Allergic rhinitis (hay fever) is an allergic-induced inflammation of the mucous membrane that lines the nasal cavity. A good patient education program and regular medical examinations make allergic rhinitis no longer unbearable.
Allergic rhinitis (hay fever) is an allergic-induced inflammation of the mucous membrane that lines the nasal cavity. It is a genetically inherited disease characterized by sneezing, runny nose, itchy nose, nasal congestion, and itchy, watery eyes. In our country, its incidence rate ranges from 2 to 37% in children and from 8 to 30% in adults.
Allergic rhinitis (AR) can be diagnosed based on the patient’s complaints and examination results. Allergic rhinitis can be diagnosed easily with the ENT examination of any patient admitted to our clinic with the complaints of recurrent sneezing, runny nose, and itchy, watery eyes.
A simple skin test can give the patient a chance of treatment, which is likely to provide permanent results. The most common allergens are house dust (mite), grass and tree pollens, fungus, and animal species.
No matter what the allergen is, there are 4 alternatives in treatment of the disease. They can be performed alone or in conjunction with each other.
1-DRUG THERAPY: Drugs exist at every step of treatment. These are nasal sprays with cortisone or physiological saline solution, nasal decongestant tablets, antihistamine tablets, and anti-allergy (antileukotriene) tablets that prevent contact with allergy in another way.
Nasal sprays with physiological saline solution that we can easily use at all ages, especially during pregnancy provide mechanical cleaning in the nose. We can prepare such solutions at home or can buy their ready to use forms from pharmacies. In the preparation of the formula, 1 teaspoon (approximately 5 mL) of salt and 1 teaspoon of baking soda are mixed in a glass of boiled hot water.
After cooling, it is sprayed into the nose with the help of injectors and then the nose is cleaned. This procedure is repeated regularly for a period of 5 to 7 days.
Cortisone-containing nasal sprays are used as the first-line treatment for allergic rhinitis. During its use, the head is bent forward, the spray is applied twice to each nostril, then the solution is sniffed in to increase its effect. 2 or even 3 cans of nasal spray can be used continuously. Especially new generation sprays with very low systemic side effects can be used from 2 years of age. Local side effects may include scab formation, bleeding and dryness in the nose.
Among oral tablets, nasal decongestants can be used for a period of 5 to7 days. Due to their side effects, such products should be used with caution in patients with problems such as heart diseases, low or high blood pressure, prostate enlargement, and glaucoma. Their use more than 2 times a day worsens the dryness of the throat and can cause drowsiness; so they should be used carefully.
Oral tablets called antihistamines, which are good for runny nose, sneezing and itching, can be used regularly for 1 or 2 months. They are good for all allergic rhinitis complaints except nasal congestion. Especially new generation antihistamines have less side effects. Their most common side effects are drowsiness and dullness. These products mostly used as the second-line treatment can be used in combination with steroid nasal sprays.
Drugs called antileukotrienes are especially effective in patients with pulmonary complaints. These drugs that prevent the allergen from sticking to the cell wall have a different mechanism of action than other drugs. They are also used in the form of chewable tablets intended for children. It is not effective in acute cases. It is used for protection purposes.
2-PROTECTIVE TREATMENT: Protection is the most important treatment for allergic rhinitis. First of all, if the allergen can be detected with a simple test, protective precautions should be taken accordingly. House dust is the most common cause of allergies; so it is important to design the environment and bedroom considering this fact.
In cases of animal hair allergy, the animal should be taken away from the environment. Despite this action, allergens can remain in the environment for 3 to 4 months. Regarding pollen allergy, it is necessary to pay attention to the pollen season, and all kinds of precautions should be taken to ensure that the pollen load is not kept in the environment.
Regardless of which of the other treatments is performed, preventive measures should be taken. This is a way of life and a lifelong protection against allergens should be adopted in order to avoid encountering any serious disease such as asthma in the future.
3-IMMUNOTHERAPY (VACCINE THERAPY): Vaccine therapy is the only permanent treatment for allergic rhinitis. The logic of this treatment is to desensitize the patient by giving him/her the allergen in low doses. The length of the treatment period is 3.5 years.
The treatment intended to desensitize the person to these allergens begins to be performed with a low dose and then the doses are increased gradually. According to the literature, the success rate ranges between 60% and 90% on average; however, I found this rate to be 89% in my own study, which suggests that the rate can be kept high with good patient selection.
Whether a patient is a good candidate for vaccine treatment is determined with skin prick test. Today, vaccine treatment is performed in 2 ways as the use of Subcutaneous and Sublingual administration routes. Sublingual administration makes it easier to use the medication, and has a lower potential to cause side effects.
4-SURGICAL TREATMENT: Surgical treatment is an adjunctive treatment in the treatment of allergic rhinitis. If we surgically correct organic pathologies such as nasal deviation, concha hypertrophy, nasal polyps or sinusitis, we can at least reduce nasal congestion and improve the physiology of the nose. There is no doubt that surgery cannot eliminate allergies, but can eliminate the pathologies caused by allergy.
NO MATTER WHAT TREATMENT IS DONE, ALLERGIC RHINIT IS A WAY OF LIFE. THE PATIENT’S REGULAR FOLLOW-UP CHECKS AND TREATMENT PROCEDURES SHOULD BE PERFORMED BY AN EXPERIENCED MEDICAL STAFF.