How to Manage Allergic Rhinitis?

Management

The diagnosis of allergic rhinitis is often straightforward, with its features of swelling and blockage of the airway, congestion, excess mucous production, sneezing, and runny nose. Other symptoms include itchiness and watery eyes.

Sometimes, allergic rhinitis has to be distinguished from a cold or influenza. There is no fever with allergic rhinitis last for weeks and even months, but that of a cold or influenza seldom last more than a week.  Patients with allergic rhinitis may have itchy eyes and nose but not those with a cold or influenza.

The identification of the allergen is important in managing the condition. If the cause of allergic rhinitis is doubtful, allergy tests are carried out:

·        Skin prick test:

This is involves placing the allergens on the arm and pricking the skin to introduce the allergen into it. If the skin becomes itchy, red and swollen, it is a possible reaction.

·        Blood test:

This involves measuring the level of lgE antibody produced in the blood in response to a suspected allergen.

The doctor will prescribe treatment after taking into consideration the type, frequency and severity of the symptoms, patient’s preference for oral tablets or a nasal spray, and whether there are allergic conditions like conjunctivitis or asthma.

The medicines prescribed include antihistamines and corticosteroids. Antihistamines block the action of the histamine released during an allergic attack. They can be taken as tablets, as nasal sprays, or drops. The earlier antihistamine has drowsiness as a side effect. The newer antihistamines do not usually cause drowsiness, although some people still get this side effect.

Special precautions are necessary if antihistamines are used in children and pregnant women.

Corticosteroids act by affecting the body’s response to the allergen. It takes a longer time to act but lasts longer. The side effects, although rare, include nasal dryness and irritation and nose bleeds.

It is not advisable to use nasal decongestants for more than a week as they can worsen the congestion. Nasal decongestants cannot be used if one is taking the group of anti – depressants called monoamine oxidase inhibitor (MAOI).

There are occasions when a referral will be made to a specialist, particularly if the response to treatment is unsatisfactory. After an evaluation, the specialist may prescribe different medicine or suggest immunotherapy. This treatment is only suitable for certain types of allergic rhinitis. It involves increasing the patient’s exposure to the allergen gradually so that the patient becomes less sensitive to it, and decreases the likelihood of an adverse reaction when exposed to the allergen in the future.

This treatment has to be done under medical supervision as there is a small risk of anaphylactic shock, which is potentially life threatening.

Surgery is rarely recommended. However, if there are nasal polyps which worsen the allergic rhinitis, surgery may be beneficial.

Prevention is always better than cure. The avoidance of the allergen will prevent the allergic rhinitis. A discussion with the doctor will be helpful on the prevention of exposure to dust mites, animal flakes and pollen.

By Dr Milton Lum