Allergic rhinitis means inflammation of the lining of the nose that follows an allergic reaction — an overreaction of the immune system to something that’s normally harmless.

The substance that triggers the allergic reaction is called an allergen. Common allergens include pollen, dust mites and their droppings, skin scales or saliva from pets, and mould spores.

For many people, allergies are more than just an annoyance — they have a serious impact on life. The good news for allergy sufferers is that many things can help.

Allergic rhinitis used to be categorised into 2 groups:

  • seasonal allergic rhinitis – where symptoms occur at particular times of the year – people commonly call this hay fever; and
  • perennial allergic rhinitis – where symptoms occur at any time of the year.

But most people are sensitised to allergens from both groups – both seasonal and perennial. Allergic rhinitis is now categorised according to how severe the symptoms are (whether they are affecting your day to day life) and how persistent they are.

Symptoms

Both types of allergic rhinitis cause symptoms such as sneezing, a running or blocked up nose, itchy, watery or red eyes and a scratchy throat. You might also feel lethargic and find it difficult to concentrate on anything other than where the nearest tissue box is.

The key symptoms of allergic rhinitis are:

  • sneezing bouts
  • itchy nose, eyes, palate and ears
  • runny nose – lots of watery fluid streaming from the nose
  • watery, red, puffy eyes — often itchy
  • a blocked nose, and sometimes blocked ears as well
  • a sore throat, tickly cough and husky voice
  • bad breath
  • snoring.

If your allergic rhinitis is severe and untreated, you might sleep poorly at night, and become sleepy during the day. You may be more prone to sinus infections and eye infections. If you have asthma, allergic rhinitis can make your asthma symptoms more difficult to control.

Causes

Substances that cause allergic rhinitis are present in the air and are breathed into the nose. They include:

  • grass, weed and tree pollens
  • house dust mite faeces (‘dust mite allergen’)
  • mould spores
  • animal dander (hair and skin flakes) especially from cats, and less commonly
  • cockroach droppings (‘cockroach allergen’).

Grass, weed and tree pollens

Wind-borne pollens are the cause of seasonal allergic rhinitis, which usually occurs in spring and summer. The length of the pollen season depends on where you live and the plant species involved.

Wind-borne pollens can travel hundreds of kilometres, so it’s not necessarily the plants and trees in your immediate neighbourhood that are the problem. Australian native trees and plants are not usually problematic – it’s usually exotic (imported foreign) trees and grasses that cause the most problems as they are wind pollinated.

Flowering plants with big colourful flowers are not usually an allergy problem, because they tend to be pollinated by bees, not the wind, and their pollen is heavy.

Daily pollen forecasts during the main pollen season are available for some east coast locations from: https://www.pollenforecast.com.au/ and some weather apps for smartphones.

Dust mites

Dust mite allergen is the most common cause of perennial allergic rhinitis. As well as the dust mite itself, the faeces of the dust mite are an allergen. House dust may contain a high load of decaying dust mites and their faeces, and so it can cause allergic rhinitis all year round.

Mould spores

Mould can cause allergic rhinitis when the spores are inhaled. It is common in Australian houses. Mould flourishes in areas of high humidity where there is little or no ventilation, such as bathrooms, kitchens, basements, walk-in wardrobes and bedrooms with ensuite bathrooms.

Animal dander

Pet dander is a common cause of allergic rhinitis. Dander is tiny flecks of skin, shed by animals such as dogs and cats. It is also possible to be allergic to proteins in an animal’s saliva or urine.

Risk factors

Nearly one in 5 Australians is affected by allergic rhinitis. Three out of 4 Australians with asthma also have allergic rhinitis. It can be made worse by cigarette smoking, including passive smoking.

Complications

Allergic rhinitis is often accompanied by allergic conjunctivitis, which manifests as eye symptoms such as itchy, watery and red eyes.

The risk of developing sinusitis is higher in people with allergic conjunctivitis.

Having allergic rhinitis that’s not treated and well controlled may also increase your risk of developing asthma. If you are allergic to grass pollens and have allergic rhinitis, you could be susceptible to thunderstorm asthma – having an asthma attack caused by thunderstorms. If you have a pollen allergy, you should stay indoors during thunderstorms and use preventer medication.Thunderstorm asthma is caused by pollen grains absorbing moisture, bursting open and releasing tiny allergic particles, which can travel deep into the lungs.

Tests and diagnosis

The symptoms of allergic rhinitis can be similar to other conditions that might affect your nose, such as colds or nasal polyps. See your doctor to confirm whether your symptoms are due to allergic rhinitis or some other condition.

It may be obvious from your history which substance (‘allergen’) is causing your rhinitis, or your doctor may need to order allergy blood tests or skin-prick tests to find out what you are allergic to. This is an important step in treating allergic rhinitis, because once you know which allergen is triggering your symptoms, you may be able to avoid it.

Allergen avoidance

Avoiding what you’re allergic to is recommended, even if you are having treatment. Once you have identified the offending allergen(s), you can take steps to try to avoid them. Here are some tips to allergy proof your home.

It can be difficult to completely remove things like dust mites from your environment, and more research is needed into whether this really benefits allergy symptoms. For those willing to try to minimise house dust mites, the approach includes:

  • wash bedding weekly in water hotter than 55 degrees Celsius
  • use dust mite resistant covers for mattresses and pillows
  • remove soft toys from the bedroom
  • wash soft toys regularly in hot water
  • keep your house well ventilated, avoiding a build up of moist air inside the house
  • select furnishings and floor coverings that don’t encourage dust
  • use a vacuum cleaner with an appropriate air filter
  • use damp dusting techniques when house cleaning.

For those allergic to animals/pet dander, removing them from the house entirely and keeping them outdoors may be the best solution — but a compromise may be to ban four-legged friends from the bedroom.

Allergens carried in the air (airborne allergens), such as pollen, are almost impossible to steer entirely clear of. However, it can help to stay indoors as much as possible on high-pollen days (windy days and after thunderstorms are often especially bad), to avoid mowing the lawn, and to shower after you’ve been exposed to a lot of pollen.

Minimising mould in your home can help if you are allergic to mould. Some strategies include removing pot plants from indoors, clearing overflowing gutters, promoting ventilation throughout your home, removing visible mould with recommended mould cleaners, sealing any leaks and generally avoiding having damp areas in the home.

What type of doctors can help with allergic rhinitis?

If your allergies are affecting your everyday life, discuss your options with your General Practitioner, who will be able to recommend treatment options.

If necessary, they will be able to refer you to an allergy specialist or clinical immunologist, who may suggest you have skin prick testing or blood tests for allergy, and who will work out a treatment plan for you.

Treatment for allergic rhinitis

Medicines to treat and help prevent allergic rhinitis are available from your doctor or over-the-counter at your pharmacy. These can be very effective in reducing your symptoms. Always continue to avoid allergens whenever possible, even when taking medicines.

The best type of product for you will depend upon your symptoms, for example whether you have sneezing, itching, nasal discharge or blockage, or eye problems.

Some medicines are started before the pollen season, and taken every day to help prevent your symptoms occurring. Others can be used ‘as needed’ for quick relief when symptoms occur.

Your doctor or pharmacist will be able to advise the most suitable product for you and when and how to take it.

Medicines from the pharmacy

Here is an explanation of some of the more common products for allergic rhinitis found in the pharmacy.

Medicines for allergic rhinitis
Medicines Available as How they work Comments
Corticosteroids
  • Nasal spray
Corticosteroids reduce inflammation
  • Preventative action — need to take regularly
  • May take a few days before maximal effect is achieved
  • Can be used long term under medical supervision, but use the lowest dose that controls symptoms
  • Can make the nose feel dry
  • Tell your doctor about other forms of corticosteroids you or your child may be taking (e.g. asthma inhalers, tablets)
Antihistamines
  • Nasal spray
  • Eye drops
  • Tablets
Antihistamines block histamine, a chemical released during an allergic reaction
  • Can use as needed, regularly or before exposure to allergen
  • Onset of action varies from about one hour to several hours
  • Some cause drowsiness
  • May cause dry mouth, problems urinating and constipation
  • In children, can cause nightmares, irritability and restlessness
  • Side effects are less common with newer antihistamines
  • May interact with other medicines — check with your doctor or pharmacist
  • Some should be avoided by pregnant women — check with your pharmacist
Decongestants
  • Nasal spray
  • Eye drops
  • Tablets
Decongestants narrow blood vessels so fluid doesn’t leak through the nasal lining
  • Provide quick relief for a blocked nose
  • Can make congestion worse if used for more than a few days (known as rebound nasal congestion or rhinitis medicamentosa)
  • Decongestant tablets can cause problems if you have high blood pressure, heart disease, an enlarged prostate or overactive thyroid (this also applies for combination products containing decongestants and antihistamines)
  • Side effects include restlessness, anxiety, disturbed sleep and rapid heart rate

Other treatment options

Ipratropium bromide (e.g. Atrovent Nasal) is another type of medicine available as a nasal spray that your doctor may recommend for a severe runny nose. It is available from the pharmacy.

Sodium cromoglycate nasal spray (e.g. Rynacrom) can help prevent intermittent mild allergic rhinitis symptoms.

Intranasal saline If used regularly, saline (salt water) sprays (such as Fess nasal spray) can help relieve a blocked nose, thin the secretions and wash away irritants. These can be used in conjunction with any other treatments and are available from pharmacies. Steam inhalation can also ease a stuffy nose — especially if you add a few drops of eucalyptus oil to the water.

If your symptoms are not relieved by these medicines, you should see your doctor — other medicines may be suitable for you.

Prescription medicines for allergic rhinitis

As well as medicines from the pharmacy or pharmacist, there are also prescription medicines available for the treatment of allergic rhinitis.

Montelukast sodium (e.g. brand names Singulair, Lukair), a leukotriene receptor antagonist, is one prescription medicine that is available for treating the symptoms of allergic rhinitis. It may be beneficial for people with both allergic rhinitis and asthma, as it may be effective for both conditions. Montelukast, available as tablets, may not be suitable for pregnant or breast feeding women, or children under the age of 2 years.

Some nasal corticosteroids and combination medicines that contain both antihistamines and corticosteroids are also available on prescription.

Some medicines are started before the pollen season, and taken every day to help prevent your symptoms occurring. Others can be used ‘as needed’ for quick relief when symptoms occur. Your doctor can advise you on which option is best for you.

‘Allergy shots’ — immunotherapy

If the above strategies haven’t relieved your symptoms, there is another approach that you may be able to try. Allergen immunotherapy (sometimes called ‘allergy shots’ or desensitisation) involves injections of an allergen under your skin — the aim is to gradually desensitise your immune system to the allergen and subdue your body’s reaction to a particular allergen. Eventually you may be able to tolerate the allergen without few or no symptoms, avoiding the need for medication.

Before you have allergy immunotherapy, you must have had allergy skin prick or blood tests to identify your particular allergens. Immunotherapy works best if you have allergy to a single substance, such as pollen or dust mites.

Allergen immunotherapy is prescribed by an allergy specialist. The injections are personalised to your particular allergen(s) and are given once a week or once every 2 weeks. The injections must be supervised by a doctor specialising in allergy treatment — you will need to be referred by your GP.

The injections start with a low dose, which is increased over a few months to reach the maintenance dose. At this point the injections are needed less frequently, but still follow a regular schedule.
There is another method of immunotherapy, called sublingual immunotherapy (SLIT), which involves giving tablets or liquid under the tongue, rather than having injections. This has worked well in house dust mite allergy.

For some people, immunotherapy can significantly reduce allergic rhinitis symptoms. If it works, it should bring relief within 6 months to a year. The drawback is that treatment must usually be continued for at least 3–5 years.

Complementary therapies for allergic rhinitis

There is no evidence for some of the methods promoted as useful diagnostic tests or treatments for allergic rhinitis, including kinesiology, Vega testing, IgG testing, iridology, homeopathy, reflexology, and hair analysis. These tests are NOT recommended by expert bodies in allergy.

Similarly, so far there is not enough evidence that nutritional approaches, such as exclusion diets or taking quercetin or vitamin C, benefit allergic rhinitis symptoms. You should always tell your doctor about any supplements or herbal products you are taking, to avoid potentially harmful interactions with medicines.

If you have allergic rhinitis, one herb to be wary of is echinacea, as it can cause a worsening of seasonal allergies. Serious allergic reactions to echinacea are also possible — these are more likely if you have an inherited tendency to allergies, and especially if you are allergic to ragweed, chrysanthemums, marigolds or daisies.

Finally, some good news about getting older — many people with allergic rhinitis find that their symptoms improve by the time they reach middle age.

Last Reviewed: 10/08/2020

Your Doctor. Dr Michael Jones, Medical Editor.



References

1. ASCIA. Allergic rhinitis (hay fever). Updated April 2019. https://www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis/allergic-rhinitis-or-hay-fever
2. eTG. Allergic rhinitis and conjunctivitis. Published March 2015. Amended April 2019. © Therapeutic Guidelines Ltd (eTG March 2020 edition).
https://tgldcdp.tg.org.au/viewTopic?topicfile=rhinitis-rhinosinusitis#toc_d1e70
3. Australian Medicines Handbook. Symptomatic treatment of allergic rhinitis in adults. Last modified July 2020. https://amhonline.amh.net.au/chapters/ear-nose-throat-drugs/tables/allergic-rhinitis-table
4. ASCIA. Allergen immunotherapy. Updated March 2019. https://www.allergy.org.au/patients/allergy-treatment/immunotherapy
5. Smith WB, Kette FE. Allergen immunotherapy for respiratory allergic disease in Ausralia in 2016. Med J Aust 2017; 206(2):60-62. https://www.mja.com.au/system/files/issues/206_02/10.5694mja16.00953.pdf

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