Allergic Rhinitis / Hay Fever

Allergic Rhinitis / Hay Fever: Overview

Alternative Names: Hay fever (Note that despite its name, it is not caused by hay, and does not produce a fever.)

Allergic rhinitis is inflammation of the inside the nose that occurs when the immune system reacts to allergens in the air as if they were harmful.

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Incidence; Causes and Development; Contributing Risk Factors

Allergic rhinitis is the most common form of allergy, estimated to affect roughly 1-in-5 people.

Tiny particles floating in the air
Tiny particles are almost always present in the air we breathe, and many can cause an allergic response

It is caused by the body's immune system overreacting to irritants in the environment and producing antibodies to fight them off.  Common examples of irritants are:

  • Pollens, grasses, or ragweed (in certain seasons and areas), causing 'hay fever'
  • Dust, chemicals found in house dust mite excrement, cockroaches
  • Animal dander (flakes of skin)
  • Droplets of urine or saliva from certain animals
  • Mold and fungus spores
  • Spicy foods

During an allergic episode, the immune system releases chemicals that cause the mucous membrane inside the nose to become swollen, and excess mucus to be produced.

The following may increase the risk of having allergic reactions:

  • A family history of allergies
  • Asthma
  • Atopic syndrome (a tendency to be hyperallergic)
  • Smoking or prolonged exposure to second-hand smoke
  • Wood smoke and other air pollution
  • Airborne fumes and chemicals such as hairspray, perfumes
  • Changes in temperature or humidity, wind

Signs and Symptoms

A pollen count forecast on TV
A typical pollen forecast as part of a daily TV weather forecast

For many people, symptoms vary with the seasons, which is why the term 'pollen season' exists and weather reports often include a 'pollen forecast' and 'pollen count'.  For others, it is a year-round problem.

Symptoms start soon after exposure to an allergen.  They are usually mild, but for some people they can be severe and long-lasting, leading to sleep problems and difficulty performing everyday activities.  These include:

  • Blocked, stuffy or runny nose
  • Sneezing
  • Itchy nose and/or eyes
  • Watery eyes
  • Dark circles under eyes
  • A sore/scratchy throat
  • "Sinus" symptoms – headache, feeling of pressure behind the eye, pain above the cheekbones and on the lower forehead, aching teeth
  • Coughing
  • Skin rashes or hives
  • Diarrhea and/or frequent urination
  • Recurrent headaches and/or fatigue (generally after long-term exposure to allergens)

Diagnosis and Tests

A health care provider will examine the patient's nose and nasal secretions, and ask if they have noticed any specific allergy triggers.  If the cause of allergies is not obvious, the patient may be referred to an allergist – a physician who can pinpoint the triggers by performing skin or blood tests.

Treatment and Prevention

Red vacuum cleaner with HEPA filter to remove allergen particles
A vacuum cleaner with a HEPA or ULPA filter will trap more than 99% of allergen particles

The best way to prevent allergic rhinitis is to avoid the allergen(s) that cause it.  It is often difficult to completely avoid allergens, but reducing exposure is an important step.  Depending on which allergens are causing problems, a combination of the following is often effective:

  • Cover pillows and mattresses with plastic covers
  • Use synthetic materials (acrylic) instead of animal products (wool, feathers)
  • Minimize dust-collecting household items
  • Use hard floor coverings instead of carpet
  • Regularly wash or vacuum fabrics and fabric-covered items such as soft toys, pillows, curtains
  • Use a vacuum cleaner with a HEPA (high efficiency particulate air) filter
  • Use air purifiers, dehumidifiers, or dust filters
  • Clean with a damp cloth instead of dry dusting
  • When the pollen count is high, stay inside, shower and change clothes after being outside, and avoid drying laundry outside
  • Minimize mold and mildew exposure by keeping the house dry and well ventilated, opening windows when showering or cooking, and not storing clothes tightly packed or in damp areas
  • Minimize exposure to pets by limiting them to certain rooms or (even better) keeping them outside.  Wash pets every week or two, groom dogs outside, and regularly wash their bedding.

Mild allergy symptoms can be controlled by using over-the-counter long-acting, non-sedating antihistamines and by regular nasal irrigation (rinsing the nasal passages with salt water to remove irritants).  Taking antihistamine medication an hour before entering a house with pets can help minimize symptoms.

If these measures are not effective, a doctor may prescribe a steroid nasal spray.  Corticosteroids reduce inflammation and swelling; they take longer to work than antihistamines, but their effect lasts longer.

For more severe cases, immunotherapy – also known as hyposensitization or desensitization therapy – may be carried out under supervision.  This involves repeated injections of gradually increasing amounts of the identified allergen in order to desensitize the immune system.

Allergic rhinitis may be successfully treated with alternative therapies, beginning with dietary changes.  Use the tincture and homeopathic remedies for acute allergic reactions.  Acupuncture, butterbur supplements, honey, and probiotics are other alternative remedies.

Complications

In some cases, allergic rhinitis can lead to nasal polyps, inability to sleep, worsening of asthma symptoms, recurring middle ear infections and/or sinus infections, reduced effectiveness at work or school, and headaches.

Signs, symptoms & indicators of Allergic Rhinitis / Hay Fever:

Lab Values - Cells

Symptoms - Allergy

Counter-indicators

Symptoms - Head - Eyes/Ocular

(Frequent) itchy eyes

Itching is the hallmark of allergic conjunctivitis, as well as other forms of allergic eye disease.  The itching may be mild to severe.  In general, a red eye in the absence of itching is not caused by ocular allergy.

Symptoms - Head - Nose

Conditions that suggest Allergic Rhinitis / Hay Fever:

Circulation

Dental / Oral

Bruxism (Clenching/Grinding Teeth)

Allergy may play a role in bruxism.  It is reported that bruxism is more frequent in those experiencing periods of allergic rhinitis or asthma.

Eyes / Ocular

Allergic Conjunctivitis

The most common cause of allergic conjunctivitis is hay fever.

Metabolic

Meniere's Disease

Several studies have found a strong connection between inhalant allergies and Meniere's Disease.

Symptoms - Allergy

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Risk factors for Allergic Rhinitis / Hay Fever:

Allergy

Allergy to Foods (Hidden)

The ear, nose, and throat are common target organs for food allergens.  Congestion or inflammation of the nose (rhinitis) may be due to airborne irritants and allergens, but food allergy may be an undiagnosed cause of this common problem.

Family History

Hormones

Symptoms - Environment

Mild/significant diesel exhaust exposure

Diesel exhaust fumes and ozone can enhance the effects of inhaled allergens or have an effect on immune function.

Allergic Rhinitis / Hay Fever suggests the following may be present:

Allergy

Recommendations for Allergic Rhinitis / Hay Fever:

Amino Acid / Protein

Cysteine / N-Acetylcysteine (NAC)

N-acetylcysteine is recommended at 200mg three times per day.

Botanical / Herbal

Echinacea (Coneflower)

A tincture of equal parts of coneflower (Echinacea), goldenseal (Hydrastis canadensis), cleavers (Gallium asparine), eyebright (Euphrasia officinalis), ginger root (Zingiber officinalis), and elderberry (Sambucus nigra) will strengthen your immune system, increase circulation, and help your respiratory system work better.  Take 30 drops two or three times per day.

Stinging Nettle

Nettles are traditionally used for hay fever and may be drunk as an infusion, 2 cups a day.

Rose Hip

Rose hips can be used as an infusion or solid extract.

Picrorhiza

[Dorsch W, Stuppner H, Wagner H, et al.  Antiasthmatic effects of Picrorhiza kurroa: Androsin prevents allergen- and PAF-induced bronchial obstruction in guinea pigs.  Int Arch Allergy Appl Immunol 1991;95: pp.128-33]

Chinese Medicine

Acupuncture

Treatment with acupuncture can help promote both immune system function and drainage of lymphatic fluid.

Diet

Increased Fruit/Vegetable Consumption

Fresh fruits and vegetables, whole grains, nuts, seeds, plenty of water and fresh juices are all recommended.

Animal/Saturated Fats Avoidance

Do not eat foods that trigger your allergies: eat fewer foods and additives that are likely to cause inflammation and allergic reactions, such as saturated fats (meats and dairy products), refined foods, eggs, citrus, bananas, chocolate, peanuts, shellfish, food coloring, preservatives, caffeine, alcohol, tobacco, and sugar.

Therapeutic Fasting

Fasting lowers the allergic reactions producing hay fever.

Drug

Conventional Drug Use

Prescription Drugs
Nonsedating antihistamines may cause life-threatening irregular heartbeat and should not be taken with other drugs or if you have other liver or heart problems.  Oral decongestants may have systemic side-effects.  Nasal corticosteroid sprays are effective if used properly; improvement takes 1 to 2 weeks.  Systemic steroids are prescribed only for severe allergic rhinitis; generally prescribed for short amounts of time because of their many side-effects.

Over-the-Counter
Antihistamines may cause drowsiness.  Alpha-adrenergic topical sprays reduce congestion but there is a rebound effect if used for more than a few days.  Cromolyn sodium is the only preventative drug choice; works as well as antihistamines but does not cause drowsiness; take continuously or it will not work effectively; it is virtually without side-effects.

NOTE: Extended use of antihistamines or nasal sprays can make your allergic rhinitis worse.

Environmental

Habits

Laboratory Testing

Test for Manganese Levels

Low blood manganese levels may accentuate allergies.

Mineral

Zinc

Zinc is recommended at 20 to 30mg per day.

Oxygen/Oxidative Therapies

Physical Medicine

Topical Applications

A saltwater nasal rinse will flush out pollen and other irritants, shrink your sinus membranes and increases drainage.  Use a nasal rinse made with water and salt to taste like tears.  Rinse each nostril and, with your head over a sink, hold your head sideways and let the water run from your upper nostril to your lower nostril.  Keep your nostrils lower than your throat to prevent the salt water from draining into the back of your throat.

Massage

Therapeutic massage can assist drainage of lymphatic fluid.

Vitamins

Vitamin B5 (Pantothenic Acid)

Pantothenic acid supplementation may reduce allergic reactions, especially allergic rhinitis.  Clinical observation: The majority of over 100 patients with allergic rhinitis who took 250mg of pantothenic acid twice daily had almost instant relief.  [Martin W.  On treating allergic disorders.  Townsend Letter for Doctors Aug/Sept 1991: pp.670-1]

Clinical observation: A physician with allergies took 100mg at bedtime and found that his nasal stuffiness cleared in less than 15 minutes and that he stopped awakening at 4 or 5 AM with cough and mucous secretion.  He subsequently found that many of his patients also noted significant relief of nasal congestion from supplementation.  [Crook WG.  Ann Allergy 49: pp.45-46, 1987]

Clinical observation: Observations made in our laboratory indicated that pantothenic acid at about 500mg daily could be used to combat allergy.  Subsequently a pharmaceutical house found that, while it was somewhat effective, it was not superior to certain available antihistaminics.  [Williams RJ.  The expanding horizon in nutrition.  Texas Rep Biol Med 19[2]: pp.245- 58, 1961]

Note: Pantothenic acid is quite effective in treating nasal congestion caused by allergy.  However, if the dosage is too high, it can cause nasal dryness and pruritus.  [Roger Williams, U.  of Texas at Austin – personal communication to Wayne Martin, quoted in Martin W.  Pantothenic acid for allergies.  Townsend Letter for Doctors & Patients June, 1997: p.108]

Szorady conducted allergy skin tests on 24 children injecting them with histamine.  Pantothenic acid reduced the intensity of skin reaction by 20-50% in all children.  [Marz, p.209, 1997]

Bioflavonoids

Plants high in bioflavonoids such as quercetin and curcuma (rose hips, bilberry) are especially useful because they reduce your body's production of histamines or leukotrienes (substances that cause allergy symptoms) and strengthen connective tissue.

Quercetin appears to stabilize the membranes of the mast cells that release histamine.  Since quercetin's action is preventive, it is best taken daily a week or two before pollen season and continued throughout.

Vitamin B6 (Pyridoxine)

One older study reported that L-tyrosine (200mg), vitamin B6 (2.5mg) and niacinamide (10mg) when given in combination for the treatment of hay fever, hives, allergic headaches and poison oak dermatitis produced significant symptomatic relief when 1-3 tablets were taken four times/day in milder cases and up to 6 tablets 4-6 times/day in more severe cases.  In some cases characterized by more chronic disorders, such as chronic sinusitis, a worsening of symptoms often occurred during the first few days of treatment.  This study found that treatment with each the nutrients individually, or with any two in combination, was ineffective.  (Widmann RR, Keye JD Epinephrine precursors an control of allergy.  Northwest Med 1952:51:588-590.)

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