Allergic Rhinitis

Topic Overview

What is allergic rhinitis?

Allergic rhinitis, often called allergies or hay fever, occurs when your immune system overreacts to particles in the air that you breathe-you are allergic to them. Your immune system attacks the particles in your body, causing symptoms such as sneezing and a runny nose. The particles are called allergens, which simply means they can cause an allergic reaction.

People with allergies usually have symptoms for many years. You may have symptoms often during the year, or just at certain times. You also may get other problems such as sinusitis and ear infections as a result of your allergies.

Over time, allergens may begin to affect you less, and your symptoms may not be as severe as they had been.

What are the symptoms of allergic rhinitis?

In most cases, when you have allergic rhinitis:

• You sneeze again and again, especially after you wake up in the morning.
• You have a runny nose and postnasal drip. The drainage from a runny nose caused by allergies is usually clear and thin. But it may become thicker and cloudy or yellowish if you get a nasal or sinus infection.
• Your eyes are watery and itchy.
• Your ears, nose, and throat are itchy.

Which allergens commonly cause allergic rhinitis?

You probably know that pollens from trees, grasses, and weeds cause allergic rhinitis. Many people have allergies to dust mites, animal dander, cockroaches, and mold as well. Things in the workplace, such as cereal grain, wood dust, chemicals, or lab animals, can also cause allergic rhinitis.

If you are allergic to pollens, you may have symptoms only at certain times of the year. If you are allergic to dust mites and indoor allergens, you may have symptoms all the time.

How is allergic rhinitis diagnosed?

To find out if you have allergies, your doctor will ask about your symptoms and examine you. Knowing what symptoms you have, when you get them, and what makes them worse or better can help your doctor know whether you have allergies or another problem.

If you have severe symptoms, you may need to have allergy tests to find out what you are allergic to.

• Your doctor may do a skin test. In this test your doctor puts a small amount of an allergen into your skin to see if it causes an allergic reaction.
• Your doctor may order lab tests. These tests look for substances that put you at risk for allergies.

How is it treated?

There is no cure for allergic rhinitis. One of the best things you can do is to avoid the things that cause your allergies. You may need to clean your house often to get rid of dust, animal dander, or molds. Or you may need to stay indoors when pollen counts are high.

Unless you have another health problem, such as asthma, you may take over-the-counter medicines to treat your symptoms at home. If you do have another problem, talk to your doctor first. Others who also should talk to their doctor before starting self-treatment include older adults, children, and women who are pregnant or breastfeeding.

If your allergies bother you a lot and you cannot avoid the things you are allergic to, immunotherapy (such as allergy shots) may help prevent or reduce your symptoms. To have this treatment, you first need to know what you are allergic to.

Finding the treatment that works best for you may take a little time.

Frequently Asked Questions

Cause

Allergic rhinitis, often called hay fever, occurs when your immune system overreacts to particles in the air that you breathe-you are allergic to them. Your immune system causes symptoms such as sneezing and a runny nose. The particles are called allergens, which simply means they can cause an allergic reaction.

Several types of allergens cause allergic rhinitis, including pollens, mold, dust mites, animal dander, and cockroaches. Although polluted air is not an allergen, it can irritate your nose and lungs. An irritated nose or lungs may make an allergic reaction more likely when you breathe in an allergen.

Symptoms

Symptoms of allergic rhinitis may develop within minutes or hours after you breathe in an allergen. The symptoms can last for days.

Symptoms that often start as soon as you breathe in an allergen include:

• Sneezing over and over again, especially after you wake up in the morning.
• A runny nose.
• A tickle in your throat or coughing caused by postnasal drip.
• Watery, itchy eyes. This may be allergic pinkeye.
• Itchy ears, nose, and throat.

Other symptoms that may take longer to appear include:

• A stuffy nose, possibly with sniffing. This is the most common symptom in children.
• Breathing through your mouth because your nose is blocked.
• Rubbing your nose. Children tend to do this.
• Eyes being sensitive to light.
• Feeling tired, grumpy, or moody.
• Not sleeping well.
• A long-lasting (chronic) cough.
• Pressure in your ear or having a hard time hearing.
• Discomfort or pain in your face.
• Dark circles or patches under your eyes (allergic shiners).

Other problems with symptoms similar to allergic rhinitis include upper respiratory infections (URIs), nasal defects, and inflammation (rhinitis) not caused by an allergen (nonallergic rhinitis).

When symptoms may change

Your symptoms may be better or worse at different times of the year or different times in your life. For example:

• If you are allergic to dust mites, animal dander, or indoor mold, your symptoms may be more severe in winter when you spend more time indoors.
• If you have a pollen allergy, your symptoms may vary based on what plants grow in your area and what season it is.
• If you get pregnant, your symptoms might get worse. Allergic rhinitis can then make asthma and sinusitis worse.
• As you grow older, allergens may affect you less.

What Happens

The first time you are exposed to an allergen in the air, your body's immune system may recognize the allergen as a foreign substance. Your body reacts by making antibodies against the allergen.

The next time you are exposed to the allergen, the antibodies react to it. This releases histamine and other chemicals that cause the symptoms of your allergy. This is called sensitization. Sensitization may occur early in life.

Children who have allergic rhinitis may become allergic to many allergens, including dust mites, dander on cats and dogs, and tree and grass pollens.

Complications

Allergic rhinitis can affect your health if you don't treat it. If it lasts a long time, you may have complications such as sinusitis, plugged ears, and ear infections. Some people with allergic rhinitis have sleep apnea. Some have asthma, and researchers are looking at whether allergic rhinitis may lead to asthma.

Allergic rhinitis can also affect your quality of life. You may avoid seeing people, have problems sleeping, and feel tired or grumpy. You may have trouble with school or work.

What Increases Your Risk

You may be more likely to have allergic rhinitis and other allergies if:

• You have a family history of allergies, especially allergic rhinitis. A child is more likely to have an allergy if both parents have an allergy or have the same type of allergy.
• You are exposed to dust mites, animal dander, or other indoor allergens.
• You are exposed to pollens or molds.

When to Call a Doctor

Call your doctor if:

• You have pain in the sinus area and other symptoms of sinus infection. (Symptoms may include fever or a creamy, yellow or green discharge from the nose.)
• Your allergy symptoms get worse and you don't know why.
• You are taking a prescription or over-the-counter allergy medicine that does not help your symptoms.
• Your allergy medicine is causing side effects that bother you, such as decreased coordination or increased drowsiness.
• You have a fever or ear pain.
• You have a cough or cold that lasts longer than 1 to 2 weeks.
• You have severe itching of the eyes or nose.
• Your allergy disturbs your life.

Who to see

Health professionals who can evaluate and treat mild allergic rhinitis symptoms include:

• Family medicine physicians.
• Pediatricians.
• Internists.
• Nurse practitioners.
• Physician assistants.

You may need to see an allergy specialist (allergist), depending on your symptoms or which other treatments you may need. For example, you may need to see a specialist if your medicines are not working or cause severe side effects or if you are thinking about getting immunotherapy (such as allergy shots).

Your doctor may refer you to an ear, nose, and throat (ENT) specialist (also called an otolaryngologist or otorhinolaryngologist). An ENT specialist may be helpful if your doctor thinks you may have nasal polyps or other obstructions in your nose.

Exams and Tests

Your doctor can usually diagnose allergic rhinitis by examining you and asking you questions about your symptoms, activities, and home. If your doctor thinks that you have allergic rhinitis, and you don't have complications, he or she may decide to treat your symptoms without doing lab tests. The doctor will then check your symptoms again later.

But you may need further testing if:

• You and your doctor need to find out exactly what things you are allergic to so that you can take steps to avoid them.
• Treatment is not helping your symptoms.
• You have severe symptoms.
• You are considering immunotherapy (such as allergy shots).

For further testing, your doctor may suggest that you have allergy tests. For example, a skin test can show how your skin reacts to an allergen. Or a blood test can measure the level of immunoglobulin E (IgE) antibodies, which your body makes in response to certain allergens.

These tests can help your doctor know whether allergic rhinitis is causing your symptoms and find the best treatment. They can also help your doctor see if you have complications, such as sinusitis or asthma.

Other tests for allergies

In most cases, you do not need testing. But your doctor may suggest some tests to make sure that another condition is not causing your symptoms. These tests include:

• Imaging tests, such as X-rays, CT scans, and MRIs. These tests can show if you have a sinus infection (sinusitis), chronic inflammation (thickening) of the sinus lining, structural defects of the nose, or, in rare cases, cancer.
• Rhinoscopy or nasal endoscopy. Both of these tests look for nasal polyps and other problems that may block the nasal cavity.
• Mucociliary clearance testing. This test looks for abnormal cilia in people who have very thick nasal discharge. Cilia are tiny hairs on the lining of the nasal passages. These tiny hairs beat back and forth to remove particles from the nose. Certain rare diseases can cause problems in the cilia, which can lead to more nasal discharge.

Treatment Overview

The main treatments for allergic rhinitis are avoiding allergens, managing symptoms with medicine and other home treatment, and, in some cases, getting immunotherapy (such as allergy shots). How often you need treatment depends on how often you have symptoms.

Avoid allergens

It is important to avoid allergens that are causing your symptoms. By doing this, you may be able to reduce your allergy symptoms and manage them without medicine or with fewer medicines.

You may need to clean your house often to get rid of dust, animal dander, or molds. Or you may need to stay indoors when pollen counts are high.

For more information on how to avoid and control allergens, see Home Treatment.

Manage symptoms

Taking medicines and doing other home treatments can help you manage your symptoms. For example, over-the-counter allergy medicines (such as corticosteroid nasal sprays, antihistamines, or decongestants) may help relieve some of your symptoms. They may come in the form of a nasal spray, pill, liquid, or eyedrops. Or your doctor may prescribe stronger types of these medicines. You can do other things at home to help your symptoms, such as cleaning your nasal passages.

To learn more about managing your symptoms, see Medications and Home Treatment.

Think about immunotherapy

If medicines don't help your symptoms or if they cause bad side effects, your doctor may suggest immunotherapy. For this treatment, you get shots or use pills that have a small amount of certain allergens in them. Your body "gets used to" the allergen, so you react less to it over time. This kind of treatment may help prevent or reduce some allergy symptoms.

Allergies: Should I Take Allergy Shots?

Know when surgery is or isn't needed

Sometimes people need surgery to fix a problem that makes treating allergies harder. You and your doctor should not consider surgery unless other treatments have failed.

To learn when surgery may be needed, see Surgery.

Treatment for children

Treatment for children who have allergic rhinitis is much the same as for adults who have allergies. Treating children with medicine may be more difficult because of the possible side effects. Some medicines also may not be approved to treat children. Be safe with medicines. Read and follow all instructions on the label.

Prevention

Experts don't know how to prevent allergic rhinitis. Being exposed to many allergens, secondhand smoke, and air pollution can irritate the nose and throat and may contribute to how a person develops an allergy.

You can take steps to reduce the symptoms of allergic rhinitis or to make symptoms less severe.

Home Treatment

Allergic rhinitis is a long-term problem. It takes time and effort to control allergies through home treatment. But home treatment is one of the best things you can do to help your allergies.

Avoid allergens

If you can avoid or reduce your contact with allergens, you may be able to reduce your allergy symptoms and manage them without medicine or with fewer medicines. Controlling your contact with allergens and reducing your symptoms may also make it less likely you will develop complications such as sinusitis. You do this by:

• Controlling dust and dust mites. For example, dust regularly and wash bed linens in hot water.
• Controlling animal dander and other pet allergens. One way to do this is to restrict pets to certain areas of your home.
• Controlling indoor molds. Clean bathtubs and showers monthly.
• Avoiding outdoor pollens. This includes staying inside while pollen counts are high.

For more information, see:

Allergies: Avoiding Indoor Triggers.

Allergies: Avoiding Outdoor Triggers.

Manage symptoms

If avoiding allergens doesn't help your symptoms or is not possible:

• You can treat a stuffy nose by cleaning your nasal passages with saline solution (salt water).
• You may be able to prevent or manage mild sinus infections by using a humidifier in your home, drinking plenty of liquids, and avoiding tobacco smoke.
• You may try taking over-the-counter allergy medicines to relieve symptoms.

It is helpful to track your symptoms and how they affect you. For example, do your symptoms keep you from sleeping, make it hard to concentrate, or make you sleepy? Also track your allergens and how long after exposure to them you start to have symptoms. This information will help your doctor prevent and treat the problem. You can keep a symptom diary(What is a PDF document?) to track this information.

Medications

Medicines are a key part of treatment for allergic rhinitis.

Over-the-counter medicines

You can get corticosteroid nasal sprays over-the-counter or by prescription. These help reduce inflammation in the nose. They work well for most people. They start working quickly, but it may be several weeks before you get the full effect.

There are other types of allergy medicines you can buy without a prescription, such as:

• Antihistamines. These help your sneezing, runny nose, itching, and watery eyes.
• Decongestants. These help relieve a stuffy nose.
• Eyedrops. These help red, itchy, and watery eyes.

Prescription medicines

If over-the-counter medicines don't work or in special cases, such as if you are pregnant, your doctor may suggest other medicines. Other medicines include:

• Ipratropium bromide. It can relieve a runny nose.
• Leukotriene modifiers. These can relieve a stuffy nose, itching and sneezing, and a runny nose.

Use medicine safely

Some people begin using over-the-counter medicines for allergic rhinitis before they see their doctors. These medicines can work well. But people who have other medical problems, older adults, children, women who are pregnant or breastfeeding, and people who have more than occasional mild symptoms should see a doctor before starting self-treatment. For example:

• If you are pregnant, talk with your doctor about which allergy medicines are safe when pregnant. Some medicines might be better for you and your baby than others. If possible, don't use medicine for at least the first 3 months of your pregnancy.
• When you treat children with medicine, know that it may be more difficult than treating adults because of the possible side effects. Some medicines also may not be approved for treating children. Be especially careful with antihistamines and decongestants. They may not be safe for young children, so check the label first. If you do give these medicines to a child, always follow the directions about how much to give based on the child's age and weight.

Be safe with medicines. Read and follow all instructions on the label. Do not use the medicine longer than the label says.

What to think about

You may want to think about using different medicines at different times of the day. For example, during the day you could use a nondrowsy antihistamine such as fexofenadine (such as Allegra) or loratadine (such as Claritin). But if you are at home in the evening and sleepiness is not a concern, you can think about using an antihistamine like diphenhydramine (Benadryl) or chlorpheniramine (Chlor-Trimeton). These are less expensive but can make you feel sleepy. You may also try a combination of medicines to relieve all of your symptoms. Talk with your doctor about which symptoms are most important for you to treat and which medicines may work best for you.

If you don't take your medicine, your symptoms may come back or get worse. When you give medicine to children, explain to them why they are taking medicine and how it can help them. Also tell them what side effects may occur.

You may use medicine daily for quick relief of symptoms that occur suddenly or are getting worse. Or you may use it in advance if you know you may breathe an allergen. For example, if you have severe pollen allergies, your doctor may suggest that you start using a corticosteroid spray 1 to 2 weeks before the pollen season starts.

Surgery

Although surgery doesn't cure allergic rhinitis, you may need it to fix a physical defect of the nose or sinuses. Problems such as these can make allergic rhinitis harder to treat. You and your doctor should not consider surgery unless other treatments have failed.

Possible surgeries include:

• Endoscopic surgery on your nose to correct a crooked nose (deviated nasal septum) or remove noncancerous (benign) nasal polyps. For information on this surgery, see the topic Sinusitis.
• Draining fluid from the middle ear (tympanotomy or myringotomy) or inserting tubes to help the ears drain (tympanostomy). This is sometimes done in children who have allergic rhinitis and ear infections. To learn more about these surgeries, see the topic Ear Infections.

Other Treatment

Immunotherapy

If medicines can't control your allergic rhinitis, you may think about having immunotherapy in the form of allergy shots or sublingual tablets. Allergy shots are small doses of allergens that your doctor injects under your skin. With sublingual immunotherapy, you dissolve a tablet under your tongue daily. Each tablet has a small amount of allergen in it. These treatments help your body "get used to" the allergen, so your body reacts less to it over time.

Allergy shots work best if you are allergic to pollens, animal dander, or dust mites. Doctors use allergy shots mainly to treat an allergy caused by one allergen or a closely related group of them, such as grass pollens. If you are allergic to more than one type of allergen, you may need to get shots for each type of allergen to relieve all of your symptoms. The allergens can usually be combined into one or two shots.

Deciding on allergy shots is a personal decision. Although expensive, allergy shots may not cost more than the combined cost of medicine, doctor and emergency room visits, and missed days of school or work over several years. But you may need allergy shots for 3 to 5 years. And there is some risk of severe whole-body reactions (anaphylaxis).

For help deciding whether to get allergy shots, see:

Allergies: Should I Take Allergy Shots?

Other treatments

Because allergic rhinitis can't be cured and may be frustrating to treat, people may try alternative treatment methods, such as homeopathy. But most of these treatments either have not been studied or have not been proved to work. Such treatments may be expensive. And some can be dangerous to your health.

Talk to your doctor if you are thinking about trying a complementary or alternative therapy or if you want to know about new treatments that are being studied for allergic rhinitis.