US Pharm. 2024;49(7):15-16.

Inflammation in the Nasal Passages

Allergic rhinitis is inflammation in the nose and occurs when someone breathes in allergens. The most common allergens are molds, dust, pollens, animal dander, and dust mites. The immune system sees these allergens as harmful invaders and tries to fight them off. It activates inflammatory cells that make chemicals such as histamine, causing the symptoms of allergic rhinitis. People usually experience congestion, runny nose, sneezing, postnasal drip, and itchy nose, but they can also suffer from other effects. These may include itchy eyes or throat, sore throat, dry cough, hoarse voice, popping of the ears, facial pain or pressure, puffy, watery, or swollen eyes, dark discoloration of the skin below the eyes, or disruption of sleep.

Seasonal or Year-Round

Allergic rhinitis affects about 20% of the population. It can develop at any age and occur during a certain season or all year long. Risk factors for allergic rhinitis include family history of allergies, asthma, food allergies, eczema, and exposure to secondhand cigarette smoke. A diagnosis is typically made by taking a thorough medical history and conducting a physical examination. The doctor may ask you if symptoms change depending on the time of day or season, if anything triggers symptoms or makes them better, if there are any changes to diet, if there are any pets, if you are taking medications, or if there are any other exposures.

Avoiding Allergic Triggers

The first step to managing allergic rhinitis is to avoid or limit exposure to its triggers, although this may not always be possible. Some ways to limit exposures to allergens include staying inside and closing windows, using the air conditioning at home or in the car, avoiding fans that draw air from outside, hanging laundry inside rather than outside, showering and changing after spending time outside, using a pollen mask, using air or furnace filters, and reducing mold indoors and outdoors. Keep in mind that more pollen is in the air on hot, dry, and windy days. For those with year-long allergic rhinitis, covering pillows and mattresses with dust mite covers, reducing dust and dust mites at home, removing carpets, using blinds instead of curtains, keeping pets away from sleeping areas, using an air purifier, washing bedding and toys with hot water once weekly, and using certain filters on vacuums can help. Sometimes, avoidance is not enough, and medications are needed.

Medications to Treat Allergic Rhinitis

There are several medications that are used to treat allergic rhinitis. Discuss which one may be best for you with the doctor or pharmacist. Steroid nasal sprays are preferred for alleviating symptoms. They should be used daily since it may take several days to a couple of weeks for the symptoms to improve. Some people might experience a bad taste or smell or irritation or dryness in the nose. Antihistamines can be used for itching, sneezing, and runny noses. Older oral antihistamines such as diphenhydramine (Benadryl) and chlorpheniramine (Chlor-phen) can cause sleepiness and impair functionality.

Newer oral antihistamines such as loratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec), desloratadine (Clarinex), and levocetirizine (Xyzal) cause less, if any, drowsiness and are preferred over older antihistamines. Antihistamines can also come as a nasal spray or eye drops. Nasal sprays work very quickly and are likely to work better than oral antihistamines. The eye drops can be used for itchy eyes. Cromolyn is another option to prevent seasonal allergic rhinitis. It must be used several times a day and works best before symptoms start; however, it is less effective than other therapies. Leukotriene receptor antagonists are used with other medications in severe cases. Ipratropium nasal could help relieve a runny nose but should be avoided in those with glaucoma or an enlarged prostate. Oral and nasal decongestants are typically avoided because using them for more than a few days can worsen congestion. They also cannot be used in people with high blood pressure or heart conditions. Nasal irrigation can help rinse out allergens and other irritants from the nasal lining. Rinsing the nose before using other medications can help them absorb better.

If nothing else works, the doctor might prescribe an immunotherapy or order an allergy test. Allergy testing may help identify a specific allergen. Remember to consult the doctor or pharmacist if you are pregnant because only some of these medications are safe in pregnancy. Lastly, if you experience trouble breathing or if the symptoms worsen or do not improve, contact your physician.