About Allergic Rhinitis
Allergic rhinitis is the most common allergic disease, affecting 20–40 million people in the US alone, including 10-30% of adults and up to 40% of children. In the US, the prevalence of seasonal and perennial allergic rhinitis in the general population is about 10% and 10–20% respectively.
Allergic rhinitis is more common in children than adults and is one of the major chronic conditions in children <18 years old. In 80% of cases, it develops before the age of 20 years. Symptoms develop by 2–3 years of age in 20% of cases, and 40% of cases have symptoms by 6 years .
Prevalence is greater in boys than girls, but there is little difference between the sexes in adulthood. Symptoms tend to improve with age, particularly in those who have an early onset of the disease.
The prevalence of allergic diseases varies worldwide. The International Study of Asthma and Allergies in Childhood (ISAAC) found that 12-month prevalences of allergic rhinoconjunctivitis in 13–14 year olds varied between 1.4% and 39.7%: low prevalences were found in Albania, Georgia, Estonia, Lativia, Romania, and Indonesia, and high prevalences were found in Nigeria, Paraguay, Malta, Hong Kong, and Australia.
The prevalence of allergic rhinitis is increasing in both adults and children, particularly in populations with a Western lifestyle: the number of children affected has doubled in the last 20 years. The cause of this increase is uncertain, but possible factors include higher levels of airborne pollution, increased levels of hygiene (the hygiene hypothesis), rising dust mite populations, less ventilation in houses and offices, dietary factors, and the trend towards sedentary lifestyles.
Treatments of Allergic Rhinitis
There are many ways of reducing the symptoms of allergic rhinitis and these are listed below.
You should discuss your symptoms with your doctor who can advise you on which treatments would be best for you.
Allergen avoidance is active avoidance of the allergen that causes your allergy. This is usually recommended for all people with allergic rhinitis
Drug treatment: the main treatments are antihistamines, corticosteroids, cromones, and decongestants. Which one you need depends on the severity of your disease, your age, and the type of allergic rhinitis you suffer from. Many are available from your local pharmacy, but some may need a prescription from your doctor
Immunotherapy is given to people with severe disease who cannot use drug treatments. To get immunotherapy, you will probably have to visit an allergy specialist
Alternative medicine: these are natural remedies that are available from your local pharmacy, health food shop, or from specialists. Most alternative medicines are not proven to improve allergic rhinitis
Allergen avoidance should be the first approach to controlling the symptoms of allergic rhinitis
Antihistamines, corticosteroids, cromones, and decongestants can be used depending on patient age, disease severity, and type of allergic rhinitis
Immunotherapy may indicated in patients in whom pharmacological treatments are ineffective or cause side effects, and who are allergic to a limited number of allergens
- Seasonal allergic rhinitis in adults and children
- Perennial allergic rhinitis in adults
- Perennial allergic rhinitis in children
Treatment of Seasonal Allergic Rhinitis in Adults and Children
The following table indicates treatments for seasonal allergic rhinitis in adults and children, based on the guidelines of van Cauwenberge et al. (the guidelines do not consider the cost of treatments).
|Severity of disease||Nasal symptoms*||Eye symptoms|
|Mild or intermittent symptoms||Oral or nasal antihistamines** or cromones||Topical antihistamines** or cromones|
|Moderate (or mild and not controlled by antihistamines or cromones)||Nasal corticosteroids||Topical antihistamines** or cromones|
|Severe (or moderate and not controlled by nasal corticosteroids)||Nasal corticosteroids with oral or nasal antihistamines**||Nasal corticosteroids with oral or topical antihistamines**|
*Short course of oral or nasal decongestants (for <10 days and not in children <1 year old) can be added if nasal obstruction presents
**Non-sedating, second-generation antihistamines recommended
Reatment of Perennial Allergic Rhinitis in Adults
Allergen avoidance methods are recommended for perennial allergic rhinitis in adults irrespective of disease severity.
The following table indicates treatments based on the guidelines of van Cauwenberge et al. (the guidelines do not consider cost of treatments).
|Severity of disease||Treatment|
|Mild or intermittent symptoms||Oral or nasal antihistamines**|
|Moderate or frequent symptoms (or mild and not controlled by antihistamines)||Nasal corticosteroids for a few months maximum|
|Severe (or moderate and not controlled by nasal corticosteroids)||Topical corticosteroids plus oral antihistamines|
**Non-sedating, second generation antihistamines recommended
If symptom relief is not provided by the above treatments, then the patient should be evaluated for an underlying disease of non-allergic origin eg chronic sinusitis. Topical decongestants (for <10 days), oral decongestants, or a short-course of oral steroids may alleviate resistant nasal obstruction.
Immunotherapy may be useful with house dust mite and animal dander allergens.
Treatment of Perennial Allergic Rhinitis in Children
The principles of treating perennial allergic rhinitis in children are the same as for adults, but care must be taken to minimise the potential for side effects. The following are recommendations from van Cauwenberge et al. (the guidelines do not consider the cost of treatments).
- Allergen avoidance is very important for young children, because of the risk of developing new sensitisations to the allergen. Strict allergen avoidance may also reduce the need for drug treatment
- Antihistamines (oral or nasal) or cromones should be used for perennial disease of any severity. (Non-sedating, second-generation antihistamines are recommended)
- Topical corticosteroids can be used if antihistamines and cromones fail to control symptoms (taking care not to exceed doses for the child’s age, and to alter the dosage if the child is already receiving steroids eg for asthma)
- Topical corticosteroids can be combined with antihistamines if they do not provide relief alone
- Immunotherapy can be tried if pharmacological treatment fails
- Topical or oral decongestants should not be used in children <1 year old because of the risk of side effects
- Oral corticosteroids should be avoided in young children
Gardening With Allergies
When you have allergies, thoughts of gardening may lead to thoughts of pollen, mold, fragrance sensitivity, insect bites, or skin rash. But having allergies is no reason to miss out on the joys of gardening, as long as you take a few simple precautions. Find out how to plant and tend a low-allergen garden and how you can keep your allergies under control while gardening. Learn how to make those outdoor chores more enjoyable.