- Hay Fever (Rhinitis) | Symptoms & Treatment | ACAAI Public Website
- Intranasal corticosteroids
- Nasal sprays
- Leukatriene pathway inhibitors
- Eye allergy preparations and eyedrops
- Treatments that are not recommended for allergic rhinitis
- Allergic rhinitis – Treatment
- Cleaning your nasal passages
- Add-on treatments
- Treatment of Allergic Rhinitis
- Relieve Allergy Symptoms Without Drugs
- Nonallergic Rhinitis: Causes, Symptoms, and Treatment
Hay Fever (Rhinitis) | Symptoms & Treatment | ACAAI Public Website
The first approach in managing seasonal or perennial forms of hay fever should be to avoid the allergens that trigger symptoms.
- Stay indoors as much as possible when pollen counts are at their peak, usually during the midmorning and early evening (this may vary according to plant pollen), and when wind is blowing pollens around.
- Avoid using window fans that can draw pollens and molds into the house.
- Wear glasses or sunglasses when outdoors to minimize the amount of pollen getting into your eyes.
- Wear a pollen mask (such as a NIOSH-rated 95 filter mask) when mowing the lawn, raking leaves or gardening, and take appropriate medication beforehand.
- Don’t hang clothing outdoors to dry; pollen may cling to towels and sheets.
- Try not to rub your eyes; doing so will irritate them and could make your symptoms worse.
- Keep windows closed, and use air conditioning in your car and home. Make sure to keep your air conditioning unit clean.
- Reduce exposure to dust mites, especially in the bedroom. Use “mite-proof” covers for pillows, comforters and duvets, and mattresses and box springs. Wash your bedding frequently, using hot water (at least 130 degrees Fahrenheit).
- To limit exposure to mold, keep the humidity in your home low (between 30 and 50 percent) and clean your bathrooms, kitchen and basement regularly. Use a dehumidifier, especially in the basement and in other damp, humid places, and empty and clean it often. If mold is visible, clean it with mild detergent and a 5 percent bleach solution as directed by an allergist.
- Clean floors with a damp rag or mop, rather than dry-dusting or sweeping.
Exposure to pets
- Wash your hands immediately after petting any animals; wash your clothes after visiting friends with pets.
- If you are allergic to a household pet, keep the animal your home as much as possible. If the pet must be inside, keep it the bedroom so you are not exposed to animal allergens while you sleep.
- Close the air ducts to your bedroom if you have forced-air or central heating or cooling. Replace carpeting with hardwood, tile or linoleum, all of which are easier to keep dander-free.
Many allergens that trigger allergic rhinitis are airborne, so you can’t always avoid them.
If your symptoms can’t be well-controlled by simply avoiding triggers, your allergist may recommend medications that reduce nasal congestion, sneezing, and an itchy and runny nose.
They are available in many forms — oral tablets, liquid medication, nasal sprays and eyedrops. Some medications may have side effects, so discuss these treatments with your allergist so they can help you live the life you want.
Intranasal corticosteroids are the single most effective drug class for treating allergic rhinitis. They can significantly reduce nasal congestion as well as sneezing, itching and a runny nose.
Ask your allergist about whether these medications are appropriate and safe for you. These sprays are designed to avoid the side effects that may occur from steroids that are taken by mouth or injection.
Take care not to spray the medication against the center portion of the nose (the nasal septum). The most common side effects are local irritation and nasal bleeding.
Some older preparations have been shown to have some effect on children’s growth; data about some newer steroids don’t indicate an effect on growth.
Antihistamines are commonly used to treat allergic rhinitis.
These medications counter the effects of histamine, the irritating chemical released within your body when an allergic reaction takes place.
Although other chemicals are involved, histamine is primarily responsible for causing the symptoms. Antihistamines are found in eyedrops, nasal sprays and, most commonly, oral tablets and syrup.
Antihistamines help to relieve nasal allergy symptoms such as:
- Sneezing and an itchy, runny nose
- Eye itching, burning, tearing and redness
- Itchy skin, hives and eczema
There are dozens of antihistamines; some are available over the counter, while others require a prescription. Patients respond to them in a wide variety of ways.
Generally, the newer (second-generation) products work well and produce only minor side effects. Some people find that an antihistamine becomes less effective as the allergy season worsens or as their allergies change over time.
If you find that an antihistamine is becoming less effective, tell your allergist, who may recommend a different type or strength of antihistamine. If you have excessive nasal dryness or thick nasal mucus, consult an allergist before taking antihistamines.
Contact your allergist for advice if an antihistamine causes drowsiness or other side effects.
Proper use: Short-acting antihistamines can be taken every four to six hours, while timed-release antihistamines are taken every 12 to 24 hours.
The short-acting antihistamines are often most helpful if taken 30 minutes before an anticipated exposure to an allergen (such as at a picnic during ragweed season). Timed-release antihistamines are better suited to long-term use for those who need daily medications.
Proper use of these drugs is just as important as their selection. The most effective way to use them is before symptoms develop. A dose taken early can eliminate the need for many later doses to reduce established symptoms.
Many times a patient will say that he or she “took one, and it didn’t work.” If the patient had taken the antihistamine regularly for three to four days to build up blood levels of the medication, it might have been effective.
Side effects: Older (first-generation) antihistamines may cause drowsiness or performance impairment, which can lead to accidents and personal injury.
Even when these medications are taken only at bedtime, they can still cause considerable impairment the following day, even in people who do not feel drowsy.
For this reason, it is important that you do not drive a car or work with dangerous machinery when you take a potentially sedating antihistamine. Some of the newer antihistamines do not cause drowsiness.
A frequent side effect is excessive dryness of the mouth, nose and eyes.
Less common side effects include restlessness, nervousness, overexcitability, insomnia, dizziness, headaches, euphoria, fainting, visual disturbances, decreased appetite, nausea, vomiting, abdominal distress, constipation, diarrhea, increased or decreased urination, urinary retention, high or low blood pressure, nightmares (especially in children), sore throat, unusual bleeding or bruising, chest tightness or palpitations. Men with prostate enlargement may encounter urinary problems while on antihistamines. Consult your allergist if these reactions occur.
- Follow your allergist’s instructions.
- Alcohol and tranquilizers increase the sedation side effects of antihistamines.
- Do not use more than one antihistamine at a time, unless prescribed.
- Keep these medications the reach of children.
- Know how the medication affects you before working with heavy machinery, driving or doing other performance-intensive tasks; some products can slow your reaction time.
- Some antihistamines appear to be safe to take during pregnancy, but there have not been enough studies to determine the absolute safety of antihistamines in pregnancy. Again, consult your allergist or your obstetrician if you must take antihistamines.
- While antihistamines have been taken safely by millions of people in the last 50 years, don’t take antihistamines before telling your allergist if you are allergic to, or intolerant of, any medicine; are pregnant or intend to become pregnant while using this medication; are breast-feeding; have glaucoma or an enlarged prostate; or are ill.
- Never take anyone else’s medication.
Decongestants help relieve the stuffiness and pressure caused by swollen nasal tissue. They do not contain antihistamines, so they do not cause antihistaminic side effects. They do not relieve other symptoms of allergic rhinitis.
Oral decongestants are available as prescription and nonprescription medications and are often found in combination with antihistamines or other medications. It is not uncommon for patients using decongestants to experience insomnia if they take the medication in the afternoon or evening.
If this occurs, a dose reduction may be needed. At times, men with prostate enlargement may encounter urinary problems while on decongestants. Patients using medications to manage emotional or behavioral problems should discuss this with their allergist before using decongestants.
Patients with high blood pressure or heart disease should check with their allergist before using. Pregnant patients should also check with their allergist before starting decongestants.
Nonprescription decongestant nasal sprays work within minutes and last for hours, but you should not use them for more than a few days at a time unless instructed by your allergist. Prolonged use can cause rhinitis medicamentosa, or rebound swelling of the nasal tissue. Stopping the use of the decongestant nasal spray will cure that swelling, provided that there is no underlying disorder.
Oral decongestants are found in many over-the-counter (OTC) and prescription medications, and may be the treatment of choice for nasal congestion. They don’t cause rhinitis medicamentosa but need to be avoided by some patients with high blood pressure. If you have high blood pressure or heart problems, check with your allergist before using them.
Nonprescription saline nasal sprays will help counteract symptoms such as dry nasal passages or thick nasal mucus. Un decongestant nasal sprays, a saline nasal spray can be used as often as it is needed. Sometimes an allergist may recommend washing (douching) the nasal passage. There are many OTC delivery systems for saline rinses, including neti pots and saline rinse bottles.
Nasal cromolyn blocks the body’s release of allergy-causing substances. It does not work in all patients. The full dose is four times daily, and improvement of symptoms may take several weeks. Nasal cromolyn can help prevent allergic nasal reactions if taken prior to an allergen exposure.
Nasal ipratropium bromide spray can help reduce nasal drainage from allergic rhinitis or some forms of nonallergic rhinitis.
Leukatriene pathway inhibitors
Leukotriene pathway inhibitors (montelukast, zafirlukast and zileuton) block the action of leukotriene, a substance in the body that can cause symptoms of allergic rhinitis. These drugs are also used to treat asthma.
Immunotherapy may be recommended for people who don’t respond well to treatment with medications or who experience side effects from medications, who have allergen exposure that is unavoidable or who desire a more permanent solution to their allergies. Immunotherapy can be very effective in controlling allergic symptoms, but it doesn’t help the symptoms produced by nonallergic rhinitis.
Two types of immunotherapy are available: allergy shots and sublingual (under-the-tongue) tablets.
- Allergy shots: A treatment program, which can take three to five years, consists of injections of a diluted allergy extract, administered frequently in increasing doses until a maintenance dose is reached. Then the injection schedule is changed so that the same dose is given with longer intervals between injections. Immunotherapy helps the body build resistance to the effects of the allergen, reduces the intensity of symptoms caused by allergen exposure and sometimes can actually make skin test reactions disappear. As resistance develops over several months, symptoms should improve.
- Sublingual tablets: This type of immunotherapy was approved by the Food and Drug Administration in 2014. Starting several months before allergy season begins, patients dissolve a tablet under the tongue daily. Treatment can continue for as long as three years. Only a few allergens (certain grass and ragweed pollens and house dust mite) can be treated now with this method, but it is a promising therapy for the future.
Eye allergy preparations and eyedrops
Eye allergy preparations may be helpful when the eyes are affected by the same allergens that trigger rhinitis, causing redness, swelling, watery eyes and itching.
OTC eyedrops and oral medications are commonly used for short-term relief of some eye allergy symptoms.
They may not relieve all symptoms, though, and prolonged use of some of these drops may actually cause your condition to worsen.
Prescription eyedrops and oral medications also are used to treat eye allergies. Prescription eyedrops provide both short- and long-term targeted relief of eye allergy symptoms, and can be used to manage them.
Check with your allergist or pharmacist if you are unsure about a specific drug or formula.
Treatments that are not recommended for allergic rhinitis
- Antibiotics: Effective for the treatment of bacterial infections, antibiotics do not affect the course of uncomplicated common colds (a viral infection) and are of no benefit for noninfectious rhinitis, including allergic rhinitis.
- Nasal surgery: Surgery is not a treatment for allergic rhinitis, but it may help if patients have nasal polyps or chronic sinusitis that is not responsive to antibiotics or nasal steroid sprays.
Allergic rhinitis – Treatment
Treatment for allergic rhinitis depends on how severe your symptoms are and how much they're affecting your everyday activities.
In most cases treatment aims to relieve symptoms, such as sneezing and a blocked or runny nose.
If you have mild allergic rhinitis, you can often treat the symptoms yourself.
You should visit your GP if your symptoms are more severe and affecting your quality of life, or if self-help measures have not worked.
It's possible to treat the symptoms of mild allergic rhinitis with medicines you buy from a pharmacy or shop, such as long-acting non-sedating antihistamines.
If possible, try to reduce exposure to the allergen that triggers the condition.
Find out more about preventing allergic rhinitis
Cleaning your nasal passages
Regularly cleaning your nasal passages with a salt water solution, known as nasal douching or irrigation, can also help by keeping your nose free of irritants.
You can do this by using a solution made with sachets bought from a pharmacy.
Small syringes or pots that often look small horns or teapots are also available to help flush the solution around the inside of your nose.
To rinse your nose:
- stand over a sink, cup the palm of 1 hand and pour a small amount of the solution into it
- sniff the water into 1 nostril at a time
- repeat this until your nose feels comfortable (you may not need to use all of the solution)
While you do this, some solution may pass into your throat through the back of your nose.
The solution is harmless if swallowed, but try to spit out as much of it as possible.
Nasal irrigation can be carried out as often as necessary, but a fresh solution should be made each time.
Medication will not cure your allergy, but it can be used to treat the common symptoms.
If your symptoms are caused by seasonal allergens, such as pollen, you should be able to stop taking your medication after the risk of exposure has passed.
Visit your GP if your symptoms do not respond to medication after 2 weeks.
If you have frequent or persistent symptoms and you have a nasal blockage or nasal polyps, your GP may recommend a nasal spray or drops containing corticosteroids.
Corticosteroids help reduce inflammation and swelling. They take longer to work than antihistamines, but their effects last longer.
Side effects from inhaled corticosteroids are rare, but can include nasal dryness, irritation and nosebleeds.
If you have a particularly severe b symptoms and need rapid relief, your GP may prescribe a short course of corticosteroid tablets lasting 5 to 10 days.
If allergic rhinitis does not respond to treatment, your GP may choose to add to your original treatment.
They may suggest:
- increasing the dose of your corticosteroid nasal spray
- using a short-term course of a decongestant nasal spray to take with your other medication
- combining antihistamine tablets with corticosteroid nasal sprays, and possibly decongestants
- using a nasal spray that contains a medicine called ipratropium, which will help reduce nasal discharge and make breathing easier
- using a leukotriene receptor antagonist medication, which blocks the effects of chemicals called leukotrienes that are released during an allergic reaction
If you do not respond to the add-on treatments, you may be referred to a specialist for further assessment and treatment.
Immunotherapy, also known as hyposensitisation or desensitisation, is another type of treatment used for some allergies.
It's only suitable for people with certain types of allergies, such as hay fever, and is usually only considered if your symptoms are severe.
Immunotherapy involves gradually introducing more and more of the allergen into your body to make your immune system less sensitive to it.
The allergen is often injected under the skin of your upper arm. Injections are given at weekly intervals, with a slightly increased dose each time.
Immunotherapy can also be carried out using tablets that contain an allergen, such as grass pollen, which are placed under your tongue.
When a dose is reached that's effective in reducing your allergic reaction (the maintenance dose), you'll need to continue with the injections or tablets for up to 3 years.
Immunotherapy should only be carried out under the close supervision of a specially trained doctor, as there's a risk it may cause a serious allergic reaction.
Treatment of Allergic Rhinitis
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Relieve Allergy Symptoms Without Drugs
Want a natural remedy for your stuffy, runny, itchy nose? Natural treatments can't replace your allergy medications, but they can work alongside them. From acupuncture to supplements, here are some simple things that might help you breathe easier.
Acupuncture. In this ancient Chinese therapy, an expert sticks tiny needles gently — and, many people say, painlessly — into your skin at specific points.
Studies of acupuncture for the treatment of allergies have shown mixed results, with the most rigorous studies showing very modest clinical benefit.
Acupuncture may be a reasonable option for interested patients with relatively mild disease who wish to minimize medication use and find the cost of therapy acceptable.
Allergy-proofing your home. You can't stop pollen from blowing outside. But you do have some control over what happens inside your home. Keep your windows shut when pollen is in the air. Run the air conditioning instead. If you can, change your clothes before coming inside (or as soon as you get in), remove your shoes, and shower.
HEPA filters. Studies are mixed about whether air filters help with allergy symptoms. That’s because far more allergens rest on surfaces rugs, furniture, and countertops than simply hang in the air.
So cleaning is an important step in controlling your allergy and asthma triggers. If you buy an air filter, make sure it's a HEPA filter. These capture fine, pollen-sized particles. It's a good idea to get a vacuum cleaner with a HEPA filter, too.
Regular vacuums can blow allergens back into the air.
Nasal washes. You could use a saline solution (salt water) in a neti pot or a squeeze bottle to rinse out your sinuses. Use distilled or sterile water.
If you use tap water, you must boil it and let it cool off first, or filter it with a filter that says “NSF 53” or “NSF 58” or says “absolute pore size” of 1 micron or smaller.
Clean the bottle or neti pot after every use, also using distilled, sterile, boiled, or filtered water.
Protection. If it's allergy season, keep your triggers at bay. Don't do outdoor activities when pollen counts are high. Most pollen peaks between 5 a.m. and 10 a.m. each day, and can also be high around midday when it’s warm and windy. And anytime you garden or clean the garage, wear a dust mask and sunglasses to keep allergens your nose, mouth, and eyes.
Saline sprays. These over-the-counter salt water sprays can flush out your nasal passages. They help clear out pollen and other irritants.
Supplements. There's evidence that some supplements help nasal allergies. Butterbur is one of the most promising and well-researched. Studies show that butterbur — specifically a butterbur extract called Ze 339 — works as well as some allergy drugs.
Stiill, butterbur has been linked to liver damage. Those intesretd in using it should also be aware of this potential hazard and be advised about early symptoms. Fermented red ginseng resulted in significant improvement in nasal congestion and rhinitis quality of life.
An Indian herbal product containing extract from the stem of Tinospora cordifolia has been shown in studied to give significant improvement in sneezing, nasal discharge, nasal obstruction, and itchy nose – but it can raise your white blood cell count.
There's evidence that other supplements, such as quercetin, may help, too.
Check with your doctor before you start using any supplements regularly, especially if you take daily medication or have any health conditions.
Natural allergy remedies can make a difference. Just remember that they shouldn't replace medications and other treatments. If your symptoms aren't improving and they’re affecting your life, see a doctor. Medications, allergy shots, or other treatments could make things better.
AAFA: “Air Filters.”
AAAAI: “Indoor Allergens: Tips to Remember.”
Brinkhaus, B. Annals of Internal Medicine, Feb. 19, 2013.
Clifford W. Bassett, MD, allergy ambassador, Asthma and Allergy Foundation of America; Medical Director, Allergy and Asthma Care of NY; Clinical Assistant Professor of Medicine, NYU School of Medicine.
Jennifer McDaniel, MS, RD, CSSD, LD, spokesperson, Academy of Nutrition and Dietetics.
Natural Medicines Comprehensive Database: “Butterbur.”
Natural Medicines Comprehensive Database: “Natural Medicines in the Clinical Management of Allergic Rhinitis.”
Natural Medicines Comprehensive Database: “Kefir.”
Winchester Hospital: “Probiotics for Hay Fever and Asthma in Children.”
CDC: “Safe Ritual Nasal Rinsing.”
Mayo Clinic: “Hay Fever.”
© 2019 WebMD, LLC. All rights reserved. Allergy Shots
Nonallergic Rhinitis: Causes, Symptoms, and Treatment
- Causes of Nonallergic Rhinitis
- Treatment of Nonallergic Rhinitis
Nonallergic rhinitis is a medical term that describes a set of symptoms that resemble nasal allergies and hayfever but that occurs without a known cause. It produces symptoms such as:
- Postnasal drip
- Runny nose
- Stuffy nose
Usually, it develops in adulthood, and symptoms last year-round.
Un allergic rhinitis, nonallergic rhinitis does not involve the immune system. About 58 million Americans have allergic rhinitis. By comparison, 19 million have nonallergic rhinitis.
Nonallergic rhinitis can cause just as much misery as allergic rhinitis. It can also be associated with the same complications, such as:
Both types of rhinitis are associated with:
- Decreased production at work
- Increased doctor visits
- Side effects from treatment, such as drowsiness, nosebleed, and nasal dryness
Because the two are so similar, it's often necessary to perform allergy tests and blood tests to tell them apart.
Often, what causes nonallergic rhinitis is unknown. And the condition is often confirmed only after other conditions such as allergic rhinitis or infection are ruled out.
Environmental irritants are common triggers of nonallergic rhinitis. Some are found in the home and others are more common in the workplace.
Examples of what can trigger symptoms include:
- Car exhaust
- Cigarette smoke
- Cleaning solutions
- Hair spray
- Laundry detergents
- Metal salts
- Wood dust
When such triggers cause nonallergic rhinitis, they also often cause asthma.
Some medications can trigger non-allergic rhinitis. Examples include:
Foods and beverages may also sometimes be triggers. Examples include:
- Hot foods, such as soup
- Spicy foods
- Alcoholic beverages, especially beer and wine
Other triggers include:
- Illegal drugs. Cocaine and other snorted street drugs often cause chronic nonallergic rhinitis.
- Weather changes. Sudden changes in weather or temperature can trigger nonallergic rhinitis. Skiers, for instance, often develop a runny nose. And some people are affected by any cold exposure. In some cases, people even start sneezing after leaving a cold, air-conditioned room.
- Hormone changes. Nonallergic rhinitis often occurs during periods of hormonal imbalance. For instance, it may occur during puberty, menstruation, or pregnancy. It usually starts during the second month of pregnancy and lasts until childbirth. Hormonal conditions such as hypothyroidism can also trigger symptoms.
Nonallergic rhinitis can't be cured. But it can be controlled by:
- Avoiding rhinitis triggers
- Using home remedies such as nasal irrigation
- Taking over-the-counter and prescription medications
Allergy shots — immunotherapy — are not used to treat nonallergic rhinitis.
If you have nonallergic rhinitis, it's important that you not smoke and not allow smoking in your home.
Other strategies to reduce exposure to triggers include:
- Avoid wood-burning stoves and fireplaces if they cause symptoms.
- Avoid cleaning agents, household sprays, perfumes, and scented products if they cause symptoms.
- Ask family, friends, and co-workers not to use scented products that cause symptoms.
- Avoid any chemical or material that tends to make you sneeze or have a runny nose.
- Talk to your doctor about the medications you now take. If your nonallergic rhinitis is triggered by a medicine you need, your doctor may suggest a substitute.
Many people with nonallergic rhinitis benefit from performing nasal irrigation. This refers to rinsing of the nostrils with a salt water — saline — solution one or more times a day. Over-the-counter products for doing this include bulb syringes, neti pots, and bottle sprayers.
During each irrigation, rinse each nostril with at least 200 mL (about 3/4 cup) of commercially or home-prepared solution.
It's important to note that, according to the CDC, if you are irrigating, flushing, or rinsing your sinuses, use distilled, sterile, or previously boiled water to make up the irrigation solution. It’s also important to rinse the irrigation device after each use and leave open to air dry.
When performed once or twice a day, nasal irrigation may especially help treat postnasal drip. It's also a helpful technique to clear the sinuses before using medicated nasal sprays.
Medications for nonallergic rhinitis include:
Nasal antihistamines. Prescription products such as azelastine (Astelin) and olopatadine (Patanase) can relieve symptoms of postnasal drip, congestion, and sneezing within minutes. They are most effective when used on a regular basis.
Nasal glucocorticoids. Daily use of medications such as budesonide (Rhinocort Allergy), fluticasone (Flonase), or triamcinolone (Nasacort Allergy 24HR) may help relieve symptoms. These nasal sprays are available over the counter. It may take days or weeks to notice the full effects. Sometimes, people benefit from using a combination of nasal antihistamines and nasal glucocorticoids.
Nasal ipratropium. Ipratropium bromide (Atrovent) is considered the best treatment for the watery nasal discharge that comes from eating and drinking certain foods and beverages.
Decongestants. Oral decongestant medications — such as pseudoephedrine — may help relieve congestion.
But these are not generally recommended unless nasal antihistamines and nasal glucocorticoids do not help symptoms.
Decongestant nasal sprays containing oxymetazoline (Afrin) and phenylephrine (Neo-synephrine) should not be used for more than two to three days at a time. Doing so can cause overuse (rebound) congestion.
In some cases, surgery to remove nasal polyps or correct a deviated septum can improve the way medications for nonallergic rhinitis work. Surgery is only considered as a treatment by itself, though, when other treatments have failed to reduce symptoms.
American College of Allergy Asthma & Immunology: “Allergic Rhinitis (Hay Fever).”
Settipane R. Allergy Asthma Proc, 2001.
UpToDate.com. “Patient information: Allergic rhinitis (seasonal allergies) (Beyond the Basics).”
Wallace D. Journal of Allergy and Clinical Immunology, 2008.
© 2018 WebMD, LLC. All rights reserved.