Seasonal allergy or “hay fever” is a medical condition that presents as sneezing, runny and stuffy nose, itchy eyes and throat, ear itching and popping, and cough in response seasonal exposure to pollens (trees, grasses, weeds) or molds. All allergies can interfere with sleep quality and make it difficult for adults and children to function during the day. The allergy is the result of a misdirected immune system. Normally when people inhale pollens and molds, they should have no symptoms. When people have allergies, their immune system makes an abnormal response such that exposure to these substances triggers the above mentioned symptoms. Seasonal allergies can occur at any time of life and can get better or worse throughout one’s life. Approximately 20-30% of the population has allergies. Allergies can lead to some other medical conditions including chronic ear or sinus infections, cough, and asthma.
Year round allergies
Some people have year round allergies called “perennial allergies.” These result from chronic exposure to year round allergens including dust mite, animals, cockroaches, and some molds. The symptoms are similar to seasonal allergies and include runny and stuffy nose, post nasal drip, eye itching and irritation, throat clearing and cough. All allergies can interfere with sleep quality and make it difficult for adults and children to function during the day. Allergies can lead to some other medical conditions including chronic ear or sinus infections, cough, and asthma. Like seasonal allergies, perennial allergies can occur at any time during one’s life.
Up to 20% of the population may develop eye symptoms in association with their allergies. The symptoms include eye itching and redness, eye tearing and occasionally some crusting. People can also develop swelling around the eyes and darkening under the eyes (called allergic shiners). There are other medical conditions that can present with eye discomfort including infection triggered conjunctivitis (“pink eye), dry eyes, blepharitis (“dandruff of the eyelids”). Your provider can help sort this out but all of these conditions can be treated. Treatment of eye allergy or “allergic conjunctivitis” includes avoiding the substance causing the allergy, application of cold compresses to the eye area, frequent use of refrigerated artificial tears throughout the day, reduction in contact lens wear, and use of medicines. There are both over the counter and prescription eyedrops that can be used to lessen the symptoms. In addition over the counter antihistamine pills and in some situations, prescription nasal steroids and nasal antihistamines can also be used.
Other causes of nasal congestion
The combination of some or all of the following symptoms: runny nose, sneezing, nasal stuffiness and itching, are called “rhinitis.” Rhinitis can result from a variety of causes. These causes include non-allergic or vasomotor rhinitis, rhinitis due to colds or sinus infections, rhinitis due to pregnancy or certain medications, and rhinitis due to alterations in the sinus and nasal anatomy.
Vasomotor rhinitis has symptoms that are very similar to nasal allergies (runny nose, nasal congestion, post nasal drip and sinus pressure) but the cause of the symptoms is different. People with vasomotor rhinitis can have their symptoms triggered by physical factors such as temperature changes, humidity changes, strong odors, air pollution and smoke. Sometimes there is no clear trigger. Vasomotor rhinitis is often referred to as a “migraine of the nose” and in fact there are some people that have associated migraine headaches. While there is no cure for vasomotor rhinitis, there are many medications to help with symptoms include nasal steroid and nasal antihistamine sprays, sinus saline irrigation, and in some cases ipatroprium bromide nasal spray.
Sometimes pregnancy and even medications can cause rhinitis. The most common culprits are over the counter nasal and sometimes oral decongestant therapies. People will often times have overuse of nasal decongestant sprays (a common ingredient in these sprays is called oxymetazoline). Many days of regular use leads to rebound nasal blockage as the medication wears off which then triggers people to use more spray. When people get to this point, they are referred to as being “addicted to their nasal spray.” The following medications have also been associated with rhinitis symptoms: high blood pressure medications (typically in a class called alpha blockers, beta blockers, and calcium channel blockers), some antidepressants, erectile dysfunction drugs, and hormones such as estrogens and progesterones.
The common cold and acute or chronic sinus infections can cause rhinitis symptoms. Sinus infections are discussed separately. Finally alterations in nasal and sinus anatomy can be associated with rhinitis. In children, enlarged adenoids/tonsils are a common cause of nasal congestion and snoring. Children are also fond of putting things in their noses such as beans, peanuts or small toys which will inevitably lead to nasal symptoms. Adults can have nasal polyps which are benign growths of inflammatory tissue originating in the sinuses, septal deviations, or more rarely nasal tumors that cause nasal symptoms.