Seasonal Allergy/Allergic Rhinitis/Hay Fever Handout



What are allergies? Allergies are the immune system’s reaction to a normally harmless trigger. When your body senses a substance it considers to be a foreign invader, it releases chemicals designed to defend against the offending agent which causes allergy symptoms. Not everyone has allergies, and it’s not yet understood why some people have allergies and others do not. It is thought to be a primitive response designed to defend against types of bacteria. When your body is initially exposed to an allergen, it may not necessarily react immediately. Your body will develop IgE (Immunoglobin E) antibodies specific to the allergen to guard against the next exposure. The IgE molecules attach to mast cells. When your body is exposed again, your body releases mast cells with the specific IgE in the nose, eyes, lungs, and skin. This triggers a release of substances designed to stop the allergen: histamine and leukotrienes. Histamine causes hives, itching of the skin, swelling, and irritation of the nasal passages. Leukotrienes aggravate sneezing, itching, and eye symptoms with increased mucus production, and further inflammation in the nasal passages and lungs. This occurs with 10 minutes of exposure and resolves about an hour after the offending agent is removed. Outdoor pollens: Grass, weeds, and trees. Tend to be seasonal. Indoor allergens: Dust mites, cockroaches, mold spores, and animal dander. Can become chronic. Seasonal Allergies: Seasonal allergies tend to be overt and immediately noticeable with itchy, watery eyes, sneezing, nasal congestion, post nasal drip, fatigue, irritability, and dry cough. Chronic allergies are less severe and can persist year round. Chronic Allergies and Sensitization: As you are continually exposed to an allergen, nasal inflammation develops. Continued exposure to allergens results in more noticeable symptoms, with progressively lower doses of the allergen. Your body reacts to allergen more quickly with each exposure.Allergy sensitization can take years to manifest. You may not be aware of having allergies until symptoms become severe enough to seek treatment or be found during an exam for another concern such as a dry cough or sinus infection. You may notice a mildly stuffy nose or nasal irritation without the overt symptoms of seasonal allergies. When is rhinitis not allergic? When there is no correlation to an allergic trigger or lack of eye symptoms. Examples of non-allergic triggers can be foods, weather, and cigarette smoke. Non-allergic rhinitis is treated with a nasal steroid or nasal antihistamine. Discuss all symptoms you are experiencing with your primary care manager. Related Conditions: Allergic conjunctivitis: Seasonal - Eye itching, tearing, conjunctival swelling, watery discharge, burning, and sensitivity to light.Eczema: Chronic - Itchy, dry skin, red patches, and papules that can affect the neck, elbows, knees, abdomen. Asthma: Chronic - Cough, chest tightness, wheezing, and difficulty breathing.Sinusitis: Secondary infection - Nasal inflammation leads to bacterial infection of the sinuses. Symptoms include purulent runny nose, facial or tooth pain, and cough. Otitis Media: Secondary infection of the middle ear. Symptoms include ear pain, feverTreatment of Allergic Rhinitis: Treatment is aimed at avoiding known allergens, preventing flares, and symptom relief. You and your primary care provider can select a drug from each class to use depending on the severity and frequency of your symptoms. Review of Medications Commonly Use for Allergies and Over the Counter Medications:Nasal Steroids: Nasal steroids are prescribed to prevent inflammatory response in the nasal passages and reduce the surface area for allergens to cling to. Studies show regular use of nasal steroids reduces allergic symptoms and can be more effective than anti-histamines. Nasal steroids will sometimes cause a dry nose and nose bleeds. If this occurs, reduce use to every 2d or 3d day. Nasal Steroids: Beconase, Flonase, Fluocinonide, Fluticasone, Nasarel, and NasonexLeukotriene Receptor Blockers (LRB’s): Reduce inflammatory effects in the nasal and lung tissues. LRB’s are commonly used in asthma management to prevent inflammation in the lungs and have also been found to be beneficial for chronic allergies. Leukotriene Blockers: Montelukast, SingulairMast Cell Stabilizers: Stabilizes mast cells in order to prevent break down of the mast cell that would release histamine. Mast Cell Stabilizers: Cromolyn Nasal, NasalCrom, Olopatadine, PatanaseNasal Decongestants: Shrink tissues and blood vessels in the eyes and nose that swell with allergies or upper respiratory infections. These medications are also found in-over-the counter cold and allergy medications. They are commonly marketed with anti-histamines and marked as PE or D to indicate decongestant. Example: Allegra-D, Sudafed PE. Nasal Decongestants: Phenylephrine, Oxymetazoline, Pseudoephedrine, SudafedIntranasal Anti-histamines: Reduce the inflammatory response in the nasal passages in order to reduce itching, sneezing, runny nose, and inflammation. Intranasal Anti-histamines: Astepro, Astelin, AzelastineOral Anti-histamines: Reduces sneezing, runny nose, itching of the eyes, nose, and palate:1st generation anti-histamines: Atarax (Hydroxyzine), Benadryl (Diphenhydramine), Doxyalamine, Brompheniramine (Bromed) Chlorpheniramine (Chlor-Trimeton), Meclizine (Bonine), Phenergan (Promethazine), Vistarel (Hydroxyzine) 2d generation anti-histamines: Cetirzine (Levocertirzine, Zyzal, Zyrtec), Fexofenadine (Allegra), Loratadine (Alavert, Clarinex, Claritin, Desloratadine)Your body will tend to get used to oral anti-histamines with chronic use. If this is noted, rotate to another type of anti-histamine. Reserve anti-histamines for overt allergy symptoms. Use a nasal steroid or mast cell stabilizer for chronic use. Do not use two different anti-histamines within the same 12 hour period. First generation anti-histamines typically cause drowsiness in adults and some children. First generation antihistamines are often found in over the counter sleep medications, allergy medications, and cold medications. Second generation anti-histamines are less likely to cause drowsiness with the exception of Cetirzine. Cetirzine causes drowsiness in most adults, and conversely, alertness in toddlers. Comments about over the counter cold and allergy medications: Be alert to duplicate ingredients. Read the label carefully for the active ingredients in the medication. Especially if using more than one brand of medication such as Alka-Seltzer, Dayquil, Nyquil, Tylenol, and Vicks. ................
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