Allergic rhinitis
Allergic rhinitis | |
---|---|
Other names | Hay fever, pollenosis |
Frequency | ~20% (Western countries)[2][7] |
Allergic rhinitis, of which the seasonal type is called hay fever, is a type of
Allergic rhinitis is typically triggered by environmental allergens such as pollen, pet hair, dust, or
Exposure to animals early in life might reduce the risk of developing these specific allergies.
Allergic rhinitis is the type of
Signs and symptoms
The characteristic symptoms of allergic rhinitis are:
There can also be behavioral signs; in order to relieve the irritation or flow of mucus, people may wipe or rub their nose with the palm of their hand in an upward motion: an action known as the "nasal salute" or the "allergic salute". This may result in a crease running across the nose (or above each nostril if only one side of the nose is wiped at a time), commonly referred to as the "transverse nasal crease", and can lead to permanent physical deformity if repeated enough.[17]
People might also find that cross-reactivity occurs.[18] For example, people allergic to birch pollen may also find that they have an allergic reaction to the skin of apples or potatoes.[19] A clear sign of this is the occurrence of an itchy throat after eating an apple or sneezing when peeling potatoes or apples. This occurs because of similarities in the proteins of the pollen and the food.[20] There are many cross-reacting substances. Hay fever is not a true fever, meaning it does not cause a core body temperature in the fever over 37.5–38.3 °C (99.5–100.9 °F).[citation needed]
Cause
Pollen is often considered as a cause of allergic rhinitis, hence called hay fever (See sub-section below).
Predisposing factors to allergic rhinitis include eczema (atopic dermatitis) and asthma. These three conditions can often occur together which is referred to as the atopic triad.[21] Additionally, environmental exposures such as air pollution and maternal tobacco smoking can increase an individual's chances of developing allergies.[21]
Allergic rhinitis triggered by the pollens of specific seasonal plants is commonly known as "hay fever", because it is most prevalent during haying season. However, it is possible to have allergic rhinitis throughout the year. The pollen that causes hay fever varies between individuals and from region to region; in general, the tiny, hardly visible pollens of wind-pollinated plants are the predominant cause. The study of the dispersion of these bioaerosols is called Aerobiology. Pollens of insect-pollinated plants are too large to remain airborne and pose no risk. Examples of plants commonly responsible for hay fever include:
- Trees: such as pine (hinoki(Chamaecyparis obtusa) tree pollen.
- "Allergy friendly" trees include:
- Grasses (Family Phleum pratense). An estimated 90% of people with hay fever are allergic to grass pollen.
- Weeds: ragweed (Ambrosia), plantain (Plantago), nettle/parietaria (Urticaceae), mugwort (Artemisia Vulgaris), Fat hen (Chenopodium), and sorrel/dock (Rumex)
Allergic rhinitis may also be caused by allergy to Balsam of Peru, which is in various fragrances and other products.[23][24][25]
Genetic factors
The causes and pathogenesis of allergic rhinitis are hypothesized to be affected by both genetic and environmental factors, with many recent studies focusing on specific
Another study focusing on Han Chinese children found that certain SNPs in the protein tyrosine phosphatase non-receptor 22 (
Finally,
Diagnosis
Allergy testing may reveal the specific allergens to which an individual is sensitive. Skin testing is the most common method of allergy testing.
Allergy testing is not definitive. At times, these tests can reveal positive results for certain allergens that are not actually causing symptoms, and can also not pick up allergens that do cause an individual's symptoms. The intradermal allergy test is more sensitive than the skin prick test, but is also more often positive in people that do not have symptoms to that allergen.[36]
Even if a person has negative
Classification
- Seasonal allergic rhinitis (hay fever): Caused by seasonal peaks in the airborne load of pollens.
- Perennial allergic rhinitis (nonseasonal allergic rhinitis; atopic rhinitis): Caused by allergens present throughout the year (e.g., dander).
Allergic rhinitis may be seasonal, perennial, or episodic.[8] Seasonal allergic rhinitis occurs in particular during pollen seasons. It does not usually develop until after 6 years of age. Perennial allergic rhinitis occurs throughout the year. This type of allergic rhinitis is commonly seen in younger children.[39]
Allergic rhinitis may also be classified as mild-intermittent, moderate-severe intermittent, mild-persistent, and moderate-severe persistent. Intermittent is when the symptoms occur <4 days per week or <4 consecutive weeks. Persistent is when symptoms occur >4 days/week and >4 consecutive weeks. The symptoms are considered mild with normal sleep, no impairment of daily activities, no impairment of work or school, and if symptoms are not troublesome. Severe symptoms result in sleep disturbance, impairment of daily activities, and impairment of school or work.[40]
Local allergic rhinitis
Local allergic rhinitis is an allergic reaction in the nose to an allergen, without systemic allergies. So
The symptoms of local allergic rhinitis are the same as the symptoms of allergic rhinitis, including symptoms in the eyes. Just as with allergic rhinitis, people can have either seasonal or perennial local allergic rhinitis. The symptoms of local allergic rhinitis can be mild, moderate, or severe. Local allergic rhinitis is associated with conjunctivitis and asthma.[38]
In one study, about 25% of people with rhinitis had local allergic rhinitis.[41] In several studies, over 40% of people having been diagnosed with nonallergic rhinitis were found to actually have local allergic rhinitis.[37] Steroid nasal sprays and oral antihistamines have been found to be effective for local allergic rhinitis.[38]
As of 2014, local allergenic rhinitis had mostly been investigated in Europe; in the United States, the nasal provocation testing necessary to diagnose the condition was not widely available.[42]: 617
Prevention
Prevention often focuses on avoiding specific allergens that cause an individual's symptoms. These methods include not having pets, not having carpets or upholstered furniture in the home, and keeping the home dry.[43] Specific anti-allergy zippered covers on household items like pillows and mattresses have also proven to be effective in preventing dust mite allergies.[35]
Studies have shown that growing up on a farm and having many older siblings can decrease an individual's risk for developing allergic rhinitis.[2]
Studies in young children have shown that there is higher risk of allergic rhinitis in those who have early exposure to foods or formula or heavy exposure to cigarette smoking within the first year of life.[44][45]
Treatment
The goal of rhinitis treatment is to prevent or reduce the symptoms caused by the inflammation of affected tissues. Measures that are effective include avoiding the allergen.
Antihistamines
Antihistamine drugs can be taken orally and nasally to control symptoms such as sneezing, rhinorrhea, itching, and conjunctivitis.[citation needed][46]
It is best to take oral antihistamine medication before exposure, especially for seasonal allergic rhinitis. In the case of nasal antihistamines like azelastine antihistamine nasal spray, relief from symptoms is experienced within 15 minutes allowing for a more immediate 'as-needed' approach to dosage. There is not enough evidence of antihistamine efficacy as an add-on therapy with nasal steroids in the management of intermittent or persistent allergic rhinitis in children, so its adverse effects and additional costs must be considered.[47]
Ophthalmic antihistamines (such as azelastine in eye drop form and ketotifen) are used for conjunctivitis, while intranasal forms are used mainly for sneezing, rhinorrhea, and nasal pruritus.[48]
Antihistamine drugs can have undesirable side-effects, the most notable one being
Pseudoephedrine is also indicated for vasomotor rhinitis. It is used only when nasal congestion is present and can be used with antihistamines. In the United States, oral decongestants containing pseudoephedrine must be purchased behind the pharmacy counter in an effort to prevent the manufacturing of methamphetamine.[48] Desloratadine/pseudoephedrine can also be used for this condition[citation needed]
Steroids
In 2013, a study compared the efficacy of mometasone furoate nasal spray to betamethasone oral tablets for the treatment of people with seasonal allergic rhinitis and found that the two have virtually equivalent effects on nasal symptoms in people.[49]
Systemic
Other
Other measures that may be used second line include:
Topical decongestants may also be helpful in reducing symptoms such as nasal congestion, but should not be used for long periods, as stopping them after protracted use can lead to a rebound nasal congestion called rhinitis medicamentosa.[citation needed]
For nocturnal symptoms, intranasal
Nasal saline irrigation (a practice where salt water is poured into the nostrils), may have benefits in both adults and children in relieving the symptoms of allergic rhinitis and it is unlikely to be associated with adverse effects.[52]
Allergen immunotherapy
Alternative medicine
There are no forms of complementary or alternative medicine that are evidence-based for allergic rhinitis.[35] Therapeutic efficacy of alternative treatments such as acupuncture and homeopathy is not supported by available evidence.[56][57] While some evidence shows that acupuncture is effective for rhinitis, specifically targeting the sphenopalatine ganglion acupoint, these trials are still limited.[58] Overall, the quality of evidence for complementary-alternative medicine is not strong enough to be recommended by the American Academy of Allergy, Asthma and Immunology.[35][59]
Epidemiology
Allergic rhinitis is the type of allergy that affects the greatest number of people.[10] In Western countries, between 10 and 30 percent of people are affected in a given year.[2] It is most common between the ages of twenty and forty.[2]
History
The first accurate description is from the 10th century physician
See also
- Hemp fever
References
- ^ a b "Environmental Allergies: Symptoms". NIAID. April 22, 2015. Archived from the original on June 18, 2015. Retrieved June 19, 2015.
- ^ PMID 25629743.
- ^ a b c d e f g h "Cause of Environmental Allergies". NIAID. April 22, 2015. Archived from the original on June 17, 2015. Retrieved June 17, 2015.
- ^ a b c "Environmental Allergies: Diagnosis". NIAID. May 12, 2015. Archived from the original on June 17, 2015. Retrieved June 19, 2015.
- ^ a b "Environmental Allergies: Treatments". NIAID. April 22, 2015. Archived from the original on June 17, 2015. Retrieved June 17, 2015.
- ^ a b c d e "Immunotherapy for Environmental Allergies". NIAID. May 12, 2015. Archived from the original on June 17, 2015. Retrieved June 19, 2015.
- ^ PMID 20176255.
- ^ ISBN 978-1-259-86290-8.
- ^ "Allergic Rhinitis (Hay Fever): Symptoms, Diagnosis & Treatment". Cleveland Clinic. Archived from the original on March 23, 2022. Retrieved March 23, 2022.
- ^ ISBN 9789997619846. Archivedfrom the original on July 25, 2020. Retrieved September 23, 2016.
- ^ ISBN 9781441910349. Archivedfrom the original on September 8, 2017.
- ^ a b Justin Parkinson (July 1, 2014). "John Bostock: The man who 'discovered' hay fever". BBC News Magazine. Archived from the original on July 31, 2015. Retrieved June 19, 2015.
- ^ from the original on July 25, 2020. Retrieved September 23, 2016.
With respect to what is termed the exciting cause of the disease, since the attention of the public has been turned to the subject an idea has very generally prevailed, that it is produced by the effluvium from new hay, and it has hence obtained the popular name of hay fever. [...] the effluvium from hay has no connection with the disease.
- ^ ISBN 9783318021950. Archivedfrom the original on June 10, 2016.
- ^ from the original on April 22, 2018. Retrieved April 21, 2018.
- ^ Valet RS, Fahrenholz JM (2009). "Allergic rhinitis: update on diagnosis". Consultant. 49: 610–3. Archived from the original on January 14, 2010.
- ISBN 978-0781734981.
- PMID 10101519.
- PMID 16285612.
- .
- ^ ISBN 978-1-259-64403-0.
- ^ "Allergy Friendly Trees". Forestry.about.com. March 5, 2014. Archived from the original on April 14, 2014. Retrieved April 25, 2014.
- ]
- ^ Denver Medical Times: Utah Medical Journal. Nevada Medicine. January 1, 2010. Archived from the original on September 8, 2017. Retrieved April 27, 2014.
- ^ George Clinton Andrews; Anthony Nicholas Domonkos (July 1, 1998). Diseases of the Skin: For Practitioners and Students. Archived from the original on September 8, 2017. Retrieved April 27, 2014.
- S2CID 21799632.
- ^ S2CID 39239208.
- S2CID 32689683.
- PMID 32973951.
- PMID 32973951.
- ^ Song SH, Wang XQ, Shen Y, Hong SL, Ke, X. "Association between PTPN22/CTLA-4 Gene Polymorphism and Allergic Rhinitis with Asthma in Children". Iranian Journal of Allergy, Asthma and Immunology: 413–419.
- S2CID 29759402.
- PMID 28785260.
- ^ Xiao L, Jiang L, Hu Q, Li Y. "MicroRNA-133b Ameliorates Allergic Inflammation and Symptom in Murine Model of Allergic Rhinitis by Targeting NIrp3". CPB. 42 (3): 901–912.
- ^ a b c d "American Academy of Allergy Asthma and Immunology". Archived from the original on July 25, 2020. Retrieved November 25, 2019.
- ^ "Allergy Tests". Archived from the original on January 14, 2012.
- ^ S2CID 3472235.
- ^ from the original on February 2, 2022. Retrieved December 27, 2020.
- ^ "Rush University Medical Center". Archived from the original on February 19, 2015. Retrieved March 5, 2008.
- S2CID 11933433.
- S2CID 22470654.
- ISBN 9780323278201. Archivedfrom the original on July 25, 2020. Retrieved April 20, 2019.
- ^ "Prevention". nhs.uk. October 3, 2018. Archived from the original on February 18, 2019. Retrieved February 17, 2019.
- ^ Akhouri S, House SA. Allergic Rhinitis. [Updated 2020 Nov 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538186/ Archived March 18, 2022, at the Wayback Machine
- PMID 11449200.
- ^ "Antihistamines for Allergies". MedlinePlus.gov. Retrieved March 18, 2023.
- PMID 20614452.
- ^ ISBN 978-0071478991.
- PMID 23127728.
- S2CID 24169670.
- PMID 21377716.
- PMID 29932206.
- .
- ^ Creticos P. "Subcutaneous immunotherapy for allergic disease: Indications and efficacy". UpToDate. Archived from the original on July 25, 2020. Retrieved December 2, 2019.
- PMID 17253469.
- PMID 16675332.
- PMID 15042943.
- PMID 30992709.
- S2CID 31349218.
Further reading
- "Sublingual Immunotherapy (SLIT) Allergy Tablets - American Academy of Allergy, Asthma & Immunology". Archived from the original on March 3, 2022. Retrieved April 28, 2022.
External links
- Allergic rhinitis at Curlie