Allergic rhinitis and how to cope with it

Symptoms

Symptoms of allergic rhinitis are similar to the symptoms of the common cold, but last longer and always occur at the same time of the year. These primarily include frequent sneezing, a stuffy or runny nose, postnasal drip, itching and redness of the nose and eyes, burning and watering eyes, dry cough, and scratchy throat.

Eye symptoms occur in 40 – 70 % of patients due to the presence of reflexes that connect the nasal mucosa and the conjunctiva by neural mechanisms, as well as due to the direct contact of the allergen with the conjunctiva. Eye symptoms are more pronounced in patients with seasonal rhinitis.

Furthermore, allergic rhinitis is a disease whose severity of symptoms varies from year to year for unexplained reasons, sometimes regardless of the concentration of pollen in the air. It is often associated with other diseases of the upper respiratory tract such as sinusitis, otitis and nasal polyps.

Allergic rhinitis can be divided into:

• Intermittent allergic rhinitis (symptoms occur less than 4 days per week and less than 4 weeks per year) which is associated with various external allergens such as grass, tree, and weed pollen.
• Persistent allergic rhinitis (symptoms last more than 4 days per week and more than 4 weeks per year) which is most commonly caused by household allergens such as mites, dust, mould, and pet hair, and is usually more pronounced in winter.

Effects of allergic rhinitis

Allergic rhinitis reduces concentration, causes headaches, fatigue, affects work ability, and in case of children leads to school absence. These symptoms can be mild without interfering with daily activities, or moderate to severe whereby quality of life is impaired (negative impact on sleep and rest, symptoms interfere with learning and productivity at work, treatment costs are high).

Preventive measures

Preventive measures and various therapeutic procedures are used in treatment, while the importance of breastfeeding is emphasised as a preventive measure in infants.

Preventive measures primarily include allergen avoidance, specifically: refraining from staying outdoors and especially physical activities during high concentrations of pollen in the air, reducing the concentration of mites in one’s home (especially in the bedroom), removing carpets, upholstered furniture, heavy curtains, and feather pillows, as well as using special blankets for mattresses, doing laundry and washing bed linen at temperatures above 60 °C, and room ventilation.

Reducing contact between the nasal mucosa and allergens is also advised: before leaving indoor areas, it is recommended to spray an ectoine preparation into the nose, which coats the nasal mucosa like a filter, and prevents contact between allergens and the mucous membrane. After staying in the environment where a person has been exposed to allergens, it is recommended to immediately take off the clothes that were worn, shower, and wash hair to reduce the concentration of allergens in the immediate living environment.

Daily nasal irrigation with a saline solution helps to establish the physiological function of the cilia on the nasal mucosa. Diluting the secretion facilitates its excretion from the nose, rinsing out the allergens in the process.

Therapeutic interventions

Therapeutic interventions include immunotherapy and pharmacotherapy (use of drugs).

Immunotherapy

Specific immunotherapy can be used when hypersensitivity to only one particular allergen or to one perennial allergen is present. For a long time it was performed by subcutaneous administration of the allergen. However, sublingual administration is recommended today, which is performed by placing the allergen solution under the tongue. This method of administration involves no potentially dangerous systemic allergic reactions. In most patients, allergy symptoms are reduced, while in some they disappear entirely.

The best results are achieved with allergies to grass pollen or house dust mites.

Pharmacotherapy

Because immunotherapy is not suitable for a large number of patients, drug treatment is required. It is important to know that all medications can only control the symptoms of the disease, but not cure allergic rhinitis. Therefore, the focus should be on relieving and controlling the symptoms of the disease.

However, pharmacotherapy is almost always necessary because a mild form without therapy often progresses to a moderate or severe form.

1. Oral antihistamines

Second-generation oral antihistamines, antileukotrienes, intranasal corticosteroids, and decongestants are commonly used.

Second-generation oral antihistamines are used today to relieve symptoms, and are effective in case of nasal discharge, sneezing, and itchy nose, but do not show effectiveness in nasal congestion.

Oral antihistamines are also more effective in relieving eye symptoms compared to intranasal corticosteroids, so they are the first treatment option for mild and intermittent allergic rhinitis.

2. Intranasal corticosteroids

Intranasal corticosteroids are the most effective drugs for allergic rhinitis. They show an inhibitory effect on the early and late phase of the allergic reaction, and act on all nasal symptoms. New-generation intranasal corticosteroids can be used for a longer period of time due to low bioavailability (they are safe), and do not cause atrophy of the nasal mucosa. Systemic corticosteroids are used very rarely in allergic rhinitis, predominantly in severe nasal congestion or severe allergic rhinitis.

3. Decongestants

Decongestants are also used in the treatment of allergic rhinitis. They have a short-term application; it is recommended to use them for up to 5 days. Nasal decongestants have a vasoconstrictive effect on the nasal mucosa, reducing blood flow and tissue swelling, i.e. nasal congestion. Prolonged use causes rebound nasal congestion. Instead, a hypertonic saline solution can be used, which has a milder decongestant effect.

Adverse reactions or side effects may occur with the use of drugs. Pharmacovigilance measures aim to ensure patient protection and safe drug use: Marti Farm has many years of experience and knowledge precisely in this area.

Marti Farm has also developed its own software for monitoring drug safety – the pharmacovigilance system Sympto®. The magazine “Poslovni dnevnik” has recently published an article about our pharmacovigilance system, which you can access via the link Poslovni dnevnik: article.

Conclusion

Allergic rhinitis is one of the most common reasons to see a doctor and a major health problem. In order to achieve better control of an allergic disease, it is necessary to avoid allergens, get acquainted with the characteristics of the disease, and apply preventive measures with appropriate therapy if necessary.