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Q. What is allergic rhinitis?A. Bouts of sneezing, called allergic rhinitis in

medical terminology, is one of the commonestforms of allergy. It may occur in children or inolder people, but, mostly, it occurs among youngadults. Males and females are equally affectedby it. The symptoms may be mild or very severeand distressing.

Q. What is seasonal allergic rhinitis?A. Sneezing, running of the nose and itching in the

eyes occurring in a person in a particular season,year after year, are the characteristics of seasonalallergic rhinitis. In other months of the year, theperson feels perfectly normal. The condition isalso called hay fever, though it has no causalconnection with hay and no fever occurs in thiscondition.

Q. What is the cause of seasonal allergicrhinitis?

A. The cause of seasonal allergic rhinitis is theexposure to pollens of the grasses, weeds andtrees, that are present in the air in a particularseason. The condition is also called pollinosisi.e., caused by exposure to pollens.

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Q. What is perennial allergic rhinitis?A. Some persons have sneezing and running nose

almost all the year round. This conditions is alsoreferred to as “perennial allergic rhinitis”. Thesesymptoms occur more often in the early morning,but may last throughout the day and even the night.A majority of the patients complain of a blockedor stuffy nose and of post-nasal discharge as well.

Children develop a peculiar mannerism ofwiping their nose. They elevate the tip of the nosewith the palm of the hand and wriggle the noseand mouth from side to side; this gives them atemporary relief from the symptoms. Constantrubbing of the nose sometimes leads to thedevelopment of a crease across the nose, calledthe “allergic crease”.

Q. What is the cause of perennial allergicrhinitis?

A. The condition is caused by allergy to pollens thatoccur throughout the year, or to number ofpollens that collectively occur throughout theyear; moulds (fungi) present in the air all the yearround may also be the causative factor. Housedust may also cause perennial allergic rhinitis.

Q. Do seasonal or perennial allergic rhinitis

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patients develop asthma?A. In some patients, symptoms of asthma also

appear. These may start at the onset of the disease,or they may appear later. In certain cases, alongwith sneezing, there is cough only and no asthma.Symptoms of cough and asthma may continueeven when attacks of sneezing cease.

Q What complications can occur because ofallergic rhinitis?

A. Allergic reaction in the nose and throat can leadto congestion and inflammation causing nasalpolyps, tonsillitis, enlarged adenoids, sinusitisand the middle ear disease.

Nasal polyps look like bunches of grapes inthe nose. They are due to the presence of fluidbehind the nasal mucous membrane, causing itto hang down because of the weight of the fluid.They disturb breathing, making the person a mouthbreather. The patient loses sense of smell becausethe smelling area in the nose is encroached uponby the polyps.

Tonsils and adenoids get usually enlarged andinfected, causing fever and bad throat. Surgicalremoval of tonsils and adenoids is not the answerto the problem. Allergic rhinitis needs first to be

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treated and controlled.

Sinusitis is inflammation of the mucous liningof the sinuses. It causes fever, stuffy nose, sleepdisturbances, posterior nasal discharge into thethroat, which may be foul smelling.

Infection in the middle ear in children, inmajority of the cases, is a complication ofallergic rhinitis.

Q. How is the diagnosis of allergic rhinitisestablished?

A. Medical history of the patient reveals thediagnosis most of the time. The history of allergyin parents and siblings may be present.

Local examination of the nose and throat isnecessary. This reveals swollen greyish-palemucous membrane. Nasal polyps may also beseen. Laboratory examination of the nasalsecretions reveals the presence of eosinophilcells. This establishes the diagnosis.

The substances to which a person is allergiccan be established by doing the skin allergy tests.Positive reactions correlating with the history ofthe presence of symptoms in the same monthsor seasons in which those pollens are present inthe air, establish the allergic agents.

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Q. How is allergic rhinitis differentiated fromviral common cold?

A. Common cold usually begins with malaise, achesand pains, diminished appetite and a slight riseof temperature. Running nose and sneezing occureither simultaneously or soon after. The nasaldischarge is at first watery but later it becomesthick.

History of the disease, family history,examination of the nose, and nasal smear, help todifferentiate between allergic rhinitis andcommon cold. A nasal smear does not showeosinophils in a viral infection, while it does soin a case of allergic rhinitis.

Q. How is relief from symptoms obtained incases of allergic rhinitis?

A. Rest in bed, sipping warm drinks, if necessary,with a tablet of paracetamol (Crocin, Calpol) ishelpful. Anti-histamine tablets provide relief,though most of them also cause drowsiness.Combinations of paracetamol and antihistaminesare also available. Given at the beginning of anattack, they are effective in lessening itching,sneezing and running of the nose. Takingantihistamines with tea, or coffee lessens the

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feeling of drowsiness.

Nose drops containing ephedrine andantihistamines lessen stuffiness of the nose.Cauterization i.e., burning the mucous membraneof the nose so that it becomes insensitive tostimuli, is more harmful than good. Nasal surgeryis rarely, if ever, indicated. Nasal sprayscontaining newer antihistamines and or newersteroids such as Fluticasone are helpful.

Q. Are newer anti-histamines better than theusual ones in cases of allergic rhinitis?

A. Yes. They are longer-acting and cause lessdrowsiness. They may be tried.

Q. Should corticosteroids be taken as tabletseither alone or in combinations withantihistamines in case of allergic rhinitis?

A. Corticosteroids should preferably be avoided. Ifit is a matter of a week or a fortnight and allergicrhinitis is very troublesome, steroids can be givenalongwith antihistamines. They should be givenby sprays into the nose. Oral steroids should beavoided. As allergic rhinitis, especially theperennial one, is a long-standing problem, reliefobtained from the use of steroids will become ahabit and ultimately result in lot of injuriouseffects.

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Q. What is the role of injection treatment(hyposensitization or immunotherapy) incases of allergic rhinitis?

A. If after taking the history of the patient anddoing the skin tests, the causative agent has beendiagnosed, then hyposensitization should betried. In case of seasonal allergic rhinitis whensymptoms last only for a week, a fortnight or so,one has to see whether one should go throughthe skin test procedure and the subsequenthyposensitization or take anti-histamines and thelikes for the period the troublesome symptomsexist. But if the symptoms are troublesome orprolonged, hyposensitization should beconsidered.

Q. What measures can be taken by the allergicrhinitis patient so as to get minimum ofsymptoms?

A. 1. To avoid needless outdoor activities in theseason in which the symptoms occur or getaggravated.

2. To keep bedroom windows closed and to useair-conditioner, if possible, in the bed room.

3. To use HEPA (High Efficiency ParticleArrestor) air filter in the bedroom.

4. To use an effective face mask.

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Q. How useful is the nasal filter in cases ofallergic rhinitis?

A. Nasal filter, as it is available, has a soft plasticrim and a very fine synthetic fibre mesh. Thisfilter with a proper shape of the rim and size, fitswell into each of the nasal cavities.

As many of the allergic rhinitis patients havelot of excretions coming from the nose, the meshgets choked up with the excretions and thepatients have difficulty in breathing through thenose and they start breathing through the mouth.This destroys the purpose of putting in the nasalfilter.

Q. Should a person with allergic rhinitiscontinue smoking, if he is already a smoker?

A. Allergic rhinitis patient is more liable to getcomplications of the disease such as sinusitis ifhe smokes. This is because the smoke is anirritant and an inflammatory agent. Infections andother complications set in more easily andquickly in smokers. Hence, an allergic rhinitispatient should stop smoking.

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