Hay fever, nasal allergy or allergic rhinitis
Allergic rhinitis is characterized by many symptoms (not all symptoms must be present): continuous sneezing, itchy and runny nose with transparent and liquid nasal secretions, itchy palate, nasal congestion ("stuffy nose").
Frequently, the eyes are involved in the form of conjunctivitis, with itching, redness, irritation, swelling of the conjunctivae and tears. About a quarter of the population in developed countries (among them Israel) suffers from chronic rhinitis (not every case is because of allergy). Chronic rhinitis significantly affects our quality of life and our performance at work and school. Many people who suffer from allergic rhinitis cannot comfortably breath at night, a lot of them snore regularly and breath through the mouth. This may lead to irreversible changes in their facial structure, to inadequate rest and chronic fatigue. In children, bad school performance may be associated with allergic rhinitis leading to chronic fatigue and concentration and hearing problems.
Allergic rhinitis can be secondary to allergic reactions to trees pollen, grasses pollen, weeds pollen. Allergic rhinitis can also be secondary to house dust mites (microscopic insects that feed on human skin flakes that we shed off and concentrate in dust), or secondary to secretions from animals of skin particles shed by them. Allergic rhinitis can also be an occupational disease for those engaging in work with flour (pastry chef for example) or latex (rubber).
Rarely, allergic rhinitis may be due to food allergies, but in these cases there must be other symptoms such as an itching rash and swelling around the mouth immediately after eating the allergy-inducing food.
Not all rhinitis is allergic. Other causes for non-allergic rhinitis are certain drugs, atrophic rhinitis, vasomotor rhinitis, hormonal rhinitis (in example in a pregnant woman).
People suffering from chronic rhinitis, especially those suffering from allergic rhinitis also suffer from increased airflow sensitivity, increased sensitivity to certain odors such as smoking, perfumes, detergents, etc., which could become an obstacle in their social performance.
In addition, persons with untreated allergic rhinitis may develop paranasal sinus disease, nasal polyps, hearing problems such as those secondary to fluid accumulation in the ears. It is also known that active and untreated allergic rhinitis may contribute to the development of asthma. These complications are responsible for unwarranted morbidity and surgery.
The single most important intervention in allergic rhinitis treatment is trigger avoidance, as long as it is known and it is feasible. This can be done for example, when the cause is an animal. There are also cases where it is not possible, for example when the cause is allergy to grasses pollen, which will be unrelentingly delivered by the wind during the warm season (in Israel, during many months).
Antihistamine drugs may be used to quickly relief symptoms. It is important to note that prolonged use of drugs designed to "open the nose" such as decongestants, should be avoided because they can lead to dependence and affect cardiac function. Using these medications must be restricted to short periods.
If the allergy is chronic or frequently recurring, it is important to start treatment with a corticosteroid spray (which is almost exempt from important side effects). Corticosteroid sprays are very effective, and usually induces a complete remission of symptoms. Important to note, the desired effect of corticosteroid sprays is reached some days after starting treatment and therefore their effectiveness should not be judged immediately.
In the minority of cases, in which corticosteroid spray therapy is not effective, "allergy shots" or "allergy vaccines" (immunotherapy) can be offered provided that an allergen trigger has been identified and that a vaccine to it exists. It is important to note that for this treatment it is necessary to visit the doctor weekly for a period ranging from 3-5 months, and then monthly for another 3-5 years. Side effects may occur during vaccine treatment, such as swelling at the injection site (the arm), itching, and even widespread symptoms like itchy rashes and rarely shortness of breath like in asthma exacerbations. Vaccine treatment, which is needed for some patients, implies heavy logistics for the patient and there is a risk of adverse responses. In the presence of effective treatments mainly devoid of important side effects (like corticosteroid sprays), treatment with vaccines is warranted only in a minority of patients. Importantly, vaccine therapy is possible only if the cause of the allergy is known and there is an available vaccine for it.
In conclusion, nasal allergy is a serious disease that affects our quality of life and can be successfully treated.