JOSEPH R. ANTICAGLIA,
MD Medical Advisory Board
Allergic Rhinitis (AR) has been called Rose Fever, Spring Fever, Summer Cold, and Hay Fever. But, it does not cause a fever. It is not the common cold and it’s not limited to one season… Incidentally, how many people do you know who are allergic to hay?
So clinicians prefer to use the term ‘Allergic Rhinitis’ to describe the swelling of nasal mucous membranes on the inside of the nose, when you inhale an allergen; i.e. something you are allergic to – such as tree pollen or cat dander. It’s the stuffy nose you experience when exposed to allergic triggers. It causes a cascade of chemical reactions which release histamine (and other chemicals) that provokes symptoms of itchy noses, itchy teary eyes, nasal obstruction, watery runny nose, and sneezing.
You can hear a mother imploring her child to, “Use your tissues!” Little Billy responds by giving her an Allergic Salute. He uses the palm of the hand to rub the tip of the nose upwards to wipe away mucous or relieve an itchy nose.
Virtually everyone knows somebody who has nasal allergies. It is the fifth most common chronic disorder in the U.S. One out of six Americans suffer from AR or more than 40 million people in the U.S. and it’s costly. Americans spend 2 to 5 billion dollars each year for its treatment and diagnosis.
AR is an ‘atopic’ disorder, meaning patients often have a family history of allergies. One notes a history of infantile eczema and wheezing, because not infrequently it can show up in later years as AR. In children AR can be linked to problems of attention, behavior and learning.
Adults are not exempt from its miserable onset. It can start in childhood and last a lifetime and be associated with chromic ear infections, asthma, nasal polyps and sinusitis. It can be intermittent, lasting fewer than 4 weeks per year or persistent, lasting more than 4 weeks per year.
Outdoor allergens (trees, grass) are usually seasonal while indoor allergens are usually perennial; i.e. bothersome all year long (pet dander, dust mites, molds). Patients can be afflicted by both..
When AR interferes with your quality of life (QOL), medical treatment is warranted and diagnostic tests may be indicated when medications do not work. But what medications and what tests are most useful?
What will follow are some guidelines for Allergic Rhinitis to help you get through, what the media often refers to, as “the worst season ever” for allergies.
What is the purpose of the Allergic Rhinitis guideline?
The purpose of the guideline is to improve the diagnosis and treatment of patients with Allergic Rhinitis and to reduce harmful and unnecessary approaches to such patients. These guidelines apply to the pediatric and adult population, but not to children under the age of 2 years. In February 2015 the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) published guidelines for patients with Allergic Rhinitis.
What are the significant points made in the guideline?
- Patient history and physical examination: Clinicians should make an accurate diagnosis of Allergic Rhinitis when patients present with symptoms and findings upon examination of the nose consistent with AR.
- Imaging: Clinicians should NOT routinely perform sinonasal imaging (sinus films) in patients who present with symptoms consistent with a diagnosis of allergic rhinitis.
- Topical steroids: Physicians should recommend intranasal steroids for patients with a clinical diagnosis of AR whose symptoms impact their quality of life (QOL).
- Oral Antihistamine: Clinicians should recommend oral, less sedating antihistamines for patients with AR and primary complaints of sneezing and itching
- Immunotherapy: Clinicians should offer immunotherapy or refer to a clinician who can offer immunotherapy (sublingual or subcutaneous) for patients with AR who are medical failures with or without environmental controls.
- Acupuncture: Clinicians may offer acupuncture to patients who re interested in non-pharmacologic therapy,
- Herbal Therapy: No recommendation.
- Inferior Turbinate Reduction: Clinicians may offer this to patients with nasal obstruction who have failed medical management.
SUMMARY:
The incidence of Allergic Rhinitis has increased dramatically. The above is a “guide” in the management of AR and not everyone ought to be treated in the same way.
With an accurate diagnosis, the use of topical steroids, oral antihistamines, allergy-specific immunotherapy and avoidance measures the quality of life in Allergic Rhinitis patients can be significantly improved.
REFERENCE:
1. AAO-HNS Clinical Practice Guideline: Allergic Rhinitis, February2, 2015. Michael D. Seidman, MD, (Chair), et al.