In this article:
- Allergic rhinitis, or hay fever, is a result of the immune system’s response against airborne allergens.
- It typically leads to a stuffy, runny, itchy nose, accompanied by cold, cough, and throat itchiness. Hay fever may also cause watery or puffy eyes.
- Primary treatment involves avoiding exposure to allergens. Allergy medicines, nasal sprays, and nasal decongestants may also be used.
- Home remedies such as steaming and self-care measures can help manage the symptoms during a flare-up.
Irritation or swelling in the mucous lining of the nose is known as rhinitis. When it occurs after exposure to allergens, it is known as allergic rhinitis or hay fever, which is a highly prevalent ailment.
While allergic rhinitis is chiefly treated with medications, parallel therapies using natural products, as well as body and mind practices are also available.
What Happens in Allergic Rhinitis?
An allergy refers to an extensive immune response to foreign substances that are otherwise not harmful to the majority of individuals. These foreign substances, or allergens, may cause allergic rhinitis, a common chronic disorder.
When allergens are inhaled through the nose or mouth, they interact with the IgE antibodies present on the surface of mast cells and sensitize them.
This interaction activates the mast cells, resulting in the release of chemicals, such as histamine, that cause inflammation and itchiness in the surrounding tissues. It may also stimulate mucus production.
In 2018, approximately 19.2 million people, or 7.7% of the population, were diagnosed with hay fever in the United States. (1)
Types of Allergic Rhinitis
Allergic rhinitis occurs in two forms:
- Seasonal: Flare-ups are limited to spring, summer, and early fall and usually occur as a result of an allergy to pollen or airborne mold spores.
- Perennial: The symptoms are observed year-round and are usually caused by allergens, such as pet hair or dander, dust mites, mold, and cockroaches. Rarely, perennial allergic rhinitis may be due to hidden food allergies.
Occasionally, individuals may experience both perennial and seasonal rhinitis, wherein the symptoms are present throughout the year and aggravate in specific pollen seasons.
Nonallergic rhinitis, on the other hand, is caused by factors other than allergens, including irritants such as chemicals and smoke, hormonal changes, nasal deformity (such as a deviated septum), certain medications, and, at times, the overuse of nasal sprays.
It is difficult to determine the reason behind this type of rhinitis, but it is associated with and has symptoms similar to nonallergic asthma.
Causes of Allergic Rhinitis
Allergic rhinitis is caused by exposure to various types of allergens, including:
- Pollen: It is a fine powder produced by grasses, trees, and weeds and is a common allergen in the United States.
- Dust mites: Approximately 40% of the global industrial population is allergic to dust mites. Several species are found in both working and living environments. The frequencies of these varying dust mite allergies differ according to age group. (2)
- Cockroach waste: Cockroach waste is among the most common indoor allergens. Around 40%-60% of people living in urban and inner-city areas have IgE antibodies against it. (3)
- Mold: It is a type of fungus that can grow easily in any moist and dark area, such as the bathroom, the basement, a field with uncut grass, a pile of dead leaves, and a cabinet below a leaking sink. Thus, it is difficult to avoid exposure to this allergen.
- Animal dander: It refers to the skin shed by animals. It is a frequent source of allergy since having pets is common worldwide. According to the American Pet Products Association, approximately 65% of homes in the United States own a pet.
During a bout of allergic rhinitis, the nasal lining becomes increasingly sensitive toward inhalants due to the swelling caused by hay fever. Therefore, the symptoms may be triggered by factors other than allergens, including:
- Strong odors, such as fragrances or cleaning products
- Temperature changes
- Altered humidity levels
Signs and Symptoms of Allergic Rhinitis
On exposure to allergens, the following symptoms may be observed immediately:
- Runny nose
- Itchy, watery eyes
- Trouble smelling
- Itchiness in body parts such as the nose, throat, skin, or mouth
However, other symptoms may develop later, including:
- Nasal redness
- Postnasal drip, causing throat irritation and clearing
- Recurrent sinus or ear infections
- Sinus pressure
- Puffy eyes
- Fatigue and irritability
- Inflammation and pale-blue appearance of the nasal cavity
- Cobblestone throat, or the development of bumps at the back of the throat
- Nasal congestion, which may further lead to:
- Allergic shiners – Dark circles under the eyes
- Mouth breathing – Impedes healthy facial development in children
- Allergic salute, or the development of a crease along the nose, due to constant rubbing of the nose with the palm to get rid of nasal itching
Diagnosing Allergic Rhinitis
Diagnosis of allergic rhinitis is generally made based on:
- Medical history
- Physical exam
Information about your symptoms, recorded over time, may help the doctor identify the factors behind your allergies.
However, if data are insufficient to determine the cause of your condition, the doctor may ask you to visit an allergy clinic for the following tests:
- Skin prick test: This involves the application of minute amounts of allergens to your skin and observing the reaction produced. It helps in determining the substances you are allergic to.
- Blood test: The immune system produces IgE antibodies on exposure to an allergen. Analyzing the presence of these antibodies in your blood helps in determining the reason behind your symptoms.
The treatment will be suggested based on the type of allergen.
Clinical Treatment for Allergic Rhinitis
Medicines are highly useful in alleviating the symptoms of allergic rhinitis. However, they cannot treat the underlying allergies, may have a few side effects, and can cause complications. Therefore, it is vital to use them judiciously.
The following medicines may be used for treatment upon consultation with a doctor or a pharmacist:
- Antihistamines: Available in the form of syrups, tablets, and intranasal sprays, antihistamines are useful in alleviating symptoms such as runny nose, sneezing, irritation, and itchiness.
They also have a mild effect on congestion and can be discontinued once the symptoms subside. Eye drops containing antihistamine might help reduce the irritation and watering of the eyes.
- Intranasal corticosteroids: These nasal sprays (INCS) have an anti-inflammatory action and should be used regularly for proper results.
Since different brands produce INCS of varying efficacies and dosages, it is recommended to consult your doctor or pharmacist and read the labels before using it.
- Combination drugs: These medications comprise both antihistamines and INCS, giving a synergistic effect.
- Decongestants: They aid relief from severe congestion. However, they are not suitable for all, and their overuse may aggravate the symptoms.
Some other medications that may be used, include:
- Nasal mast cell stabilizers
- Leukotriene receptor antagonists
- Intranasal cromolyn
Allergen immunotherapy, or allergy shots, has been developed to prevent immune reactions against a few allergens. This therapy is done by giving small dosages of the allergen to a person within a span of time to help the body adjust to it.
Allergen immunotherapy helps in reducing symptoms in people for whom medications do not work or those who cannot avoid the allergens. This therapy also prevents future sensitization.
Home Remedies for Allergic Rhinitis
The symptoms associated with allergic rhinitis may be bothersome and impede your daily life. The following cost-efficient and effective home remedies can help manage the symptoms:
1. Saline Water
Nasal congestion associated with allergic rhinitis can be treated with a saline nasal wash, which will facilitate the removal of excess mucus.
A study published in 2012 demonstrated that the use of isotonic solutions for saline nasal irrigation might be considered as an adjunct therapy for allergic rhinitis. It was found to be a safe, effective, easy, and inexpensive therapy with no side effects, even on daily use. (4)(6)
A randomized, single-blinded, placebo-controlled clinical trial conducted in 2018 showed that nasal irrigation using a self-prepared 1.8% hypertonic saline solution for 4 weeks was useful in alleviating allergic rhinitis. (5)
When compared with commercial isotonic nasal saline irrigation (CINSI), the self-made hypertonic solution was 0.9% more effective in treating nasal congestion and improving life quality. (5)
Both over-the-counter and homemade saline solutions can be used for nasal irrigation. However, it is recommended to consult your doctor before using this therapy.
- Mix 1 teaspoon of salt in 2 cups of warm distilled water, or use an over-the-counter saline solution.
- Using a bulb syringe, pour small amounts of the solution into one nostril.
- Let the solution drain through the other nostril or mouth.
- Blow your nose gently to get rid of the mucus and remaining solution.
- Replicate the process in the other nostril.
- Perform this therapy twice every day until the symptoms subside.
While multiple studies support the use of nasal irrigation in reducing nasal congestion, a symptom of allergic rhinitis, more studies are needed to test its efficacy, cost, and role.
Inhalation of steam can help in the removal of excess mucus and irritants from the nasal passages, thus facilitating relief from allergic rhinitis and associated symptoms, such as sore throat, runny nose, and sneezing.
The results of a randomized controlled trial conducted in 2018 showed that an herbal steam bath was an effective and safe treatment method for alleviating the symptoms of allergic rhinitis. (7)
Steam inhalation can help in soothing and opening congested nasal passages. A study conducted in 2019 demonstrated that breathing in hot and humid air helped elevate the mucosal temperature inside the nose. (8)
This inhibited the secretion of chemicals from mast cells and provided relief from nasal itch, runny nose, headache, sneezing, facial pain, eye symptoms, and postnasal drip in patients with allergic rhinitis. (8)
- Boil water and pour it into a big bowl.
- Add in a few drops of essential oils such as peppermint, eucalyptus, tea tree, or rosemary oil.
- Use a towel to cover your head and lean over the bowl.
- Inhale the steam with deep breaths for 5-10 minutes, and blow your nose thoroughly.
- Repeat the procedure multiple times a day until the symptoms subside.
Note: Steam inhalation is not safe for small children, give them a warm bath or shower instead.
A few studies support the use of steam inhalation and baths for providing relief from allergic rhinitis. However, studies to test its efficacy and safety are required.
3. Stinging Nettle
Stinging nettle has anti-inflammatory and antihistamine properties and has been widely used as an alternative treatment for seasonal allergies, including allergic rhinitis. It provides quick relief from itching, sneezing, coughing, and nasal congestion.
A study published in 2013 showed that stinging nettle had a high prevalence of usage (12.6%) in Turkey for providing relief from allergic rhinitis when compared with other herbal treatments. (10)
Positive results were obtained in a randomized, double-blind, placebo-controlled trial conducted in 2017 to test the efficacy of stinging nettle root extract as an adjunct therapy for allergic rhinitis. (9)
- Mix 1 tablespoon of dried stinging nettle leaf in 1 cup of hot water.
- Cover the mixture and allow it to steep for 5 minutes.
- Strain and add honey.
- Consume this tea two to three times a day until the symptoms subside.
- Alternatively, consider stinging nettle supplements.
Note: Consult your doctor before using this remedy, as it may react with your medications. Refrain from giving stinging nettle to pregnant women and young children.
Stinging nettle is known to be beneficial in treating a variety of conditions. Multiple studies have demonstrated its role in alleviating allergic rhinitis by the action of its active compounds, including phenols that inhibit inflammatory pathways. However, large-scale studies are required to determine its efficacy in the treatment of allergic rhinitis.
A 2011 study demonstrated the effectiveness and safety of using probiotics for the treatment and prevention of hay fever. However, its mechanism could not be determined. (11)
Another study conducted in 2013 supported the use of probiotics in the treatment and prevention of allergic rhinitis. The probiotic Lactobacillus acidophilus was found to be beneficial in reducing the frequency and severity of symptoms. (12)
Directions: Probiotics are available in various forms, including natural sources such as yogurt, that can help boost the immune system.
Since probiotics are found to be effective against allergic rhinitis, future research should be directed toward testing the use, efficacy, and safety of probiotics using definite selection and study population methods. It is important to investigate the mechanism of action of probiotics on the immune response during allergic rhinitis.
5. Vitamin C
The antihistamine and immune-boosting properties of vitamin C play a crucial role in managing allergy symptoms, preventing infections, and reducing the duration of illness.
A study published in 2013 demonstrated that children consuming high amounts of vitamin C experienced milder forms of allergic rhinitis. Therefore, sufficient nutrient intake, especially vitamin C, may help subside the symptoms. (13)
Oxidative stress is known to play an important role in the development of allergic diseases. This may be alleviated by using antioxidant agents, thus developing an alternate therapeutic method. (14)
A study published in 2018 elucidated the use of vitamin C for the same and found that administrating high doses of it intravenously helped subside allergy-related symptoms. (14)
- Consume vitamin C-rich foods, such as oranges, lemons, broccoli, kiwi, potatoes, strawberries, grapefruit, tomatoes, sprouts, and bell peppers.
- Alternatively, take vitamin C supplements upon consulting your doctor.
The studies that support the role of vitamin C and antioxidants in treating allergic rhinitis used a small sample size. Therefore, large-scale, randomized, controlled clinical trials are required to establish its efficiency.
Other Remedies for Allergic Rhinitis
Turmeric and honey have also been used by many to relieve allergic rhinitis, although no sufficient evidence is yet available that support their use.
Turmeric is rich in antioxidants and has immune-boosting and anti-inflammatory properties. Therefore, it may help in preventing allergies and reducing the symptoms of allergic rhinitis, including cough, sneezing, dry mouth, and congestion.
A randomized, double-blind, placebo-controlled study conducted on 241 patients with allergic rhinitis in 2016 proved the efficiency of oral curcumin in improving nasal airflow and stimulating allergic response. (15)
While a limited number of studies have been conducted to test the use of honey in allergic rhinitis, it is widely used as an anecdotal supplement.
A study conducted in 2013 demonstrated that intake of a high dose of honey was beneficial in diminishing the symptoms of allergic rhinitis. Therefore, it can be used as an adjunct therapy. (16)
Measures to Avoid Allergens
Since allergic rhinitis flares up upon exposure to allergens, it is important to follow certain preventive measures to avoid these triggers.
- Refrain from touching or rubbing your nose or eyes.
- Keep your hands clean and wash them with soap and water.
- When vacuuming, use a vacuum filter.
- Use a dehumidifier to lower the humidity levels indoors. Alternatively, avoid the use of humidifiers.
- Use hot water and detergent to wash your bedsheets and pillowcases.
- Avoid opening your windows during high-pollen and mold seasons. Instead, use air conditioners.
- Bathe your pets at regular intervals and maintain a hygiene routine. Restrict them from entering the bedroom to avoid pet dander.
- When going outside, wear a wide-brimmed hat and sunglasses to prevent pollen from entering your eyes.
- Use dust-mite proof covers for duvets, comforters, pillows, box springs, and mattresses.
- Cover your nose and mouth when working with wheat flour as it may trigger baker’s asthma. An allergy to wheat flour dust can induce allergic rhinitis and asthma symptoms as well.
However, wheat in food forms isn’t problematic. Inhaling wheat flour, rye, or soya might trigger the condition.
- Avoid other triggers that may aggravate the condition, including:
- Cold temperatures
- Tobacco or wood smoke
- Chemical fumes
- Aerosol sprays
- Areas with high air pollution
- Strong fragrances such as perfumes or air fresheners
The following measures may aid recovery:
- Consume a diet rich in complex carbohydrates and low in fat.
- Drink plenty of water to maintain body hydration.
- Refrain from consuming alcohol, dairy products, and caffeine for some days.
- Change your clothes after coming from outside to avoid allergens.
Allergic Rhinitis in Children
Allergic rhinitis is the most prevalent allergy-induced problem experienced by children. If either of the parents has allergies, the child is more likely to develop the same.
Other allergic diseases, such as asthma, food allergy, and eczema, also increase the chances of hay fever. It has been found that 80% of asthmatic children are affected by allergic rhinitis, and allergens can trigger their asthma attacks.
Therefore, allergy management may help control eczema and asthma, as well. Allergic rhinitis has been associated with attention, behavior, and learning disorders in children. It can affect the child’s daily routine and their performance at school.
It can also significantly affect their ability to sleep well, and this can worsen some other issues. Consult your doctor for a diagnosis, as the symptoms of allergic rhinitis can be similar to those of other ailments.
It is important to determine the child’s allergies at the early stages to maintain life quality and avoid missing school or work.
Risk Factors for Allergic Rhinitis
The following factors may predispose you to allergic rhinitis:
- Food allergies
- Passive cigarette smoking
- Family history of allergic rhinitis, asthma, or eczema
Complications Associated with Allergic Rhinitis
If the symptoms of allergic rhinitis are not managed, it may lead to the following complications in a few cases:
- Nasal polyps: These are fleshy growths produced as a result of inflammation in the nasal lining or sinuses. They may be grey, yellowish, or pink and vary in size.
- Middle ear infections: These infections might occur if allergic rhinitis affects the Eustachian tube, which connects the nose and middle ear.
- Chronic rhinosinusitis: Congestion and chronic inflammation of the sinuses may occur.
- Eustachian tube dysfunction: The ear can get clogged and give a popping sensation due to blockage in the Eustachian tube.
Allergic rhinitis may also lead to headaches and a decreased sense of smell at times.
Is there any link between allergic rhinitis and asthma?
Patients with allergic rhinitis are likely to develop asthma as a result of inflammation in the airway, caused by nasal inflammation since the passage is continuous.
Allergy and asthma experts have found that asthma management may help in alleviating allergic rhinitis in some individuals. Additionally, allergen immunotherapy that helps alter allergic reactions can also lead to the prevention of asthma in children.
Are sinusitis and allergic rhinitis associated with each other?
Sinusitis refers to acute or chronic inflammation in the lining of the sinuses due to infection. A blockage in the sinuses results in fluid accumulation, which acts as a breeding ground for germs.
Symptoms of sinusitis include yellowish nasal secretions and headaches. The blockage is often caused by allergic rhinitis, common cold, or nasal polyps.
What is rhinitis medicamentosa?
Rhinitis medicamentosa is a type of rhinitis, or irritation and inflammation in the nasal passageways, caused by excessive use of decongestant nasal sprays.
These nasal sprays are often used for relief from allergic rhinitis and may contain oxymetazoline and phenylephrine.
Is allergic rhinitis common during pregnancy?
Allergic rhinitis is a common ailment that may occur even before pregnancy and may improve, aggravate, or remain the same during this period. However, a few women coincidentally develop allergic rhinitis during pregnancy. (17)
Does vitamin D play a role in allergic rhinitis?
While clinical and experimental studies show an association between vitamin D and allergic rhinitis, contrasting results have been obtained.
Clinical studies suggest that low vitamin D levels in the serum may increase the risk of developing allergic rhinitis. It is also thought that gender and age may play a role in determining this relationship. Therefore, further studies are needed to establish this connection. (18)
Are viral infections associated with allergic rhinitis?
Viral infections are a common reason for an airway inflammation known as viral rhinitis. Viral rhinitis may present symptoms similar to those of allergic rhinitis, such as nasal congestion and runny nose.
Viral and allergic rhinitis may influence each other’s onset. According to recent studies, viral infections can prevent allergy development or aggravate clinical symptoms of allergic rhinitis. (19)
Why do allergy symptoms worsen at night?
The symptoms associated with allergic rhinitis are discomforting and may affect your sleep and your life quality, especially when accompanied by asthma.
The symptoms can worsen at night due to the presence of allergens, such as pet dander, pollen, and dust mites indoors, especially on your bedding.
House dust mites are the most prevalent allergens in the bedroom, present year-round. These might be difficult to avoid and are often associated with asthma, therefore having more effect on your sleep than other allergies. (20)
When to See a Doctor
It is advised to seek medical help if the symptoms accompanying allergic rhinitis affect your day-to-day activities, sleep, and work performance. The diagnosis is generally made based on your symptoms.
It is important to identify your triggers and get an allergy test for the same if needed.
What you may ask your doctor:
- Are my symptoms occurring due to an allergy or other reasons, such as the cold or flu?
- How can I identify my triggers?
- Is allergy seasonal?
- Can I take over-the-counter drugs to get relief?
- What measures should I take if the symptoms aggravate or do not subside with treatment?
- Should I consult an allergy specialist (allergist/immunologist)?
What your doctor may ask you:
- When did you first experience the symptoms?
- Did anyone else in your family have allergic rhinitis?
- Have you undergone any diagnostic tests?
- Have you started any treatment?
- Do you have other health problems?
- What time of the year, and what time of the day are your symptoms worse?
- Were there any changes to your environment when the symptoms started, for example, a new pet in the home or a new job?
Allergic rhinitis is an atopic condition that presents symptoms such as runny nose, nasal congestion, sneezing, and nasal itchiness.
It impacts the patient’s life quality and daily activities and is shown to be associated with significant morbidity, increased healthcare costs, and loss of productivity. Therefore, it is important to visit a healthcare facility for a proper diagnosis and appropriate treatment.