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Allergic Rhinitis

Overview

In the spring, all of nature awakens – while people with allergies go into hiding and suffer in silence, often needlessly. Hay fever is not only an annoyance but an illness that should be taken seriously. Fortunately, excellent treatment options are available.

The medical term for hay fever is allergic rhinitis. Respiratory allergies – like all allergies – have increased dramatically over the last decades. In Germany, at least 20 million people suffer from respiratory allergies. Scientists are still researching the causes of this dramatic increase. Two factors appear to play a role: climate change and improved hygiene – which is, of course, necessary to ward off infectious disease.

Definition

Allergic rhinitis is an allergic reaction to various tree, grass and weed pollens, animal hair, dust mites, and/or mould. The old term ‘hay fever’ comes from the 19th century, when the allergy was first seen to result from contact with hay and grass. The most common physical conditions in allergy suffers are allergic rhinitis (‘hay fever’) and conjunctivitis (pink eye). Typical symptoms are sneezing, tearing, itching and redness of the eyes, swelling of the nasal passages and runny nose.

Some types of non-allergic rhinitis can also produce similar symptoms and must be ruled out.

Causes and triggers

It is important to note when and under which circumstances hay fever symptoms occur when trying to determine allergy triggers. An allergy first appears after an initial contact with the allergen. Antibodies to the allergen build up in the blood and then ‘dock’ onto mast cells. Upon renewed contact between antibodies and allergens, various messengers are sent out from the mast cells, primarily histamine, which is responsible for the clinical symptoms of the illness.

 

In addition to eye and nose reactions, the bronchial passages are often affected.

This results in coughing and asthma (allergic asthma).

80% of respiratory allergies are triggered by the following allergens:

  • Pollen (tree, grass and weed pollen)

  • House dust mites

  • Pet dander

  • Mould

Allergic rhinitis is divided into intermittent (e.g. seasonal symptoms) and persistent (e.g. symptoms throughout the year) rhinitis, depending on the triggering allergens.

Intermittent rhinitis is primarily triggered by pollen (pollinosis). Early flowering plants and trees such as alder, hazelnut and birch trigger symptoms from February until April, grasses and rye pollen from end of May until mid-June, and weed pollen such as mugwort and buckhorn from end of July until August.

Common triggers of persistent rhinitis are pet dander, dust mites and mould spores. Cat, guinea pig and hamster hair are common pet hair allergy triggers; dog hair allergies are not as common. The animal in question does not need to be in the immediate vicinity – allergen residues in living areas (especially in upholstery, mattresses and pillows), in cars or on clothes can also trigger allergic reactions. House dust allergies are caused by house dust mites, a type of arachnid. It is not the mites themselves but rather their excrement that triggers the allergy. The mites feed on flakes of shed human skin and other house dust elements. They prefer a warm climate (20-30ºC and 75-80% humidity), such as that found in mattresses. Up to 15,000 mites can be found in a single gram of dust. Mould also prefers a warm, humid environment and can be found behind cupboards, ceilings or wall panelling, in humid parts of poorly ventilated rooms such as bathrooms, kitchens and cellars, in flower pots, on rotting plants or food scraps, in humidifiers and air conditioners. House dust allergy symptoms are usually more severe in the morning, while mould allergy symptoms often worsen at the beginning of the damp season.

Progression

Hay fever usually develops in childhood or adolescence, but more and more adults are experiencing the onset of hay fever. Once it has developed, the allergy does not go away, and in 40% of untreated cases develops into allergic asthma.

 

For this reason, early and thorough treatment is necessary.

Diagnosis

A look at the patient’s medical history, including when and where symptoms appear, is often enough to reach a diagnosis of hay fever, since the disease is characterised by a specific pattern of symptoms over time.

However, it is more difficult to determine exactly which allergens are causing the symptoms. It may therefore be useful to keep an allergy diary. The patient records the symptoms, their severity, the time of day during which they occur and how long they last. It is also important to document any medications and food that are consumed, physical activities and any environmental factors, such as poor air quality. This documentation may be enough for a doctor to identify the allergen. However, an allergy test may still be necessary. The following tests may be performed:

  • Skin test/prick test

  • IgE blood test

  • Provocation test

Treatment

Drug therapy is one treatment option for relieving hay fever symptoms. Medications can include:

  • Antihistamines (sprays, tablets or drops)

  • Anti-allergy eye drops

  • Cortisone (spray)

  • Leukotriene modifiers

  • Decongestant nose drops (these can become habit-forming and should therefore not be used for longer than ten days)

Another treatment option is allergen immunotherapy, through which long-term relief from allergies can be successfully achieved. The patient is given ever-increasing doses of the allergen over a period of at least three years and becomes desensitised to it; allergic reactions are drastically reduced or, in the best case, disappear altogether.

Tips

Various tips and tricks can make life with hay fever a little easier:

When opening windows

If you live in the countryside, be aware of the following time schedule:

- Highest pollen count: 4 am-6 am

- Lowest pollen count: 6 pm-12 am

 

For city dwellers:

- Highest pollen count: 6 pm-12 am

- Lowest pollen count: 6 am-8 am

 

Holidays/Leisure

Make sure to schedule your holidays and leisure activities around your allergy needs.

Try to avoid smoky rooms, for instance in bars and restaurants, and also avoid swimming in chlorinated water.

Smoking – even passive smoking – and chlorine irritate the airways and can make you more susceptible to allergic reactions.

Car and train trips

Leave the car windows closed. Ventilation systems with pollen filters are ideal.

On train trips, look for a seat in a section with closed windows.

And don’t forget: some antihistamines can make you feel tired. Make sure you are prescribed one of the newer antihistamines that do not cause drowsiness.

Living areas

Carpets, furniture, curtains and bedding can all attract pollen and other allergens. There are special cleaning products that can help eliminate allergens (see the ECARF Seal of Quality).

Dried flowers, wall hangings and the like are best avoided by those with hay fever, as they attract dust and other allergens.

Personal care

If you suffer from a pollen allergy, it’s a good idea to shower and wash your hair at night. Leave your street clothes outside the bedroom.

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