What is Allergic Rhinitis (AR)?: Commonly called hay fever, AR is an inflammation of the inner lining of the nose that occurs when an allergic individual encounters an airborne allergen such as house dust mites (HDM), pollen, mold, or animal dander like dogs and cats. Usually inhaled, these triggers generate allergy symptoms such as sneezing, coughing, runny nose, sore throat and itchy or watery eyes, phlegm dripping into the throat (postnasal drip), chronic cough and puffy/red itchy eyes. Those with positive family history of allergy or other forms of allergy eg. bronchial asthma, eczema, urticaria are also more likely to have AR. Although AR can develop at any age, it usually appears in individuals before the age of 30.What are the other causes for the symptoms ?There are other types of rhinitis that should not be confused with AR. All types of rhinitis affect nasal and sinus function. However, many other types of rhinitis respond to different triggers but may present quite similarly to AR. These fall into a general category of non-allergic rhinitis (NAR). Causes may include:•Infection, such as the flu or common cold•Nasal polyps (frequently present in AR patients)•Hormonal imbalance eg. pregnancy•Overuse of decongestant nasal sprays •Use of certain medications (aspirin, antihypertensives, some painkillers, oral contraceptives)•Exposure to cold temperatures, high humidity, chemicals or other irritants•Eating spicy or hot temperature foodsHowever, nasal obstructioncan also be due to structural problems within the nose eg. enlarged nasal turbinates or deviation of the nasal septum (DNS). Also, symptoms of nasal allergies must also be differentiated from cold/influenza and sinusitis. If blood is present in the nasal discharge, it is imperative to exclude cancerous growth in the nasal passage. Therefore the role of the ENT doctor is to distinguish between the different possible causes from history, clinical examination and endoscopy. Blood investigation (allergy panel and IgE test) to identify the allergic triggers can be very helpfulWhat are the complications of AR?Uncontrolled, AR can seriously impair quality of life. It can lead to snoring and may interfere with sleep (obstructive sleep apnea OSA), resulting in daytime sleepiness, and affect the ability to learn and perform tasks. In addition, untreated or improperly treated AR may eventually lead to other complications. These include chronic sinusitis, recurrent inflammation or enlargement of the adenoids and tonsils, chronic ear infections (otitis media) and ear dysfunction. Nasal polyps have also been associated with AR, though the connection is unclear.Treatment- What to do ?The most important part of treatment is to understand the recurrent and prolonged nature of the disease process. While symptoms can be improved over the short-term with treatment, commitment to long-term treatment with follow-up to exclude complications and optimise drug dosage is vital. Stopping the treatment completely just when symptoms are receding would almost certainly bring them back again. That would bring the patient and the doctor back to square one !The best way to treat AR is to avoid or limit exposure to the allergen as much as possible. Therefore, it is important to identify the allergens. Avoidance techniques will vary depending on the type of allergy. The principles in the management of AR include:•Medication: this includes the use of nasal steroid sprays, topical decongestants, antihistamine tablets, leukotriene modifiers as prescribed by your ENT doctor.•House dust mite (HDM) avoidance: oChange bed linen every week, pillow cases daily and wash bedding in hot water to kill miteoRemove carpeting, drapes, wall hangings and other dust accumulatorsoWet mop and vacuum frequentlyoReplace stuff toys (eg. teddy bears) with metal, wooden and plastic onesoDehumidifiers and HEPA air purifiers/filters •Pets: People allergic to their pets should remove the animals from the house, if possible, or at least keep the animals out of the bedroom. Bathe the pets frequently to minimize the amount of allergens on their skin. •Surgery: eg. trimming of the inferior turbinate to relieve nasal obstruction resulting from swollen turbinates for the long term. Chronic rhinosinusitis and nasal polyps may need Functional Endoscopic Sinus Surgery (FESS) and polyp removal under general anesthesia.•Immunotherapy: Taken when allergies cannot be controlled by avoidance or medications. Administered over a period of months or years, these drops below the tongue (sublingual immunotherapy SLIT) can help people build up a tolerance to their allergen triggers. This, in turn, can lead to the prevention or reduction of allergy symptoms. Immunotherapy holds the promise to the ‘cure’ of allergies. Understanding the myths of AR"Will it turn into a cancer?" NO ! Long term AR or sinusitis has not been linked with cancer. "Will it continue forever?" The severity of AR symptoms usually improves as a patient ages. While some people eventually outgrow the disease or the disease improves over the years, the condition can worsen over time in some people. Therefore, it is best to assume that you have it for the longer term and learn to manage it. In short, one just cannot afford to be satisfied with the success of short-term management."It can't be cured."Immunotherapy offers hope. However, many researches are still ongoing. There are still debates about the exact dosage, schedule, and frequency. Also, in a person with multiple allergies, this option may not be feasible.
This patient education is provided in good faith to help patients and their families learn more about their medical conditions, the options available to them and the possible consequences of their decisions. This information is not intended to be used for diagnosis, or treatment of any specific individual. Please consult with your ENT doctor regarding your particular circumstances.
A common house duct mite - so tiny that it is invisible to the naked eye (source: IMR)
DR. VINCENT TANConsultant Ear, Nose and Throat, Head and Neck Surgeon,MD (UKM), MS ORL-HNS (UKM), DOHNS RCS Edinburgh (UK), MRCS Edinburgh (UK), Postgrad. Cert.in Allergy (UK), A.M. (Mal), Fellowship in Rhinology (Singapore)Fellowship in Head and Neck Oncology & Surgery (Amsterdam)