Allergic Rhinitis - Symptoms, Treatment and Precautions

Hay Fever

Allergic Rhinitis - Hay Fever

Allergic rhinitis is an allergic inflammation of the respiratory tract, which includes the air passage in the nose. It is formed as a result of inhalation of an allergen immune system sensitive individual such as hair and skin particles that can be poured from pollen, dust and animals. In such individuals, the production of immunoglobulin E (IgE) antibodies, which bind with allergen to mast cells and histamine-containing basophils, is triggered. These antibodies that bind to mast cells cause the release of inflammatory mediators such as histamine (and other chemicals) and as a result, the appearance of Allergic Rhinitis Disease, characterized by nasal itching, tears, sneezing attacks. "Hay Fever", which is used as a synonym as the word meaning, but no signs of infection, fever and malaise are observed. When allergic rhinitis is caused by any plant pollen, the terms "Pollinosis" and especially if grass pollen causes "Hay Fever" are used.

The severity of the symptoms can vary from person to person, depending on the level of sensitivity of the immune system. In very sensitive people, urticaria or other skin rashes can also be added to existing findings.

This disease, which varies in frequency according to genetic characteristics and environmental conditions, has 10-25% allergic rhinitis among people living in western countries.

Allergic Rhinitis Symptoms and Findings

The characteristic symptoms of allergic rhinitis

- runny nose
- itchy nose
- nasal congestion
- tears (watered eyes)
- sneezing attacks in a row

Dennie-Morgan folds,a line on the nose,nasal crease,nose salute,allergic rhinitis,Hay Fever,Pollinosis,allergic shiner,
Allergic Rhinitis Attack Period - Severe Nasal Congestion - Turbinate Hypertrophy
In the photo above, there is an image showing the left nasal kivity of a patient who has had nasal congestion, sneezing, runny nose for months and does not use medication, and is waiting without taking any precautions. There is severe hypertrophy in the left inferior turbinate and it is seen that it is in contact with the nasal septum, the air passage is almost completely closed, the nasal mucosa is pale in color and there is a nearly transparent secretion. As a result of the patient's uncontrolled and untreated recurrent allergic rhinitis attacks, inflammation and edema in the nasal mucosa resulted in severe nasal congestion. In the treatment of allergic rhinitis, "avoidance", that is, the prevention of allergen contact, is the main effective way. It is appropriate for these patients to be followed up regularly by a physician who deals with allergy.

Characteristic physical signs of allergic rhinitis

- venous stasis in the lower eyelid
- swollen turbinate
- swelling and redness of the eyelid, conjunctiva, and effusion

Other physical symptoms

Presence of dark circles (Dennie-Morgan folds) under the eyes in patients with allergic rhinitis, known as "allergic shiners".

Allergic Salute
In order to relieve excessive secretion or flow in the nose, the patient may perform an upward wiping motion with his hand or rub his nose with the palm of his own hand. This action is known as "nose salute" or "allergic salute". 

allergy line on the nose - 
the allergic crease - nasal crease
As a result of this movement, as a result of repeated skin fold on the nose, a transverse line may appear (allergy line on the nose - the allergic crease - nasal crease). Allergic rhinitis, especially in people with allergic predisposition (atopic), may be detected together with other allergic skin and lung diseases (such as eczema, asthma).

Hay Fever
On the photo left, the photo obtained in the endoscopic nasal examination of the patient with an allergic rhinitis attack and severe nasal congestion is seen. In the right nasal cavity, a pale, edematous appearance and transparent nasal discharge of the lower nasal tubinate are observed.

How is Allergic Rhinitis Disease Classified?

Allergic rhinitis is divided into seasonal and perennial (year-round). 

Seasonal allergic rhinitis occurs especially during the pollen season. It is not usually seen before the age of 6. 

Perennial allergic rhinitis occurs throughout the year. This species is more common in young children.

Allergic rhinitis can also be classified as Mild-Intermittent, Moderate-Intermittent Severe, Mild-Persistent and Moderate-Severe Persistent.

When its symptoms are less than 4 days a week or less than 4 weeks >> Intermittent

When its symptoms are more than 4 per week or more than 4 weeks >> Persistent

If the symptoms are not very troublesome for the patient; if symptoms do not affect normal sleep patterns and daily activities, work or school life >> Mild

If sleep disturbance causes problems in daily activities, school or work order >> Severe

Allergic Rhinitis Treatment and Precautions To Be Taken

Allergic Rhinitis Treatment and Precautions
The purpose of the treatment of allergic rhinitis is to eliminate or reduce the symptoms caused by the present allergic reaction. In the foreground, avoiding allergens and planning medical treatment later is the standard treatment protocol. 

It is necessary to determine what allergy the patient has and to avoid this allergen. Often not all allergens are detectable and drug treatment is initiated when allergy-related complaints occur.The main drugs used in the treatment of allergic rhinitis are:


Intranasal (administered into the nose) corticosteroids are used to control symptoms associated with sneezing, runny nose, itching and nasal congestion. These drug groups are a very good choice especially for perennial allergic rhinitis. Steroid nasal sprays are often effective and safe, and can be effective without oral antihistamines. Steroid nasal sprays are the most effective drugs in the treatment of allergic rhinitis.

Systemic steroids such as prednisone are effective in reducing nasal inflammation, but their use is limited to the side effects of steroid therapy.

Antihistamine Drugs

It is often taken orally to control symptoms such as sneezing, runny nose, itching and conjunctivitis, especially in the treatment of seasonal allergic rhinitis. There are also nasal spray spreads.The most important undesirable side effects of antihistamine drugs are dizziness. Although this side effect is higher in first generation antihistamine drugs; It is less in second and third generation antihistamines such as cetirizine and loratadine.


Decongestant drugs can be used with antihistamine districts. It can be administered as an oral tablet or as an intranasal spray.Topical decongestants (those applied into the nose) may help reduce symptoms such as nasal congestion, but may cause nasal congestion and runny nose after prolonged use, and they are recommended to be used for a maximum of 5 days because of this disease called “rhinitis medicamentosa”.

Leukotriene Receptor Antagonists

In general, steroids are combined with antihistamine drugs in patients with severe allergy symptoms. They are quite effective in relieving the symptoms of allergic rhinitis.cromolynsHistamine, which causes allergic reactions from mast cells, inhibits the release of SRS-A and other factors, preventing the appearance of allergic rhinitis symptoms. When used before contact with allergen, it prevents the patient's early and late allergic reactions, but if allergic reactions have occurred, their effects are limited.

Desensitization (Immunotherapy or Vaccine Treatment)

The drug can be administered in patients with unresponsive allergic rhinitis or in patients with single allergy. It can be done in two ways: subcutaneous and sublingual. Apart from this, immunotherapy studies in the form of pills that can be taken orally against grass pollen continue in the research stage.

Other Medicines

Intranasal Drugs For Allergic Rhinitis
There are natural remedies made of methyl cellulose that covers the inside of the nose, such as “nasaleze spray”. However, these drugs should be taken before allergic reactions such as chromolines and related symptoms are revealed. If symptoms appear, its effectiveness is limited. Although it is “natural”, its use in pregnancy is not approved for now.

Alternative Treatments Complementary

Alternative treatments are not supported by current evidence of treatment. There are articles on acupuncture treatment, but there are no adequate supporting studies.

Precautions Related to Allergic Rhinitis in the Home

If you have an individual with an allergy in your home, taking the following precautions may reduce allergy symptoms and therefore the amount of medication:

- Avoiding animal feeding or weekly washing of domestic animals
- Use of HEPA filter air cleaner, electric cleaner or air conditioners- Frequent washing of beds and curtains
- Reducing humidity at home and touching the inside of the room with sun rays
- Removal of products such as woolen carpets, rugs, blankets and quilts especially in the bedroom.
- No plants and flowers in the bedroom
- The floor coverings in the house are covered with a dust-repellent product such as laminate, nylon or parquet.
- No smoking at home
- Anti-allergic production of pillows in a synthetic and silicone-free structure.

When children are not at home, it may be appropriate to ventilate the child's room, wash the bed and covers, and wipe the floors with a damp cloth.

About Allergy Tests

Allergy tests are aimed at detecting allergens in which patients' immune systems are sensitive. Skin testing is the most commonly used among allergy tests. Skin tests may include a scratch test, a prick test, a patch test, or other tests.In addition, “RAST (radioallergosorbent test)” blood test is used to determine the specific allergen sensitivity.

Intradermal allergy test is more sensitive than skin prick test; a positive response is more frequently obtained in people without any allergy symptoms.In one patient, even if intradermal test, skin prick test and blood tests are negative in terms of allergy; there may be an allergic rhinitis disease. This is called "local allergic rhinitis", special tests are required to diagnose local allergic rhinitis.

Treatment of Allergic Rhinitis in Pregnancy

Many drugs related to allergy are not very suitable for use in pregnancy.

The most innocent measures in pregnant and allergic rhinitis patients are lavage of the nose with regular saline and washing the nose and preventing allergens.

Apart from this, in case of severe symptoms during pregnancy, steroids for the nose that are in the category “B” are sprays containing the active ingredient “Budesonid” (Available in 2 different names in our country: “Inflacort Aqua Nasal Spray 100 mcg 200 Dose” and “Rhinocort Aqua Spray 50 mcg 200 Dose”). In addition, nasal sprays ("Allergocrom Nasal Spray", "Rynacrom M Nasal Spray", "Allergo Comod Nasal Spray") are also in the "B" category and can be used before the symptoms begin. It is thought that short-term use of intranasal steroids during pregnancy may be more advantageous and less side-effect than long-term use of chromolynic sprays.

Old antihistamine drugs such as chlorpheniramine and tripelennamine can be preferred in the treatment of allergic rhinitis that occurs during pregnancy and it is also in the “B” category.Immunotherapy can be continued if you are pregnant while immunotherapy continues; It is not recommended to start this treatment after pregnancy.

The pregnancy category of oral decongestants is usually “C” and is not recommended for use during pregnancy. Except for salt water, medication should not be used unless it is in difficulty. If the symptoms started, if the patient's complaints greatly affect the quality of life; It may be appropriate to use - short term - nasal steroid sprays containing budesonide.

You can find information about allergic rhinitis symptoms, treatment, medications to be taken, allergy tests in the source links below:

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
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