This was the first Allergy Academy study designed for non-healthcare professionals – more specifically for parents, families, teachers, nurses and carers working with allergy and, in particular, with allergic children. It covered the three main stages of the 'allergic march' – eczema, food allergy and asthma/respiratory allergy.

The allergic rhinitis presentation is below. Please see here for the food allergy presentations, here for the eczema presentation or here for a report on the full day.

Sniffing and Sneezing – is it an allergy?
Dr Sophie Faroque, consultant at St Mary's Hospital, London

Rhinitis

Rhinitis is a nasal inflammation that causes an itchy, runny, dripping, blocked nose; it also causes snoring, a mucous drip down the throat and is often related to hyperactivity. There can be many causes but allergic rhinitis is the predominant form in children although only in around one third of adults. There has been a significant increase in rhinitis over the last 30 years and there is a strong link between allergic rhinitis and asthma.

Most common causes

• tree pollen
• house dust mite faeces
• animal dander
• food sometimes, although not as often as is sufferers may feel that it does
• hay does not cause rhinitis
• flowers with small, heavy pollen distributed by birds and bees does not cause allergic rhinitis
• grasses and trees whose pollen is distributed by the wind, does cause allergic rhinitis

Airborne allergens and irritants cause a release of histamine in the nasal passages, which, in turn, causes inflammation and fluid production in the nasal passages, the sinuses and the eyelids.

Skin prick tests, in the context of the patient's history, can be a very useful way of diagnosing the allergy and pinpointing the allergen.

Why would one treat rhinitis?

• it significantly affects patients' quality of life
• untreated, it leads to significant complications:
– sleep disturbance
– tiredness
– headaches
– glue ear
– asthma – asthma and rhinitis need to be treated as two sides of one condition, not separately
• untreated, rhinitis can impact seriously on daily life
– work
– schooling (GCSE exams all coincide with the peak of the pollen season and the 43% of adolescents who suffer from allergic rhinitis will drop a grade if they take their exams in the pollen season)

Treatment

• avoidance
• medication
• immunotherapy
• surgery (very rarely)
• education

Avoidance

What changes are you prepared to make?

• Pets. Animal dander is a major allergen and there is really no such thing as a hypo-allergenic dog or cat. Cat allergens are particularly sticky and it can take up to four years for allergen levels to fall in a house where there has been a cat unless there is a major and deep clean.
If you cannot bear to get rid of the animal then keep it out of the bedroom and deep clean the bedroom.

• Dust mite. There is no way of completely eliminating dust mites. But you must be thorough as half measures in terms of elimination will not help. However, be sure that it is house dust mite that is the problem before cleaning – skin prick tests will identify the allergen.
– remove carpets or damp clean
– replace curtains with blinds of shutters
– reduce humidity in the room
– cover mattresses, pillows and bedding with mite proof covers
– remove soft toys and cushions
– hot wash toys to kill the mites (NB. Freezing the toys will kill the mites but not remove the faeces which are the allergic element)

• Avoiding pollen

– wear sunglasses
– do not mow grass or be near grass when it is being mowed
– plant a low allergen garden
– remove allergenic trees, such as birch, from your garden if you can
– keep windows closed when there is a high pollen count
– holiday by the sea or out of the pollen season it in the country
– avoid going out in the wind
– shower as soon as you come in from the garden
– use nasal filters – they are surprisingly successful in keeping pollen out of the nasal passages

• Medication

– antihistamines – quick and flexible although can make you drowsy. (Piriton is particularly drowsy making.) Good as eye drops.
– steroid nose sprays decrease the inflammation in the nose but need to be used correctly, prophylactically and regularly. They take time to work but are the most effective control measure in the long term. However, they must be used properly to be effective. See below.
– decongestants provide instant relief but after a few days of use you get 'rebound' making the original condition worse
– immunotherapy – it can only be used for those with one or two inhaled allergens (not for asthma) but it can be effective and can delay the onset of asthma in children
– steroids. While nasal steroids are effective and have very few side effects, taking steroids orally, especially over a long period, may impact on a child's growth.

• Using nasal steroid sprays

– make sure you start at least 4 weeks before the pollen season starts
– wash the nose out with salt water before applying the spray
– do not sniff it back or tilt back the head so that the spray runs down the back of the throat
– the spray needs to stay in the nose
– if it feels as though it is running out, wash you teeth!! It will help the spray to stay in place!
– nasal sprays will also help runny and itchy eyes

• Take home message – be proactive – treat your rhinitis – it is easy to treat and will make a huge difference to your quality of life.

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