Allergic rhinitis relief

Are you one of the many Australians diagnosed with allergic rhinitis? Some people have the seasonal variety (more commonly called hay fever), while others are affected all year round (this is known as perennial allergic rhinitis). Both types of allergic rhinitis cause symptoms such as sneezing, a running or blocked up nose, itchy, watery or red eyes and a scratchy throat. You might also feel lethargic and find it difficult to concentrate on anything other than where the nearest tissue box is.

Allergic rhinitis means inflammation of the lining of the nose that follows an allergic reaction — an overreaction of the immune system to something that’s normally harmless. The substance that triggers the allergic reaction is called an allergen. Common allergens include pollen, dust mites and their droppings, skin scales or saliva from pets, and mould spores.

For many people, allergies are more than just an annoyance — they have a serious impact on life. The good news for allergy sufferers is that many things can help.

Self-help for allergies

First, if you haven’t already done so, see your doctor for a diagnosis — he or she may recommend testing to pin point the offending allergen(s).

Avoiding what you’re allergic to is often recommended. However, it can be difficult to completely remove things like dust mites from your environment, and more research is needed into whether this really benefits allergy symptoms. For those willing to try this approach, washing bedding weekly in water hotter than 55 degrees Celsius, using dust mite resistant covers and removing soft toys from the bedroom can help with house dust mite allergy.

For those allergic to animals, removing them from the house entirely may be the best solution — but a compromise may be to ban four-legged friends from the bedroom.

Allergens carried in the air, such as pollen, are almost impossible to steer entirely clear of. However, it can help to stay indoors as much as possible on high-pollen days (windy days and after thunderstorms are often especially bad), to avoid mowing the lawn, and to shower after you’ve been exposed to a lot of pollen.

If used regularly, saline (salt water) sprays (such as Fess nasal spray) can help relieve a blocked nose, thin the secretions and wash away irritants. Steam inhalation can also ease a stuffy nose — especially if you add a few drops of eucalyptus oil to the water.

Walk into any pharmacy during hay fever season and you’ll notice an abundance of products designed to bring relief from allergic rhinitis. Here is an explanation of some of the more common ones.

Medicines for allergic rhinitis
MedicinesAvailable asHow they workComments
Corticosteroids
  • Nasal spray
Corticosteroids reduce inflammation
  • Preventative action — need to take regularly
  • May take a few days before maximal effect is achieved
  • Can be used long term under medical supervision, but use the lowest dose that controls symptoms
  • Can make the nose feel dry
  • Tell your doctor about other forms of corticosteroids you or your child may be taking (e.g. asthma inhalers, tablets)
Antihistamines
  • Nasal spray
  • Eye drops
  • Tablets
Antihistamines block histamine, a chemical released during an allergic reaction
  • Can use as needed, regularly or before exposure to allergen
  • Onset of action varies from about one hour to several hours
  • Some cause drowsiness
  • May cause dry mouth, problems urinating and constipation
  • In children, can cause nightmares, irritability and restlessness
  • Side effects are less common with newer antihistamines
  • May interact with other medicines — check with your doctor or pharmacist
  • Some should be avoided by pregnant women — check with your pharmacist
Decongestants
  • Nasal spray
  • Eye drops
  • Tablets
Decongestants narrow blood vessels so fluid doesn’t leak through the nasal lining
  • Provide quick relief for a blocked nose
  • Can make congestion worse if used for more than a few days (known as rebound nasal congestion or rhinitis medicamentosa)
  • Decongestant tablets can cause problems if you have high blood pressure, heart disease, an enlarged prostate or overactive thyroid (this also applies for combination products containing decongestants and antihistamines)
  • Side effects include restlessness, anxiety, disturbed sleep and rapid heart rate

There are also nasal sprays that your doctor may recommend, including ipratropium bromide (e.g. Atrovent Nasal) for a severe runny nose. Sodium cromoglycate nasal spray (e.g. Rynacrom) can help prevent allergic rhinitis symptoms.

If your symptoms are not relieved by these medicines, you should see your doctor — other medicines may be suitable for you.

Prescription medicines for allergic rhinitis

As well as medicines from the pharmacy or pharmacist, there are also prescription medicines available for the treatment of allergic rhinitis.

Montelukast sodium (brand name Singulair), a leukotriene receptor antagonist, is one prescription medicine that is available for treating the symptoms of allergic rhinitis. Studies have shown montelukast improves symptoms and quality of life in people with seasonal allergic rhinitis. Montelukast, available as tablets, may not be suitable for pregnant or breast feeding women, or children under the age of 2 years.

Some nasal corticosteroids and combination medicines that contain both antihistamines and decongestants are also available on prescription.

‘Allergy shots’ — immunotherapy

If the above strategies haven’t relieved your symptoms, there is another approach that you may be able to try. Immunotherapy (sometimes called ‘allergy shots’ or desensitisation) involves injections of the allergen under your skin — the aim is to regulate your immune system and subdue your body’s reaction to a particular allergen. These injections are given once a week or once every 2 weeks, and must be supervised by a doctor specialising in allergy treatment — you will need to be referred by your GP. For some people, immunotherapy can significantly reduce allergic rhinitis symptoms — if it works, it should bring relief within 6 months to a year. The drawback is that treatment must usually be continued for at least 3–5 years.

Complementary therapies for allergic rhinitis

Extracts of the shrub butterbur, which has an anti-inflammatory effect, may have some effectiveness in preventing seasonal allergy symptoms. However, there are concerns about toxins (called pyrrolizidine alkaloids or PAs) in butterbur that could potentially damage the liver and kidneys. Other possible side effects of butterbur include headache, itchy eyes and stomach upset. If you are thinking about trying butterbur, talk to your doctor and look for a standardised supplement that’s labelled PA-free.

If you have allergic rhinitis, one herb to be wary of is echinacea, as it can cause a worsening of seasonal allergies. Serious allergic reactions to echinacea are also possible — these are more likely if you have an inherited tendency to allergies, and especially if you are allergic to ragweed, chrysanthemums, marigolds or daisies.

So far, there is not enough evidence that other nutritional approaches, such as exclusion diets or taking quercetin or vitamin C, benefit allergic rhinitis symptoms. This is also the case for techniques like kinesiology, Vega testing, homeopathy, acupressure and acupuncture.

You should always tell your doctor about any supplements or herbal products you are taking, to avoid potentially harmful interactions with medicines.

Finally, some good news about getting older — many people with allergic rhinitis find that their symptoms improve by the time they reach middle age.

Last Reviewed: 21 September 2009
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References

1. eMIMS Prescribing Information, October 2009
2. MayoClinic.com. Hay fever [updated 2008, May 2; accessed 2009, Sep 28]. Available at: http://www.mayoclinic.com/health/hay-fever/DS00174
3. Sheikh A, Panesar SS, Dhami S, Salvilla S. Seasonal allergic rhinitis in adolescents and adults. BMJ Clinical Evidence 2007; 12: 509
4. Therapeutic Guidelines (eTG). Allergic rhinitis. In: Respiratory guidelines [updated 2005, Mar; accessed 2009, Sep 10]. Available from: http://www.tg.org.au
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