The Australasian Society of Clinical Immunology and Allergy

Hay fever is the common name for allergic rhinitis (from rhino meaning of the nose and itis meaning inflammatory), so it is defined as inflammation of the nose caused by allergy. However, your nose is not the only organ which may be affected by allergic rhinitis. You may also have problems with your eyes, sinuses, throat and ears.

Allergic rhinitis may occur in spring and summer or all year round

Allergic rhinitis symptoms can occur seasonally or all year round (perennially):

• Seasonal allergic rhinitis - when you experience symptoms only during spring and summer, it is usually due to allergy to various types of pollen carried by the wind and easily breathed into the nose. When most people talk about hay fever it usually means seasonal allergic rhinitis.  
• Perennial allergic rhinitis - when you experience symptoms all year around, it is usually caused by allergens such as the house dust mite, particles from family pets known as animal dander, or moulds which are carried in the air. The symptoms vary in intensity and are often unpredictable.

Depending on the severity and persistence of symptoms, allergic rhinitis can be classified into mild or moderate to severe.  The ASCIA Allergic Rhinitis checklist has been developed to assist in the recognition and appropriate treatment of allergic rhinitis and is available on the ASCIA website: www.allergy.org.au/content/view/291/234/

How does the nose work?

Since allergic rhinitis mainly affects the nose, it is important to understand how the nose works and what it does. Your nose is one of the unsung heroes of your body. In addition to providing your sense of smell, vital to your enjoyment of food and drink, your nose performs many other important functions:

• It acts as a dust mask and first line of defence against infection, protecting the delicate structure of your airways and lungs by filtering out inhaled particles (such as dust, bacteria and pollen) which may be harmful if breathed in.
• The nose begins this process with its lining of hairs, which act as a trap for the larger particles which are in the air you breathe.
• Trapped particles are either expelled through sneezing or they stick to the layer of mucus, which covers the lining of the nose.
• The mucus, which is secreted from special glands in the lining of the nose (there are about 100,000 of these), is moved steadily backwards towards your throat by millions of tiny hairs which line the nose, called cilia. It takes about 15 minutes to move particles trapped in the mucus along the nose to the throat. Once it reaches the back of your throat the mucus is swallowed. In hayfever sufferers the production of mucus is dramatically increased.
• The design of your nose is so good that if you breathe through it alone, and not through your mouth, very few particles will get past its defences. Most pollen grains (which cannot be seen by the naked eye) and anything larger are trapped.
• The nose also acts as an air conditioner, warming and humidifying the air before it reaches the sensitive lining of your lungs.
• It provides a drainage outlet for fluids from your sinuses and ears. Your sinuses are four pairs of air-filled cavities in the bones of the face, behind your nose, cheeks and forehead. The sinuses have the same sort of lining as the nose, with cilia that keep them clean by moving the mucus up and out, connecting passageways into the nose.

How does allergic rhinitis affect the nose?

Whatever allergen (for example pollen, dust mite, mould) is responsible for causing your allergic rhinitis, the allergic response in the nose is similar. The allergen comes into contact with the sensitive, moist lining in your nose and sinuses setting off the allergic response.  The release of histamine causes the lining to become inflamed and irritated and production of mucus is greatly increased. It is this increase in the amount of mucus in your nose which
is associated with many of the symptoms of allergic rhinitis.

There are several symptoms of allergic rhinitis

Not everyone will experience the same symptoms, but many people with allergic rhinitis will suffer from them at one time or another:

• a runny, sometimes streaming, nose
• a maddening sensation of tickling in the nose, throat, ears and roof of the mouth
• uncontrollable bouts of sneezing
• blocked nostrils, this may be on one side only, or on both (ears may become blocked as well)
• 'nasal' voice (like trying to talk through a pinched nose)
• inability to taste or smell food
• reddened, puffy, watering, itchy eyes
• irritating cough
• discomfort from swallowing large amounts of mucus which may lead to nausea at times

In addition, people with allergic rhinitis can find it difficult to concentrate and may become listless and irritable. They may also develop asthma, especially if they are particularly sensitive and are exposed to high levels of allergen.

Symptoms of allergic rhinitis often first appear in childhood and adolescence. Many children suffer from allergic rhinitis which is often not recognised by parents or teachers. Trying to cope with the pressures of school and exams is not easy when you constantly feel unwell and tired.

Profile of an allergic rhinitis sufferer

Whilst not everyone with allergic rhinitis will look or act the same way, there are some readily recognisable features which suggest that someone may be suffering from allergic rhinitis:

• constant sniffling, twitching and rubbing the nose, often in an upwards direction - rubbing the nose constantly, sometimes called the allergic salute, can have the result of leaving a permanent mark on the nose known as the allergic crease.
• dark circles and bags under the eyes (often known as allergic shiners) - sometimes children may develop small lines under the eyes known as Denny's lines.
• breathing through the mouth - this leads to sore throat, snoring, disturbed sleep and fatigue.

Effective treatment prevents symptoms

The first step in the management of allergy should be to try to identify the cause and then reduce your exposure to it.
Information on allergy testing is available on the ASCIA website
www.allergy.org.au/content/view/104/116/

Allergen avoidance information is also available from the ASCIA website  www.allergy.org.au/content/view/187/126/  

Non-sedating antihistamines are very effective, rarely cause drowsiness and are readily available from your local pharmacy. They are not as effective for treatment of congestion.

Corticosteroid nasal sprays are very effective in preventing allergic rhinitis when used regularly and correctly, and are safe for long term use.

Over the counter decongestant nasal sprays give quick relief and may be used for a maximum of 2-3 days. However, they are harmful in the long term by damaging nasal tissue.

Perennial (all year round) rhinosinusitis may be helped with saline douches or nasal sprays

Allergen specific immunotherapy (also known as desensitisation) is a long-term treatment which changes the immune system's response to allergens. It involves the administration of regular, gradually increasing amounts of allergen extracts, by injections or sublingual drops.
Information is available on the ASCIA website www.allergy.org.au/content/view/148/128/  

It is important to read and follow the pack warnings on all medications, especially if you plan to drive or drink alcohol, and follow the advice of your pharmacist or doctor.

You do not have to put up with the suffering and inconvenience of allergic rhinitis. If you think you may have allergic rhinitis your local pharmacist can advise you what to do, or you may need to consult your doctor.

© ASCIA 2010

The Australasian Society of Clinical Immunology and Allergy (ASCIA) is the peak professional body of Clinical Immunologists and Allergists in Australia and New Zealand

Website: www.allergy.org.au

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Postal address: PO Box 450 Balgowlah NSW 2093 Australia

Disclaimer

This document has been developed and peer reviewed by ASCIA members and is based on expert opinion and the available published literature at the time of review.  Information contained in this document is not intended to replace medical advice and any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner. The development of this document is not funded by any commercial sources and is not influenced by commercial organisations.  

Content last updated January 2010