At least one in five of us experience seasonal allergies every year. As the most common allergy disorder in the world, allergic rhinitis affects up to 30% of children and adults in the United States and in other industrialized countries. Allergic rhinitis, also known as hay fever, typically causes sneezing, nasal congestion and a runny nose. Studies have shown that untreated allergic rhinitis can significantly increase your risk of developing asthma later in life. The nasal inflammation often spreads down the length of your airway to your lungs. This concept is known as “united airway disease”.
When you have allergic rhinitis, your body reacts to small particles in the air called allergens. The first line of treatment is to avoid the allergen if possible. Allergy-inducing particles in the air may include house dust mites; mold spores; animal dander and pollen from grass, weeds and trees.
Pollen grains from trees, grasses and weeds are the most common causes of outdoor seasonal allergies. A pollen grain is the male reproductive structure of a seed bearing plant. Pollen is usually shed in early morning, but wind carries the most pollen in the afternoon and early evening. Many locations see high levels of tree and grass pollen in spring and summer while fall brings high weed pollen counts. Warmer areas of the country such as California may see elevated grass pollen counts for most of the year.
We know that seasonal allergies have become more common in the past several years. Warmer temperatures across the globe are making the pollen season more intense and longer than in the past. Pollen production is starting earlier in the year. Indoor allergens such as house dust mites, cockroaches and animal hair can cause symptoms all year. Spores from mold can be problematic in more humid climates.
It can be very helpful to have skin allergy testing done to determine which specific allergen you react to so that you can potentially avoid it. If your allergy symptoms are not improving after avoidance of allergens, nasal steroid sprays such as fluticasone are the most effective first-line treatment. It is important to keep your head down when spraying the steroid into your nose so that the medication doesn’t drip down the back of your throat. It may be helpful to inhale deeply after spraying the mist into your nostrils. It usually takes several days for the medication to have full effect.
If you have a history of seasonal allergies I would recommend starting your allergy medication a few weeks before your symptoms typically start and continuing the medication daily until your allergy season is over. If a nasal steroid spray doesn’t control your symptoms other options include oral antihistamines and/or nasal antihistamine sprays. If these methods are not successful some people benefit from allergy shots, otherwise known as subcutaneous allergen immunotherapy. Immunotherapy given underneath the tongue is also available but it may be more expensive.
We are now learning that it is critical to treat allergic rhinitis to lower the risk of developing asthma later in life. When you have allergic rhinitis, the inside lining of your nose and upper airway becomes swollen and inflamed causing the symptoms of runny nose, nasal obstruction and sneezing. The pollen-laden air we inhale enters through the nose, travels down the upper airway and then into the lower airway before passing into the lungs. Therefore, we can see that it is all one airway. The inflammation in the nose and upper airway can spread to the lower airway and cause asthma.
This concept is known as united airway disease. The interactions between the upper and lower airways have been studied for decades. We know that over 80% of people with asthma also have rhinitis. And 10 to 40% of those with rhinitis suffer from asthma.
In asthma, it is crucial to treat nasal symptoms to achieve optimal control of lung symptoms. On the other hand, if you have allergic rhinitis and your allergy symptoms are not controlled by changing your environment or by using medication, you may want to consider getting a definitive diagnosis with skin allergy testing to identify your specific allergen(s). This data will likely make your treatment more effective and individualized. For example, if you have an allergy to grass or weed pollen, you may benefit from allergy immunotherapy.
Don’t let your hay fever symptoms go untreated. Get control of the inflammation in your upper airway before asthma develops.
