Allergic rhinitis

Allergic rhinitis is inflammation of the lining of the nose set off not by an infection but by something you breathe in: pollen, house dust mite, animal proteins, mould spores. The immune system mistakes a harmless particle for a threat, and the nose answers with swelling, itching and watery discharge. It rarely stops at the nose: the same mechanism reaches the eyes and, in some people, the airways below. The condition is not catching, but it can spoil sleep and performance for years, and for children, schoolwork.

How it differs from a cold

• Itch. The nose, the palate and the ears itch, and the eyes go red and water. A cold hardly ever does this.
• Speed. The sneezing starts within minutes of walking into a dusty room or stroking a cat. A cold takes a day to build up.
• Fever. Allergy does not cause it. If a temperature and body aches appear, the cause is something else.
• Discharge. Clear and runny. Thick, yellow-green discharge with pain across the cheeks and forehead points to infection.
• Repetition. Symptoms come back in the same month every year, or every morning in the bedroom. That rhythm is usually what gives allergy away.

What the nose reacts to

Seasonal allergens. Tree pollen in late winter and spring, grass pollen in early summer, weed pollen towards autumn. Each group has its own stretch of the calendar and repeats year after year. Dry windy weather makes it worse; rain settles it.

Year-round allergens. House dust mite lives in mattresses, pillows, upholstery and carpets, and the reaction is strongest right after waking. With animals the culprit is not so much the fur as the proteins in saliva and dander, which linger in a home for months after the pet has gone. Mould favours bathrooms, cellars and air conditioning units.

Occupational allergens. Flour for bakers, wood dust for joiners, latex for healthcare staff: this kind of rhinitis eases on holiday and returns on the first shift back.

The odds are higher if a parent or a sibling has asthma, eczema or hay fever. Atopy often runs as a chain: eczema in early childhood, then rhinitis, and in some people asthma later on.

Why years of putting up with it cost you

• A blocked nose wrecks sleep: you breathe through the mouth, snore, wake up flattened and think less clearly all day.
• Drainage from the sinuses is disturbed, which is where drawn-out sinusitis comes from.
• In children the ear tube swells, fluid collects in the middle ear and hearing dips for a while, which hits speech and school hard.
• Constant mouth breathing in a child gradually changes the bite and the shape of the face.
• If asthma is present, uncontrolled rhinitis makes it worse: the upper and lower airways react together.
• Lasting blockage dulls the sense of smell and, with it, the taste of food.

What to take out of your surroundings

• In season, keep windows shut at the peak pollen hours, early morning and evening, and air the rooms after rain.
• Coming in from outside, wash your face, rinse the nose and change your clothes; wash your hair in the evening so pollen does not travel into bed.
• Do not dry laundry outdoors while the plant you react to is in flower; wrap-around glasses noticeably cut down eye irritation.
• Against mites: protective covers on the mattress and pillows, bedding washed at 60 °C, fewer rugs and soft toys in the bedroom, a vacuum cleaner with a fine filter.
• Keep animals out of the bedroom and off the bed, and wash their bedding often.
• Deal with damp and condensation and check the air conditioning filters, so mould has no conditions to grow in.

Saline rinsing washes particles out and makes breathing easier. Use ready-made pharmacy sachets or water that has been boiled and cooled, never water straight from the tap; wash and dry the device every time.

How it is treated

Treatment is chosen by a doctor, but the reasoning is worth understanding: it explains why one product seems not to work and another must not be used for long.

Steroid nasal sprays are the backbone of treatment when symptoms are marked. They act locally, build their effect over several days and reach it fully in two or three weeks, so judging them after two days makes no sense. They are used as a course, every day, not on demand. Aim the nozzle at the outer wall of the nose, not at the septum.

Antihistamine tablets deal well with itching, sneezing and running, and less well with blockage. Modern drugs in this group are less sedating than the older ones, but it is safer not to drive for the first few days. When the eyes suffer more than the nose, eye drops of the same kind are added.

Decongestant sprays clear the nose within minutes, which makes them very tempting. They can be used for a few days in a row and no longer: the lining gets used to them and swells with no allergy involved at all, and coming off such a spray is then hard. They are not suitable for young children.

Allergen immunotherapy works on the reaction itself rather than the symptoms: small doses of the allergen are given under the tongue or under the skin, the course runs for several years and an allergy specialist supervises it. It makes sense when the allergen is firmly identified and the usual medicines are not coping.

Pregnancy and breastfeeding change the options: some drugs are not used then, and the choice should be made with a doctor rather than by repeating an old prescription.

When a runny nose is not allergy

Allergic rhinitis always affects both sides and never brings blood. Anything that breaks that rule deserves separate thought, even if you genuinely are allergic.

• One nostril persistently blocked or discharge from one side only. In adults this points to polyps, a deviated septum or, less often, a tumour. In a child, one-sided foul-smelling discharge nearly always means a foreign body.
• Blood in the discharge without an injury, especially if it keeps happening alongside a blocked ear, reduced hearing or an enlarged neck gland.
• Clear fluid dripping from one nostril and increasing when you lean forward, after a head injury or nasal surgery. This can be a leak of spinal fluid, and it is urgent.
• Crusting, repeated nosebleeds and destruction of nasal tissue together with weight loss, joint pain and changes in urine tests. This is sometimes how a systemic vasculitis begins.
• Loss of smell that does not come back, with the nose blocked constantly whatever the weather: typical of polyps.
• Polyps, asthma and an attack of breathlessness after a painkiller from the non-steroidal anti-inflammatory group. That combination means those drugs are unsafe for you, and every doctor you see should be told in advance.

Call an ambulance (112 across Europe) if breathlessness, wheezing, swelling of the lips, tongue or eyelids, or a rash over the body appear: these are signs of a severe allergic reaction. Swelling around the eye with a high temperature alongside purulent nasal discharge also needs assessment straight away.

Online consultation

This condition suits a remote appointment well, because here the story matters more than the examination. Together you will map out the calendar of flare-ups, narrow down the likely allergens, go through what you have already tried and why it failed, and work out how to use a spray and how long to wait for it. The doctor will say whether an allergy specialist is worth seeing and, if one-sided symptoms or blood come up in the story, will refer you to an ear, nose and throat doctor in person.

This material is for information only and does not replace medical advice.