic Rhinitis. Certain airborne substances elicit an intense reaction when they contact the mucosa of hypersensitive individuals. Resulting symptoms include catarrh, sneezing, nasal obstruction, itching in the nose or throat, redness, itching and tears in the eyes.

These substances are called aero-allegens and can be either seasonal, if present in the air certain periods every year, or perennial, if present all year through.

Common aero-allergens, which cause symptoms, are:

• House Dust Mites. They are small, invisible for the naked eye insects, which live in our homes, and especially in blankets, mattresses, pillows, carpets, furniture fabrics, and soft furry toys. They elicit symptoms all year, more in the winter. They favour warm, moist and dirty environment.
• Animal Hairs. Cat induces the most severe allergic reaction of all pets, because it has very light hairs, which fill the rooms of the house and remain there for many days, even after removal of the pet.
• Moulds (Fungi). They grow in humid places, as in closed cabinets in the bathroom or kitchen, under fallen leaves in the garden, or in rooms with moist walls. They cause symptoms all year, although some moulds may show a seasonal increase in growth, especially in autumn.

• 

  Pollen. The plants causing allergies are reproduced by the wind, which carries their small, light pollen grains many kilometres away from the flowering site. So, physical contact with the responsible plant is not necessary for the release of symptoms. The three most important pollens for Greece are olive tree, grasses and a weed known as «pellitory wall». The first two have the peak in their flowering season in May and June, while pellitory wall flowers about a month earlier. It must be underlined that flowering seasons are variable, dependent upon various factors, the most important being weather and geographical location.

Η διάγνωση της αλλεργικής ρινίτιδας θα γίνει με προσεκτικό συσχετισμό του ιστορικού και των δερματικών δοκιμασιών αλλεργίας. Σε συγκεκριμένους ασθενείς μπορεί να είναι χρήσιμες ειδικές εξετάσεις αίματος.

Diagnosis of Allergic Rhinitis comes after careful correlation of patient’s history and allergy skin testing. In some cases, special blood tests may be useful.

Upper and Lower respiratory tract, i.e. the nose and lungs, are connected, not only anatomically, but also by means of common mechanisms in inflammation and disease. So, it is not uncommon for rhinitis to co-exist with pulmonary inflammation, usually bronchial hypereactivity and asthma. Therefore, it is important to diagnose Allergic Rhinitis early and start treatment early, before asthma develops.

If allergy is confirmed with skin testing and the result correlates well with the patient’s history, then treatment is initiated, starting with Avoidance Measures and Medical treatment.

Α. Avoidance Measures

• If there is allergy to house dust mites, special advice is given on washing bedsheets, blankets and quilts. Pillows must be washed in the washing mashine, while mattresses and carpets are cleaned often with special vacuum cleaners. If all these measures do not prove enough, acaricide (mite-killing) solutions can be used for the cleaning of furniture fabrics and carpets.
• If there is allergy to pollen, then avoidance advice is given for the flowering season of the responsible plant. Driving with open windows is not advised. Ventilation of the bedsheets should not be done in the morning, when a lot of pollen is found in the air. The allergic individual should have a bath and hairwash every night, to wash pollen away from body and hair, before going to sleep. Clothes worn during the day must be removed in another room and not in the bedroom of the hypersensitive individual.
• If allergy to animal dander is confirmed, removal of the responsible pet is advised. If this is not acceptable for the patient, then other alternative therapeutic measures, such as desennsitization, can be discussed (see below).

Β. Medical Treatment

Medical treatment of Allergic Rhinitis is based on anti-inflammatory drugs and antihistamines. The most common drug used is some steroid spray, which is safe for long-term use, due to minimal, if any, systemic absorption by the mucosa. Selected cases will need cortisone by mouth or intramuscularly.

Antihistamines also have a key role in the management of allergic rhinitis. When used, they are often prescribed for periods longer than the symptoms, to cover the underlying inflammation, which may exist even when the patient is asymptomatic.

In some cases, other drugs, like decongestive sprays or other anti-inflammatory local or systematic drugs are used.

C. Desensitization

If avoidance measures and medical treatment fail to control symptoms to the patient’s satisfaction, desensitization may be discussed. This is a specialized treatment with increasing doses of the responsible allergen, aiming at permanent cure of the allergy. Nowadays, desensitization can be done either with subcutaneous injections (shots) or sublingual drops. Its feasibility is carefully evaluated in each case, because not all allergens provide good results, and not all patients are good candidates for the treatment. The result is typically evaluated in about twelve months, and if there is a favourable response, treatment is continued for two to four more years.