Are there any complications with Allergic rhinitis?
At first glance, the symptoms of allergic rhinitis may not appear unduly troublesome, and may even be trivialised. However, they do have a significant effect on a patient’s quality of life. Apart from the obvious discomfort and social embarrassment of the rhinitic symptoms themselves, patients must also endure:
- the secondary effects of sleep disturbance:
- impairment of concentration
- mood changes
- fatigue
- headache
- the secondary effects of nasal obstruction:
- recurrent sinus infections
- recurrent sore throats
- recurrent ear problems
Rhinitis and polyps
Rhinitis is often complicated by nasal polyps. These are grapelike structures which ‘grow’ like a grape on a stalk. The stalk is usually out of sight, high up inside the nose. The body of the polyp may become quite large, large enough to push the sides of the nostrils out, giving the nose a swollen and deformed appearance. The problem with polyps is that they quickly cause obstruction. Even small ones strategically placed can block a sinus. Once again, obstruction leads to infection. Topical application of steroid may help to shrink the polyp(s), but surgical removal is often necessary. Polyps tend to recur, so make sure to treat the underlying allergies aggressively.
Rhinitis and other allergies
Finally, patients with allergic rhinitis (and asthma), as a group, are more likely to develop allergies to food.
What can we do about allergic rhinitis?
In treating allergic rhinitis you will want to:
1. Identify your relevant allergens and reduce your exposure to them.
2. Understand your non-allergic triggers.
3. Reduce nasal inflammation with medication.
4. Treat complications if and when they occur.
5. Consider a course of desensitisation to switch off your allergies.
Check out the allergies!
The most helpful investigation for the patient with rhinitis is a detailed clinical history together with physical examination of the nose and a series of skin-prick tests. This will give very reliable information on allergy to airborne allergens. Allergens commonly tested by skin-prick test include house dust mite, pollens, moulds and animal danders. Once you know which allergens are causing your trouble you can take measures to reduce your exposure to them. The most common culprit by far is the house dust mite.
Medical treatment for rhinitis
1. Nasal decongestants
? Are to be avoided at all costs (see below).
? Having said that, they may be used for a few days at the start of treatment to allow topical steroid into the otherwise blocked nose.
2. Antihistamines
? Will reduce the immediate symptoms of allergy (itch, runny nose, sneezing and itchy eyes).
? With one notable exception (Zirtek), they will have no effect whatever on the late symptoms of allergy, namely blocked nose.
? Are now available over the counter in your pharmacy. Ask for a non-sedating one!
3. Topical nasal steroid sprays
? Are quite effective.
? Are quite safe.
? Must be continued for at least two weeks before you decide that they have not worked for you.
? Must be taken every day for best effect, irrespective of symptoms.
4. Intramuscular steroid injections
? Remain an option for patients with severe disease not responsive to the above.
? May be considered in patients facing important events, e.g. exams, weddings, etc.
