Allergic Rhinitis

Allergic rhinitis; Allergic rhinitis is the different and excessive reaction of the immune system to substances that are medically normally harmless in a way that other people do not show.

Why does the body develop allergies?

The word allergy is a word that originates from Latin and means to react differently. In medical terms, it means that the immune system reacts differently and excessively to normally harmless substances in a way that other people do not.

Substances that stimulate the immune system and cause allergies are called allergens.

When the immune system first encounters an allergen that enters the body, no clinical symptoms occur, because specific antibodies (IgE) have not yet been produced against this substance. These special antibodies are produced on first contact, but on second contact the immune system reacts and allergy symptoms appear.

What are the most common allergens?

The most common known allergens are pollen, animal dander, house dust mites, mold fungi and especially foods containing artificial additives.

1. Pollens:

Flower dust, also known as pollen, which is involved in the reproduction of flowering plants, is released into the atmosphere by hundreds or thousands of plants in spring.

Allergen pollen continues its activity in three seasonal periods.

• The early spring period is of medium or short duration and the majority of the pollen of this period is tree pollen. For example, we can give trees such as willow, poplar, ash, hazelnut, plane tree.
• The early summer period starts right after the spring and lasts until the end of June. The first flowering poppy is replaced by hogweed and hare's whiskers later on. Cattail and grass weed are important in June and July. Bromis mollis (soft chess) pollen is present in the atmosphere from April to September and is allergenically important.
• During the third period, the late hay fever period, Ambrosia (grape grass) pollen is very important in allergic diseases.

2. Household Allergens:

House dust is the leading cause of year-round allergic rhinitis. The allergenic properties of house dust do not originate from a single substance; house dust consists of the residues and decomposition products of many living and non-living materials in a special environment.mites, including animal debris, pollen, food residues, bacteria, fungal spores, fungal spores, insect waste, inorganic matter particles and mites. Dermatophagoides Farinae is the most common mite in our country. Human skin rashes and places with 80% humidity, beds, sheets, pillows, quilts, blankets and carpets are places where living and non-living mites and their feces are especially abundant.

• Animal allergens include skin rashes, feathers, hair, saliva, urine and feces. Animals such as cats, dogs and birds are among the most allergenic animals.
• Fungi are one of the important factors in year-round allergic rhinitis. They grow mostly in damp and dim places. They grow in bathrooms and kitchens, behind cabinets and coffee tables in damp rooms, in the soil of houseplants and easily mix into the respiratory air throughout the year. Basements and garbage dumps are also places where fungal spores can be dense.
• Food allergen: Chocolate, foods with cacao, colored drinks (cola, instant fruit juices), fatty snacks, spicy foods (salami, sausage), colored foods (chewing gum, colored candies) are foods with allergic properties. In addition to nasal complaints, they also cause mouth, tongue and skin complaints.
• Industrial and chemical allergens: Toluene, platinum salts, chromium, nickel, latex and acids are the most important industrial allergens. Common chemical and biological allergens are flour, sawdust, detergents, washing powders, perfumes, exhaust gases, cigarette smoke and sprays.

What are the symptoms of allergic rhinitis?

Patients with allergic rhinitis present with sneezing, runny nose, nasal congestion and itchy nose. There may also be nasal discharge, cough, weakness and difficulty in smell. Some patients may experience itching in the palate and ears.

If accompanied by allergic conjunctivitis; itching, watering and redness in the eyes may accompany. High palate and dental disorders may occur due to continuous mouth breathing. Complaints in allergic rhinitis are bilateral, unilateral or yellow/green colored nasal discharge is not compatible with allergic rhinitis. Frequent pushing their nose upwards with their hands due to itching (allergic salute) and the formation of a horizontal line on the tip of the nose due to this, as well as edema under the eyes and slight dark discoloration are typical findings of allergic rhinitis. Untreated patients may experience sleep disorders due to inability to breathe easily.

In children; attention deficit, impaired concentration, exam failure and decreased self-confidence may occur.

In adults, anxiety, depression, decreased academic performance and work productivity may result in a decrease in quality of life.

What are the differences between allergic rhinitis and colds?

Symptoms of allergic rhinitis and colds can be similar.

There are several ways to tell them apart:

If you do not have a fever and have a thin, liquid runny nose, you have allergic rhinitis. But if the runny nose is more yellow, your body aches and you have a low-grade fever, this is a sign of a cold. Allergic rhinitis starts immediately after contact with the allergen. A cold, on the other hand, occurs a few days after contracting the virus. Allergic rhinitis lasts as long as you are exposed to the allergen.

A cold only lasts for three to five days.

Who gets allergic rhinitis and when?

Allergic rhinitis usually occurs in people with a predisposition to allergies, called atopic people. The incidence of other allergic diseases (eczema, urticaria, asthma) is also increased in these people. People with a family history of allergic diseases also have an increased incidence of allergic rhinitis. Symptoms of the disease usually appear before the age of 40, and complaints decrease with age. It is very rare for the disease to completely resolve on its own.

Are there different types of allergic rhinitis?

Allergic rhinitis is classified according to the duration and severity of symptoms. If the symptoms last less than four days a week or less than four weeks, it is called "intermittent" allergic rhinitis, and if they last more than four days a week and more than four weeks, it is called "persistent" allergic rhinitis.

When classifying according to severity, it is defined as "moderate/severe" if it is accompanied by disturbance in sleep, disturbance in daily activities and exercise, disturbance in work/school life, and distressing symptoms, and "mild" allergic rhinitis if none of these symptoms accompany it.

In daily practice, it is more commonly classified as "seasonal" allergic rhinitis if it occurs in the spring season and perennial allergic rhinitis if it occurs throughout the year.

Seasonal allergic rhinitis is mostly caused by tree, meadow and grass pollen flying in the air and is also called "hay fever", but this is not an accurate description. The amount of pollen may vary depending on the geographical region where you live. In dry and windy weather, pollen amounts are more intense and allergic rhinitis symptoms may increase.

In year-round allergic rhinitis, the causes are mostly indoor allergens such as house dust mites, mold fungi, cockroaches and animal hair.

How is allergic rhinitis diagnosed?

The most important point in the diagnosis of allergic rhinitis is the patient's history. For the diagnosis of allergic rhinitis, physicians first examine the symptoms seen in the patient. The season of the year, what is encountered and how the symptoms appear are important for the diagnosis. What triggers the symptoms and in which season they occur will help in making the diagnosis.

In the examination; the patient's nasal mucosa and other points are examined. In nasal endoscopy, the inner surface of the nose is pale and the soft tissues called "concha" are swollen. Dark and sticky nasal discharge can be seen in the examination of patients. Pale color, increased transparent secretion, edema, swelling and nasal flesh enlargement can be seen in the nose. When viewed through the mouth, nasal discharge and pharyngitis findings can be seen.

There are many diagnostic tests for allergic rhinitis, such as antibody IgE testing. Allergy tests applied to the skin are among the most commonly used methods. Blood or skin allergy tests can reveal the allergic agent causing rhinitis. However, even if the results of the tests are negative, the diagnosis can also be made with the symptoms seen in the patient.

Radiologic imaging tests are not necessary under normal conditions, but may be performed when treatment is unsuccessful or when a disease other than allergic rhinitis is suspected.

Allergic rhinitis can be confused with many diseases such as infectious rhinitis, non-allergic rhinitis, rhinosinusitis, polyps (flesh in the nose), adenoid size, foreign bodies, cystic fibrosis, Kartegener syndrome and tumors, so patients should be evaluated in detail.

How is allergic rhinitis treated?

The treatment of allergic rhinitis is aimed at relieving the symptoms, the disease cannot be eliminated with this treatment. Avoidance of allergens that trigger symptoms and medication are essential in the treatment of allergic rhinitis. The complaints of many patients can be controlled in this way. The most commonly used medications are antihistamines that reduce the effect of the allergen and nasal sprays containing cortisone. In the treatment of allergic rhinitis, the physician prescribes antihistamines, which prevent the release of the substance that causes the allergen. These are often very useful. Their effect is better when they are used before exposure to the allergen. They are particularly effective in relieving symptoms such as itching, discharge and sneezing. Medicines that reduce swelling of the lining of the nose are also used in treatment. Another commonly used option is nasal sprays containing cortisone. Since the cortisone in the sprays is applied only to the nasal area, there are almost no side effects. Therapeutic measures such as washing the nose are also useful.

However, all these medications must be prescribed by a physician after assessing the severity of the disease and the patient's condition. Medical treatment of the disease should also include environmental control counseling.

In addition to medication, another proven treatment is allergen vaccination (immunotherapy). Allergen immunotherapy should be performed by specialists since the method is determined individually for individuals with suitable conditions and allergies for this application. Allergen immunotherapy, which improves the symptoms of allergic rhinitis, can also prevent the development of asthma in some patients.

Although the main principles of the treatment are the cessation of contact with allergenic stimuli, drug therapy, hyposensibilization (vaccine therapy); surgical treatments (concha surgery, sinus surgery) may also be necessary for problems such as nasal flesh and sinusitis, polyps caused by allergies. With the surgical removal of edematous and polyped tissues that obstruct the nasal airflow, allergen and mucosa contact decreases, it is easier to eliminate the allergen by flowing with mucus, and a significant decrease in allergic complaints can be achieved as well as an increase in quality of life. Surgical treatments may need to be repeated if allergic flesh (polyp) develops in the nose.

Recommendations for people with allergic rhinitis:

• People with allergic rhinitis should not be in dusty and pollinated environments, and if they have to be, they should use a mask.
• Doors and windows should be kept closed in seasons when pollen is flying. Air humidifiers should be used at home, especially in homes with central heating, as dry indoor air can worsen allergic rhinitis. Pay attention to the cleanliness of the room air.
• Avoid keeping animals and plants at home. Cotton and synthetic blankets should be preferred over downy and woolen ones. Household items such as rugs and carpets that can harbor dust should not be used.
• Furniture should be cleaned twice a week. Allergy sufferers should not clean if possible, and if they have to, they should wear a mask for 15 minutes during and after cleaning.
• The mattress, pillow and quilt in the patient's bedroom should be covered with allergen-proof covers. If the bed is old, it is useful to replace it.
• Bedding should be washed at 60 degrees Celsius every week to kill house dust mites and their eggs. Children should not sleep with furry toys.
• General health rules should be followed, exercise should be practiced, smoking should be avoided and a balanced diet should be followed.

References

1.Önerci M. Allergic Rhinosinusitis ,Rekmay Ltd. Ankara 2002
2.Güneri E.Alpin Website