RHINITIS, ALLERGIC

Watery nasal discharge; sneezing; itchy eyes, nose, throat; intermittent bilateral blocked nose. Common. May be seasonal (hayfever) or perennial. Hay fever is an allergic reaction to pollen (of grasses, weeds or trees) or fungal spores. Timing of symptoms is a clue to the allergen responsible, for example:

• January to April: tree pollen
• May to July/August: grass pollen
• June/July to November: weeds, mould, spores
• All year round: house dust mites, animal dander, pet hair, moulds. (Perennial allergic rhinitis).

Hay fever, asthma, food allergy and eczema are related allergic conditions; the tendency to develop them (atopy) seems to run in families. Hay fever can affect exam performance, and often makes asthma symptoms worse.

Mild symptoms can usually be relieved using over-the-counter (OTC) antihistamine tablets, nasal sprays and eye drops; more severe symptoms may need treatment with a corticosteroid nasal spray or a combination of corticosteroid nasal spray and antihistamines. Corticosteroid sprays/drops for seasonal rhinitis should be started 2 weeks before symptoms begin and used regularly. Persistent symptoms not relieved by the above treatments may warrant referral for immunotherapy treatment.

Allergen avoidance

The best way to prevent an allergic reaction is to avoid the allergen responsible. This is not always easy or even possible.

Dust mites and pets

Dust mites, too small to see, can breed in the cleanest house, pets can be hard to avoid and animal dander finds its way into public transport.

Pollen

Advice to patients

• Check weather reports for the pollen count (average no. of pollen grains in 1m³ of air over 24 hours) and stay indoors when it is high.
• Wear wrap-around sunglasses to protect eyes from pollen.
• Shower/wash hair when returning indoors.
• Keep doors and windows shut during mid-morning and early evening, as this is when there is most pollen in the air.
• Wipe (damp dust) surfaces to remove pollen.
• Avoid grassy areas, such as parks and fields.
• Get someone else to cut the grass for you.
• Keep car windows closed; fit pollen filters to air vents, change at every service.