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Hay fever-Allergic Rhinits-Allergic Rhinosinusitis

What is allergic rhinitis?

Allergic rhinitis is also known as hay fever and allergic rhinosinusitis. Patients with this condition suffer nasal blockage, watery discharge, itchy eyes and sneezing. These problems can occur at certain times of the year or all the way through the year. This condition occurs more commonly in young people, but can occur all the way through life. Both males and females suffer.

What causes allergic rhinitis?

The air we breathe contains many particles; some of these are made of animal proteins such as pollens and skin cells. If allowed to settle they can form dust. When breathed in, these particles will cause an irritation in allergic people. This irritation causes swelling and redness of the skin and the symptoms experienced come from this. People who are allergic often have allergic relatives. If the particles enter the lungs it will causes asthma. If the particles scratch the skin they can cause eczema. Very allergic people tend to have allergic rhinitis, asthma and eczema at the same time.

What can I do about it?

If you know which particles cause the allergic reaction then it is possible to avoid them. The commonest allergies in the UK which can be avoided are pets and house dust mites. House dust mites cannot be avoided totally as they are found in the fabric of all furniture and housing. As you are closest to the "furniture" at night in your bed, it is worth buying an allergy proof mattress, pillow or duvet cover (available from Boots, Argos, John Lewis or House of Fraser). When cleaning the house you should wear a mask to stop you breathing in the particles. Damp dusting and hoovering should be carried out occasionally. Although these reduce the dust in the house, the particles are stirred up and float into the air. It takes about two hours for them to settle after cleaning and this is when they can enter the nose and lungs. It is most sensible to leave the house for two hours after you have cleaned so the remaining particles can settle down while you are out. Some lucky people can afford a cleaner!

It is very difficult to avoid pollens, but it has been found that repeated exposure to pollens regularly can reduce the reaction and cure the allergy. This is called desensitisation. The allergen is given as either a regular injection or a tablet to be held under the tongue. The tablet form, Grazax, needs to be taken for the three years and reduces hay fever symptoms by 40%.

Antihistamines are excellent for itchy eyes and sneezing. They can be taken as tablets, nose spray or eye drops. Nasal steroid sprays are useful for reducing the sensation of blockage and the watery discharge. They take a week to have an effect and therefore should be used regularly. Decongestants work very quickly to unblock those, but when they have worn off the nose feels more blocked. Nasal steroids can also be taken by injection or tablets, but these may have side effects, so prolonged use is not encouraged. Repeated use of decongestants for longer than a week can cause persistent swelling inside the nose so these should only be used occasionally.

The ENT specialist will examine your nose to look for structural abnormalities which may be causing obstruction and aggravating the allergies. He may carry out a skin test to identify which allergens (particles) are causing your symptoms. Surgery is only recommended to improve the nasal airway structurally when medical treatment fails.

Operations which can improve the airway include septoplasty, septorhinoplasty, endoscopic sinus surgery, polypectomy, adenoidectomy.

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