Seasonal allergies are usually referred to as allergic rhinitis by physicians. Patients typically complain of sneezing, runny nose and nasal congestion. These are often accompanied by itching of the eyes, nose, inner ear or palate and post-nasal drip. Many patients also have eye symptoms including itchy, burning, tearing eyes. For some patients, allergic rhinitis causes problems breathing through their noses and leads to poor quality of sleep, irritability or fatigue.
You probably notice that these are similar to the symptoms of the common cold. Indeed, it can be difficult to tell the two apart. One important difference is that most cold do not last longer than 10 days while allergy symptoms can last for as long as the patient is exposed to the allergen, i.e., pollen, grass, leaf mold, etc.
Allergic rhinitis affects 10-30% of children and adults living in the US. In the cities of the industrialized world, these percentages are increasing over time. However, it is unusual for children under 2 years of age to be affected.
There are multiple risk factors that make it more likely a patient will develop these environmental allergies. These include:
- A family history of similar allergies
- Being male
- Use of antibiotics early in your life
- Having a mother who smoked during the first year of your life
- Exposure to indoor allergens like dust mites
At this time of year, we often focus on the allergy symptoms that are caused by pollen from trees, grasses and weeds. People who suffer from these type of allergies may only have eye and nose symptoms at certain times of year. Their symptoms are predictable and reproducible each season. However, some people may have allergies to things like dust mites, pet dander or cigarette smoke that are present year-round. We call this perennial allergic rhinitis. Sometimes, we can get the same symptoms of runny nose or stuffy nose from things like changes in temperature, changes in weather, certain smells, consuming alcohol or eating spicy foods. This is called non-allergic rhinitis.
For most children, their seasonal allergy symptoms actually get a little worse every year. This is because their body becomes more sensitive to the specific allergens. In addition, factors like rainfall, wind and temperature can make some allergy seasons worse than others. Just because a patient has only had mild symptoms in the past, that doesn’t mean that seasonal allergies are not the explanation for their more severe symptoms this year.
There are some signs in a patient’s physical exam that a doctor can look for to help make a diagnosis of seasonal or perennial allergies:
- “Allergic shiners” or dark smudges and swelling of the area under the eyes
- Exaggerated wrinkles beneath the eyes
- A wrinkle across the tip of the nose caused by repeated rubbing and pushing on an itchy nose; “the allergic salute”
- Mouth breathing that leads to a high, arched palate and dental problems
- The skin inside the nose may appear pale or with a bluish tinge
- Clear discharge from the nose or seen dripping from the back of the nose into the throat
- A “cobblestone” appearance to the skin at the back of the throat
- Ear drums that show fluid behind them or are retracted
Most patients do not require any special tests. They can be diagnosed just with a simple office visit that includes a conversation with your doctor and a physical exam. If your symptoms prove to be difficult to control with medications, 2 types of tests may help your doctor confirm the diagnosis and manage your symptoms. These are skin prick testing and blood testing. The results of these tests may help you avoid the allergens that are causing your symptoms. For patients with severe symptoms that do not respond to common medications, an Allergy specialist may use the results of these tests to design a course of “allergy shots.” It is important to remember that allergy tests are not perfect. They may fail to identify allergens that are causing you problems. Sometimes, patients even have abnormal results suggesting allergy to a substance that they actually tolerate just fine.
Not all cases of allergic rhinitis need treatment. However, if your symptoms are really bothering you, there are several things that might help.
Over the counter antihistamines like Allegra, Zyrtec, Claritin, Benadryl or their generic equivalents are a good place to start. These medicines can be taken just on the days you need them and usually provide quick relief. While Benadryl often makes patients feel sleepy, the other medications listed above usually do not.
If you do not get enough relief from antihistamines, you don’t like how they make you feel or you need to take them every day, you should consider taking a nasal steroid spray like Flonase or Rhinocort or their generic equivalents. These are now available over the counter. You will need to take these for several days before you feel relief and they need to be used consistently everyday as long as your symptoms persist. These medicines deliver a very small dose of a steroid that will not affect a child’s immune system or growth. Many studies have shown that they are both safe and more effective than antihistamines.
Nasal anti-histamine sprays (like Astelin) are available with a prescription. These medications can give very quick relief but are less effective than the consistent use of a nasal steroid spray. However, it is very important to avoid nasal sprays like Afrin that contain decongestants. When these medications wear off, they can leave you more congested than you started! Nasal sprays or drops that contain only saline may be comforting and are safe at any age.
Antihistamine drops for the eyes are available by prescription (Pataday) and over the counter (Zaditor). These can be used along with other allergy medications and can be very helpful for people with significant eye symptoms. The over the counter product Zaditor is a good place to start. Again, it is very important to avoid eye drops like Visine that promise to reduce eye redness. These medicines can cause increased eye redness when they wear off.
It can be very helpful to reduce your exposure to allergens. During the pollen season, this means cleaning all the pollen off your body after you spend time out of doors. At the end of the day, children with seasonal allergies should be bathed and have their hair washed and then put on clean clothing. If you can’t do that, at least wash their hands and faces, brush their hair and change their clothes. If you can, try to use your air conditioning at home and in the car instead of opening the windows. If dust, molds or mildews seem to cause your problems, vacuuming, changing sheets and cleaning regularly may also help reduce your symptoms.
Many of these treatments strategies can be tried at home. However, if over the counter products and non-medication treatments aren’t providing enough relief, it is time to visit your doctor. We can help confirm the right diagnosis, perform testing if necessary and provide prescription medications that may be more helpful. We are always happy to answer your questions and discuss all your treatment options.