From Sniffles to Smiles: Treating Allergic Rhinitis

Welcome back! In the last article, we unmasked the secret culprit behind our sniffs: rhinitis. It is a condition where the inside of the nose is inflamed, which causes irritation. An estimated 24 to 40 percent of children worldwide suffer from this condition. 

There are two types of rhinitis: allergic and non-allergic rhinitis. The only difference between these conditions is that allergic rhinitis is an allergic reaction triggered by an allergen. Whereas non-allergic rhinitis is the result of environmental and humidity changes, This article will dig deeper into all possible treatment options and complications of allergic rhinitis.(1,2).

Image credit: treatment of allergic rhinitis

Treatment options for allergic rhinitis 

Treatment of allergic rhinitis mainly depends on disease severity, the impact of the disease on patients, and how well the patient can comply with the treatment plan. There are quite a few over-the-counter medications that can be used for immediate relief. 

Antihistamine

As implied by the name “antihistamine”, this medication effectively blocks the impact of histamine within the body during an allergic reaction. Histamine is the main culprit behind some of the uncomfortable symptoms of allergic rhinitis. Hence, antihistamines can relieve rhinitis symptoms such as a runny nose, sneezing, and itchiness. 

Antihistamine comes in two categories: first-generation and second-generation antihistamines. It is important to note that all first-generation antihistamines are sedatives that can induce a feeling of drowsiness and sleepiness in patients. 

While they are equally effective in symptom relief, second-generation antihistamines are generally preferred by many healthcare professionals due to their non-sedating properties, which spare patients from the fatigue associated with the first-generation options (1, 2).

Different variations of antihistamines on the market include oral antihistamines, intranasal antihistamines (nasal spray), and ophthalmic antihistamines (eye drops). Eye drops are usually recommended if the patient has symptoms such as watery or itchy eyes. As compared to oral medication, eye drops will bring faster relief to the symptoms related to the eye. For children, nasal spray or liquid medications are usually recommended, as these are easy to administer.

Decongestants

Decongestants are medications that help with stuffy or blocked nose, available in both oral tablet and nasal spray form. They are often given together with antihistamines, as decongestants do not resolve all the symptoms of allergic rhinitis by themselves. It is important to note that long-term use of decongestants is highly discouraged due to the increased risk of “rebound congestion”. 

Rebound congestion is a condition where the body becomes dependent on the drug, and discontinuing its use can result in even more severe nasal congestion, creating a cycle of dependency (1).

Corticosteroid 

Corticosteroids are often referred to as a preventive measure rather than a treatment, as corticosteroids are not able to provide immediate relief. They take a few weeks to show effect; therefore, patients are recommended to begin taking the medication before they expect the onset of allergic rhinitis symptoms. 

Just like antihistamines, corticosteroids are able to resolve symptoms such as sneezing, runny nose, and itchiness. In many cases, healthcare providers combine corticosteroids with antihistamines to achieve the most comprehensive relief from symptoms. This combination is often considered one of the top choices by healthcare professionals for addressing allergic rhinitis (1, 2). 

With that being said, overuse of corticosteroids is not good as it can make people more susceptible to infections. Corticosteroids are able to suppress the immune system, hence using high doses or taking this drug more frequently can make the immune system weak and increase the chances of infections (3).

Image credit : Allergen immunotherapy

Allergen Immunotherapy for allergic rhinitis

Allergen immunotherapy (allergy shots) is usually considered for patients with long-standing allergic rhinitis where all other treatment options have failed. Patients with persistent allergic rhinitis must go through serum-specific IgE antibody blood tests. Patients with persistent allergic rhinitis have higher levels of IgE antibodies in their blood, which makes the body overreact to allergens. Allergen immunotherapy basically desensitises the body to various allergens to avoid allergic reactions. Multiple studies have demonstrated that allergen immunotherapy is both effective and well-tolerated in children with allergic rhinitis (4).

How it works

Immunotherapy is a long-term treatment plan that may last for a few years, with patients gradually experiencing fewer and fewer symptoms of allergic rhinitis. During immunotherapy, the patient would be injected with specific allergens that trigger an allergic reaction. They would receive small doses of the allergen at regular intervals, typically once or twice a week. 

The goal is to expose the immune system to the allergen without provoking a severe allergic reaction. Over time, the immune system becomes less susceptible to the allergen, leading to the development of tolerance. Eventually, the patient's allergy symptoms lessen and, in some situations, may even go away entirely (1,4).

There are clinical trials, proving that patients taking allergen immunotherapy would eventually need less allergic rhinitis medication dosages compared to those patients without immunotherapy. Hence, the chances of patients overcoming allergic rhinitis completely after immunisation is higher. However, one disadvantage of immunotherapy is that the patient may develop complications such as anaphylaxis, a type of life-threatening allergic reaction that needs immediate medical attention (5,6). 

Complications of allergic rhinitis

Ear infection (7, 8)

Infections are one of the main complications of allergic rhinitis. A middle ear infection is a type of condition that has a strong association with allergic rhinitis in children. The human nose and ear might not seem like it, but they are internally connected. Allergic rhinitis may cause fluid to build up in the eustachian tube. The tube acts as the link between the back of the nose and the middle ear. The fluid buildup can lead to bacterial growth and, hence, infection.

There is evidence from a study showing that children with allergic rhinitis are at higher risk of developing middle ear infections compared to children without allergic rhinitis. Even though this infection is not life-threatening, it has a deadly impact on a child's language development and decreases their learning performance.

Image credit: Connection between asthma and allergic rhinitis

Is there a connection between allergic rhinitis and asthma?(9,10)

Asthma is another complication of long-standing allergic rhinitis. Multiple clinical studies have proven that there is a link between asthma and allergic rhinitis. Almost 40% of patients in Malaysia suffer from asthma and allergic rhinitis concurrently. To add to that, if a child develops rhinitis in the first year of their life, the chance of developing asthma in the future is twice as high compared to those without allergic rhinitis.

Therefore, parents must be aware of all the complications associated with allergic rhinitis, as long-standing rhinitis can lead to complex diseases such as asthma and infections. If a child is showing severe symptoms and all the over-the-counter medications are in vain, allergen immunotherapy must be the next choice, as it is the only form of treatment that can alter the physiology of allergic rhinitis and reduce the risk of allergic rhinitis complications.

Image credit: Non-pharmacological treatment

Non-pharmacological allergic rhinitis relief

Along with drug treatment, patients and parents should take extra measures to avoid and manage allergic rhinitis.

• Steer clear of allergens: It's critical to recognise and stay away from allergens that could cause allergic rhinitis. Pet dander, dust, and pollen are common allergies. To get rid of as much dust mist as possible, it's a good idea to routinely wash bed linens and curtains in hot water. To stop pollen from entering the house during pollen season, keep the windows closed. To keep their children away from allergies, parents should wash their children's toys in hot, soapy water.
• Place air purifiers in: Patients suffering from allergic rhinitis can breathe in safe air thanks to air purifiers that use HEPA (high-efficiency particulate air) filters, which are capable of efficiently removing minute particles from the air (1).
• Rinsing nose with saltwater: Symptoms of allergic rhinitis can be lessened by using a bulb syringe or neti pot to rinse your nose with a saltwater solution (11). 

It's crucial to remember that not everyone with allergic rhinitis will experience full relief from their symptoms through non-pharmacological therapy. Seeking consultation from a healthcare expert for a thorough assessment and appropriate guidance on pharmaceutical treatments, such as antihistamines, is recommended if symptoms are severe or persistent. 

Want to know more about rhinitis from DOC2US? Stay tuned for our next articles where we continue to explore rhinitis!

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Reference

1.      Treatment of allergic rhinitis [Internet]. [cited 2023 Oct 14]. Available from: https://www.researchgate.net/publication/236590194_Treatment_of_allergic_rhinitis

2.      Burks AW, Calderon MA, Casale T, Cox L, Demoly P, Jutel M, et al. Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report. Journal of Allergy and Clinical Immunology. 2013;131(5).

3.      Pandya D, Puttanna A, Balagopal V. Suppl 1: M2: Systemic Effects of Inhaled Corticosteroids: An Overview. Open Respir Med J [Internet]. 2014 Jan 23 [cited 2023 Oct 23];8(1):59. Available from: /pmc/articles/PMC4319197/ 

4.       Lin CF, Lin YT, Liao CK, Yeh TH. Recent Updates of Immunotherapy for Allergic Rhinitis in Children. Curr Otorhinolaryngol Rep [Internet]. 2023 Mar 1 [cited 2023 Oct 14];11(1):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9880370/ 

5.       Contoli M, Porsbjerg C, Buchs S, Larsen JR, Freemantle N, Fritzsching B. Real-world, long-term effectiveness of allergy immunotherapy in allergic rhinitis: Subgroup analyses of the REACT study. Journal of Allergy and Clinical Immunology. 2023 Aug 1;152(2):445-452.e4. 

6.       Persaud Y, Memon RJ, Savliwala MN. Allergy Immunotherapy. StatPearls [Internet]. 2023 May 1 [cited 2023 Oct 23]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK535367/

7.        Byeon H. The association between allergic rhinitis and otitis media: A national representative sample of in South Korean children. Scientific Reports 2019 9:1 [Internet]. 2019 Feb 7 [cited 2023 Oct 14];9(1):1–7. Available from: https://www.nature.com/articles/s41598-018-38369-7

8        Allergic rhinitis - Illnesses & conditions | NHS inform [Internet]. [cited 2023 Oct 14]. Available from: https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/allergic-rhinitis#complications-of-allergic-rhinitis

9.       Asthma and Allergic Rhinitis - Etiology - PORTAL MyHEALTH [Internet]. [cited 2023 Oct 14]. Available from: http://www.myhealth.gov.my/en/asthma-and-allergic-rhinitis-etiology/

10      Bergeron C, Hamid Q. Relationship between Asthma and Rhinitis: Epidemiologic, Pathophysiologic, and Therapeutic Aspects. Allergy, Asthma & Clinical Immunology 2005 1:2 [Internet]. 2005 Jun 15 [cited 2023 Oct 14];1(2):1–7. Available from: https://aacijournal.biomedcentral.com/articles/10.1186/1710-1492-1-2-81 

11.     Bergmann KC, Berger M, Klimek L, Pfaar O, Werchan B, Werchan M, et al. Non Pharmacological measures to prevent allergic symptoms in pollen allergy: A critical review. Allergol Select [Internet]. 2021 Feb 1 [cited 2023 Oct 23];5(2):349. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8638355/ 

In collaboration with Menarini

MY-BIL-202402-010

Written by

Tasnim Jaman Raisa