Maybe you or a loved one suffers from seasonal or chronic allergies related to pollens and other airborne irritants. Runny nose, stuffiness, dry mouth, itchy eyes, and a sluggish feeling are all symptoms of allergies.

While over-the-counter remedies help many sufferers, some patients require more extensive help. These people may have developed nasal polyps or have a physical obstruction that requires a medical/surgical solution for maximum allergy relief and healing. The integrated approach of the allergist/surgical specialists affiliated with the Nasal Sinus Center can determine the best course of treatment for each patient.

"My allergies were aggravated by nasal polyps. Once my sinuses were cleared, my breathing was easier. Now I do the things I've always wanted to."  - former Patient

Advice From Your Allergist on Rhinitis

Allergies, including, allergic rhinitis, affect an estimated 40 to 50 million people in the United States. Some allergies may interfere with day-to-day activities or lessen the quality of life.

The allergist-immunologist, with his or her specialized training and expertise in managing allergies and asthma, can develop a treatment plan for your individual condition. The goal will be to enable you to lead a life that is as normal and symptom-free as possible.

What is RHINITIS?
Rhinitis is a term describing the symptoms produced by nasal irritation or inflammation. Symptoms of rhinitis include runny nose, itching, sneezing and stuffy nose due to blockage or congestion. These symptoms are the nose's natural response to inflammation and irritation.

Arbitrarily, rhinitis lasting less than six weeks is called acute rhinitis, and persistent symptoms are called chronic rhinitis. Acute rhinitis is usually caused by infections or chemical irritation. Chronic rhinitis may be caused by allergy or a variety of other factors.

The nose normally produces mucus, which traps substances like dust, pollen, pollution, and germs such as bacteria and viruses. Mucus flows from the front of the nose and drains down the back of the throat, but when mucus production is excessive, it can flow from the front, as a runny nose, or become noticeable from the back, as post-nasal drip. Nasal mucus, normally a thin, clear liquid, can become thick or colored, perhaps due to dryness, infection or pollution. When post-nasal drip is excessive, thick, or contains irritating substances, cough is the natural response for clearing the throat.

Itching and sneezing are also natural responses to irritation caused by allergic reactions, chemical exposures (including cigarette smoke), temperature changes, infections and other factors.

The nasal tissues congest and decongest periodically. In most people, nasal congestion switches back and forth from one side to side of the nose to the other in cycles several hours long. Some people, especially those with narrow nasal passages, notice this nasal cycle more than others. Strenuous exercise or changes in head position can affect nasal congestion. Severe congestion can result in facial pressure and pain, as well as dark circles under the eyes.

What is Sinusitis?
Sinusitis is inflammation or infection of any of the four groups of sinus cavities in the skull, which open into the nasal passages. Sinusitis is not the same as rhinitis, although the two may be associated and their symptoms may be similar. The terms "sinus trouble" or "sinus congestion" are sometimes wrongly used to mean congestion of the nasal passage itself. Most cases of nasal congestion, though, are not associated with sinusitis.

What is Allergic Rhinitis?
Known to most people as hay fever, allergic rhinitis is a very common medical problem affecting more than 15 percent of the population, both adults and children.

Allergic rhinitis takes two different forms — seasonal and perennial. Symptoms of seasonal allergic rhinitis occur in spring, summer and /or early fall and are usually caused by allergic sensitivity to pollens from trees, grasses or weeds, or to airborne mold spores. Other people experience symptoms year-round, a condition called "perennial allergic rhinitis." It's generally caused by sensitivity to house dust, house dust mites, animal dander and /or mold spores. Underlying or hidden food allergies are considered a possible cause for perennial nasal symptoms. Some people may experience both types of rhinitis, with perennial symptoms worsening during specific pollen seasons. As will be discussed later, there are also other causes for rhinitis.

What causes the sneezing, itchy eyes and other symptoms?
When a sensitive person inhales an allergen (allergy-causing substance) like ragweed pollen, the body's immune system reacts abnormally with the allergen. The allergen binds to allergic antibodies (immunoglobulin E) that are attached to cells that produce histamine and other chemicals. The pollen "triggers" these cells in the nasal membranes, causing them to release histamine and the other chemicals. Histamine dilates the small blood vessels of the nose and fluids leak out into the surrounding tissues, causing runny noses, watery eyes, itching, swelling and other allergic symptoms.

Antibodies circulate in the blood stream, but localize in the tissues of the nose and in the skin. This makes it possible to show the presence of these antibodies by skin testing, or less commonly, by a special blood test. A positive skin test mirrors the type of reaction going on in the nose.

No hay, no fever - so why "Hay Fever?"
"Hay Fever" is a turn-of-the-century term which has come to describe the symptoms of allergic rhinitis, especially when it occurs in the late summer. However, the symptoms are not caused by hay (ragweed is one of the main culprits) and are not accompanied by fever. So physicians prefer the term "allergic rhinitis" because it's more accurate. Similarly, springtime symptoms are sometimes called "rose fever," but it's just coincidental that roses are in full-bloom during the grass-pollinating season. Roses and other sweet-smelling, showy flowers rely on bees, not wind, for pollination, so not much of their pollen gets into the air to cause allergies.

Is Allergic Rhinitis ever the cause of other problems?
Some known complications include ear infections, sinusitis, recurrent sore throats, cough, headache, fatigues, irritability, altered sleep patterns and poor school performance. Occasionally, children may develop altered facial growth and orthodontic problems. Allergy treatment can eliminate or alleviate most of these problems

Are all cases of Rhinitis caused by allergies?
Rhinitis may result from many causes other than allergic reaction. Not all rhinitis symptoms are the result of allergies. The most common condition causing rhinitis is the common cold, an example of infectious rhinitis. Most infections are relatively short-lived, lasting from three to seven days. Colds can be caused by any one of more than 200 viruses. Children, particularly young children in school or day care centers, may have from 8 - 12 colds each year. Fortunately, the frequency of colds lessens after immunity has been developed from exposure to many viruses.

Colds usually begin with a sensation of congestion, rapidly followed by a runny nose and sneezing. Over the next few days, congestion becomes more prominent, the nasal mucus may become colored, and there may be a slight fever and cough. Cold symptoms usually resolve within a couple of weeks, although a cough may sometimes persist. Cold symptoms that last longer may be due to other causes, such as chronic rhinitis or sinusitis.

What are other causes of Rhinitis?
Not all symptoms in the nasal passage are caused by allergy or infection. Similar symptoms can be caused by mechanical blockage, use of certain medications, irritants, temperature changes or other physical factors. Rhinitis can also be a feature of other diseases and medical conditions.

Drug-induced nasal congestion can be caused by birth control pills and other female hormone preparations, certain blood pressure medications and prolonged use of decongestant nasal sprays.

Decongestant nasal sprays work quickly and effectively, but they alter how the nasal passages normally work. After a few weeks of use, nasal tissues swell after the medication wears off. The only thing that seems to relieve the obstruction is more of the medicine, and the medication's effect lasts for shorter lengths of time. Permanent damage to the nasal tissues may result. Consultation with a physician to "get off" the medication is often necessary.

Cocaine also alters how the nasal passages normally work, causing a condition identical to, or even more severe than that produced by decongestant nasal sprays. If you use cocaine, it is important to tell your physician so that appropriate therapy can be prescribed.

Irritant rhinitis, or "vasomotor rhinitis" describes a group of poorly understood causes of rhinitis, with symptoms not caused by infection or allergy. Many people have recurrent or chronic nasal congestion, excess mucus production, itching, and other nasal symptoms similar to those of allergic rhinitis, but the disorder is not caused by allergy.

What triggers Vasomotor Rhinitis? (Runny Nose)
Irritants that can trigger vasomotor rhinitis include cigarette smoke, strong odors and fumes including perfume, hair spray, other cosmetics, forms of laundry detergents, cleaning solutions, pool chlorine, car exhaust and other air pollution. Other irritants are spices used in cooking, alcoholic beverages (particularly beer and wine), aspirin, and certain blood pressure medications. Some people are very sensitive to abrupt changes in weather or temperature. Skiers often develop a runny nose, but in some people any cold exposure may cause a runny nose. Others start sneezing when leaving a cold, air conditioned room. These agents are not allergens, do not induce formation of allergic antibodies and do not produce positive skin test reactions. Occasionally, one or two positive skin tests may be observed, but they do not match with the history and are not relevant or significant.

Medication - When avoidance measures don't control symptoms, medication may be the answer. Antihistamines and decongestants are the most commonly used medications for allergic rhinitis. Newer medications, such as cromolyn, inhibit the release of chemicals that cause allergic reactions. Nasal corticosteroid sprays reduce the inflammation from the allergic trigger. Medications help to alleviate nasal congestion, runny nose, sneezing and itching. They are available in many forms, including tablets, nasal sprays, eye drops and liquids. Some medications may cause side effects, so its best to consult your allergist-immunologist if there's a problem.

Immunotherapy - Allergen immunotherapy, known as "allergy shots," may be recommended for persons who don't respond well to treatment with medications, experience side-effects from medications or have allergen exposure which is unavoidable. Immunotherapy does not cure allergies but can be very effective in controlling allergic symptoms. Allergy injections are usually given at variable intervals over a period of three to five years.

An immunotherapy treatment program consists of injections of diluted allergy extract, administered frequently in increasing doses until a maintenance dose is reached. Then, The injection schedule is changed so that the same dose is given with longer intervals between injections. Immunotherapy helps the body build resistance to the effects of the allergen, reduces the intensity of symptoms caused by allergen exposure, and sometimes can actually make skin test reactions disappear. As resistance develops, symptoms should improve, but the improvement form immunotherapy will take several months to occur. Immunotherapy does not help the symptoms produced by non-allergic rhinitis.

There are many ways of treating allergens, and each person's treatment must be individualized based on the frequency, severity and duration of symptoms and on the degree of allergic sensitivity. If you have more questions, your allergist-immunologist will be happy to answer them.

About Antihistamines - Antihistamines are the most inexpensive and commonly used treatment for rhinitis. These medications counter the effects of histamine, the irritating chemical released within your body when allergic reaction takes place. Although other chemicals are involved, histamine is primarily responsible for causing the symptoms.

Antihistamines do not cure, but help relieve nasal allergy symptoms, such as sneezing, itching and discharge; eye symptoms, such as itching, burning, tearing, and clear discharge: skin conditions such as hives, eczema, itching and some rashes; and other allergic conditions as determined by your physician.

There are dozens of different antihistamines and wide variations in how patients respond to them. Some are available over the counter and others require a prescription.

Generally, antihistamines work well and produce only minor side effects. The body tends to build up resistance to some antihistamines over time. This tendency varies from individual to individual. If you find that an antihistamine loses its "strength," notify your physician who may then recommend an antihistamine of a different class or strength. Persons with nasal dryness or thick nasal mucus should avoid taking antihistamines without consulting a physician. Contact your physician for advice if an antihistamine causes drowsiness or other side effects.


Proper use- Short-acting antihistamines can be taken every four to six hours, while timed-release antihistamines are taken every 24 hours. The short-acting antihistamines are often most helpful when taken 30 minutes before the anticipated allergic exposure (e.g. a picnic during ragweed season). Timed-release antihistamines are better suited to chronic (long-term) use for those who need daily medications.

Proper use of these drugs is just as important as their selection. The most effective way to use them is before symptoms develop. An early dose can eliminate the need for a larger dose later. Many times, a patient will say thet "took one, and it didn't work', but if they had taken the antihistamines regularly for three to four days, and built up their blood levels, it might have been effective.


Side effects- The most common side effect is sedation or drowsiness. For this reason, it is important that you do not drive a car or work with dangerous machinery the first time you take an antihistamine. The first time you take an antihistamine, take it at home, several hours before bedtime. When you are sure the medicine will not cause sedation, you can then take it any time as prescribed during the day. For those who experience drowsiness, the sedation effect usually lessens over time. Some of the newer antihistamines have side effects of drowsiness.

There have not been enough studies to determine absolute safety of antihistamines in pregnancy. Again, consult your allergist-immunologist or obstetrician if antihistamines must be taken.

While antihistamines have been taken safely by millions of people in the last 50 years, don't take them before telling your allergist-immunologist if you are allergic to or intolerant of any medicines, are pregnant or intend to become pregnant while using this medication, are breast feeding, have glaucoma or enlarged prostate or have any illness.

What other medications are effective in treating Rhinitis?

Decongestants help relieve the stuffiness and pressure caused by allergic, swollen nasal tissue. Because they do not contain antihistamines, they do not cause common antihistamine side effects. However, they do not relieve the other symptoms of allergic rhinitis, such as a runny nose, post-nasal drip and sneezing. Decongestants are available as prescription and non-prescription medications and are often seen in combination with antihistamines or other medications. It is not uncommon for patients using decongestants to experience insomnia if taking the medication in the afternoon or evening. If this occurs, reducing the dose n may be needed. At times, men with prostate enlargement may encounter urinary problems while on decongestants. Patients using medications for the management of emotional or behavioral problems should discuss this with their physicians before using decongestants. Pregnant women should also check with their physicians before taking decongestants.

Nonprescription Decongestant Nasal Sprays work within minutes and last for hours, but should not be used for more than a few days at a time without a physician's order.

Oral Decongestants are found in may over-the-counter and prescription medications, and these may be the treatment of choice for nasal congenstion. They don't cause rhinitis medicamentosa, but need to be avoided by some patients, especially those with high blood pressure. If you have high blood pressure, you should check with your physician before taking them.

Nonprescription Saline Nasal Spray will counteract symptoms of dry nasal passages or thick nasal mucus. Unlike decongestant nose sprays, a saline nose spray can be used as often as needed. Sometimes, your physician may recommend washing (douching) of the nasal passage.

Corticosteroids counteract the inflammation caused by the body's release of allergy-causing substances, as well as that caused by other non-allergic factors. Thus, they generally work for many causes of rhinitis symptoms and are sometimes useful for chronic sinusitis. Corticosteriods are sometimes injected or taken orally, but usually on a short-term basis for extremely severe symptoms. Physicians warn that injected or oral steroids may produce severe side effects when used for long periods or used repeatedly and, for this reason, they should be used with extreme caution. In rhinitis, a corticosteriod is much safer when used by spraying it into the nose. Side effects are less common, but may include nasal ulceration, nasal fungal infection, or bleeding.

Antibiotics are for the treatment of bacterial infections. They do not affect the course of uncomplicated common colds, and are of no benefit for noninfectious rhinitis, including allergic rhinitis. In chronic sinusitis, antibiotics may help only temporarily, and surgery may be needed.

Eye Allergy Preparations are used when the eyes are affected by the same allergens that trigger rhinitis, causing redness, watery eyes and itching. Eye preparations are available as prescription and nonprescription medications. Check with your physician or pharmacist about these medications.

Nasal Surgery will usually cure or improve symptoms caused by mechanical blockage or chronic sinusitis not responsive to prolonged antibiotics and nasal steroid sprays. Stopping the use of offending medications will cure rhinitis medicamentosa, providing that there is no underlying disorder.