Allergic Rhinitis

Exceptional healthcare, personally delivered

Introduction The term allergy describes a response, within the body, to a substance which is not necessarily harmful in itself, but results in an immune response that causes symptoms. If very severe these can be harmful. Allergic rhinitis refers to inflammation of the nasal passages, caused by airborne allergens. It is common, affecting over 20% of the UK population. People who suffer from allergic rhinitis are at increased risk of developing asthma, so it important that is recognised and treated effectively.

Symptoms Symptoms vary amongst individuals but will commonly include: „„ Sneezing „„ Itching „„ Nasal congestion „„ Post nasal drip (a feeling that mucous is draining down the back of the throat). You may also experience other symptoms when exposed to a trigger such as: „„ Itchy, red, watery eyes „„ Cough, wheeze or shortness of breath „„ Nettle rash or eczema on direct contact with the allergen

2

Allergic Rhinitis

What time of year will my symptoms be worse? Severity of symptoms varies, dependent upon the trigger allergen(s). Allergic rhinitis can be classed as seasonal, as in pollen allergy (hay fever) and mould allergy, or perennial (all year round) as in the case of house dust mite and animal allergy. The seasonal allergies will be worse at the time when there is the most allergen present, eg Summer for hay fever.

How do I know if I have allergic rhinitis? If you are suspected of having allergic rhinitis, you will have been referred to the allergy clinic for testing. You will be seen by an Immunology doctor who specialises in allergy. The doctor will take a detailed clinical history. Skin prick testing (please see our leaflet on skin prick testing) will be performed to common aeroallergens (allergens found in the air), for example grass, tree, animals and moulds. You may also be required to provide a sample of blood.

What is causing my allergic rhinitis? You will be advised what allergens have been identified as a trigger for your symptoms. You may have one or more of the following:

Pollen Pollen allergy (or hay fever) is known as seasonal allergic rhinitis. The symptoms are most often experienced during the summer months and are caused by airborne pollens from trees, grasses, cereal crops, shrubs and weeds. These plants produce pollens at different times of the year (see below); you may therefore, suffer from hay fever at any time between January and October, depending on the pollen causing your symptoms. You may be allergic to more than one pollen.

Allergic Rhinitis

3

Allergen Peak Season Grass pollen Tree pollen Weeds, spores

May to July/August March/May June/July to November

The pollen season can vary according to where you live, starting earlier in the south of the country and lasting later in the north. Intensity differs every year according to weather conditions and environmental factors. Outdoor pollen levels are highest in the morning and early evening. Rain and cloudy weather reduces pollen counts.

House Dust Mites House dust mites are found in all homes in the UK. They thrive on warmth and humidity. Our beds provide an ideal breeding ground for them, living off shed skin cells and water from out sweat and expired breath. The allergen is the mite droppings, which are very dry and fragment into tiny, easily inhaled, particles.

Animal Allergens The allergen is found in the skin, saliva and urine of animals. When they groom, the allergen coats the skin, fur or feathers and is spread by shed skin cells (dander) or licking. The particles are very small and therefore easily inhaled. Cat allergen is particularly difficult to eradicate, it can remain on walls and ceilings months, even years, after an animal has left the house.

4

Allergic Rhinitis

Mould Allergens Mould allergens are present in the air, both inside and outside the home. Indoor, moulds prefer damp, warm environments so are particularly found in bathrooms, kitchens, fridges, shower curtains etc. Outdoor moulds are found on all kinds of plants and vegetable matter such as compost, leaves, straw etc. There are many allergens in the air, not all can be tested for. Some patients have allergic rhinitis but an exact cause is hard to find.

What can I do to help reduce my symptoms? Some simple avoidance measures can reduce your exposure to allergens. Specific avoidance measures for each allergen are given below:

Pollen „„ Stay indoors with windows shut when the pollen count is high. „„ Stay away from grassy parks, especially in the early morning and late evening, when pollen counts are at their highest. „„ Wear wrap around sunglasses. „„ Do not dry your washing outside when pollen counts are high. „„ Checking pollen counts. Pollen forecasts predict how high the pollen counts will be on any given day; this is useful to help guide you as to when to start taking your medication.

Allergic Rhinitis

5

House Dust Mites „„ Use allergen-proof barrier covers on mattresses, duvets and pillows. „„ Wash all bedding that is not encased in a barrier cover weekly at 60° or above. „„ If possible remove all carpeting in the bedroom and vacuum hard floors regularly. „„ Use a high filtration vacuum cleaner with filters such as HEPA or S-class, which are capable of removing the smallest particles. „„ Damp wipe all surfaces weekly. „„ Reduce unnecessary soft furnishings. „„ Washable stuffed toys should be washed frequently. If they cannot be washed at 60°, place in a plastic bag and freeze for 12 hours once a month before washing at the recommended temperature. „„ Reduce humidity by increasing ventilation.

Animal Allergens „„ Do not obtain any new pets. „„ Animals should not be allowed in the living area and never in the bedroom. „„ Wash cats and dogs 1-2 times a week. „„ Groom dogs regularly, outside. „„ Wash all bedding and soft furnishings on which an animal has lain. „„ Wash everything, including walls, if you have a cat. „„ Allergic children should not play on carpets where animals have been. 6

Allergic Rhinitis

Mould Allergens „„ Avoid damp basements, compost piles, fallen leaves, cut grass, barns and wooded areas. „„ Tackle any condensation or damp areas on walls, windows. „„ Pay particular attention to cleaning damp areas such as window frames, bath seals, shower curtains etc. „„ Keep rooms dry with good air circulation, ventilation and heating. „„ Do not let food decay and clean and thoroughly dry problem areas such as refrigerator seals.

What treatment is available? In addition to allergen avoidance measures, there are a number of treatment options available. Your GP may already have prescribed some medication to help relieve your symptoms or you may have tried over the counter medications. The types of medication available are: „„ Nasal sprays and drops, to reduce swelling and help clear your nose. „„ Antihistamine sprays, which work by blocking the histamine response and therefore reducing symptoms. „„ Decongestant sprays, which reduce swelling in the lining of the nose. These should not be used long term. „„ Steroid sprays which aim to reduce nasal inflammation but do not generally provide acute relief. „„ Eye drops. There are many types, these help with the itching and some contain antihistamine. „„ Antihistamine tablets are very effective in relieving symptoms. You should be aware that some antihistamines can make you feel drowsy. Allergic Rhinitis

7

Desensitisation Immunotherapy (desensitisation) is an effective and safe treatment. It requires expert management and can only be carried out in a specialist hospital clinic with staff specialising in allergy. Not everyone is suitable for desensitisation. The Immunology doctor will advise you if this is an option for you. Treatment involves courses of injection therapy over a period of 3 years. There are different types of treatment regimes depending on the allergen (please see our leaflet on desensitisation treatment for more information).

8

Allergic Rhinitis

References Pollen, fungal spores and allergies. National Pollen and Aerobiology Research Unit. www.pollenuk.co.uk MeReC Bulletin. Treatment of seasonal allergic rhinitis (hay fever). National Prescribing Centre. www.npc.co.uk Caderon MA, Alves B, Jacobson M, Hurwitz B, Sheikh A, Durham S. Allergen injection immunotherapy for seasonal allergic rhinitis, Cochrane Database of systematic reviews 2007. Issue 1. Art, No. CD001936. DOI: 10.1002/14651858. CD001936, pub2 BSACI guidelines for the management of allergic and nonallergic rhinitis. 2008. www.uptodate.com Avoiding indoor allergens fact sheet. Aug 2008. Allergy UK. www.allergyuk.org NHS Constitution. Information on your rights and responsibilities. Available at www.nhs.uk/aboutnhs/constitution

Allergic Rhinitis

9

H

www.nbt.nhs.uk

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. © North Bristol NHS Trust. This edition published May 2014. Review due May 2016. NBT002382