Allergic Rhinitis: Why Your Nose Runs All Year and What Fixes It
Allergy & Immunity

Allergic Rhinitis: Why Your Nose Runs All Year and What Fixes It

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Persistent sneezing, a blocked or running nose and itchy eyes are usually treated as a long cold or dismissed as weather sensitivity. In most cases it is allergic rhinitis, which is both diagnosable and treatable, and which worsens asthma and sleep when ignored.

What is happening

An inhaled allergen binds to IgE antibodies on mast cells in the nasal lining, which release histamine and other mediators. The early phase produces sneezing, itching and watery discharge within minutes. A late phase, four to eight hours later, brings inflammatory cells and causes the persistent blockage that antihistamines alone do not fix.

Repeated exposure causes priming, in which progressively smaller amounts of allergen trigger symptoms. This is why people feel worse as a season goes on.

Symptoms

  • Sneezing, often in runs
  • Clear watery nasal discharge
  • Nasal blockage, frequently alternating sides
  • Itching of the nose, palate, throat and ears
  • Itchy, red, watery eyes, which is allergic conjunctivitis
  • Post-nasal drip and throat clearing
  • Reduced or lost sense of smell
  • Mouth breathing, snoring and poor sleep
  • Daytime tiredness and poor concentration, which in children affects school performance
  • Dark circles under the eyes, and a horizontal crease across the nose from rubbing upward

Fever, body ache, yellow-green discharge and a sore throat point to infection instead. Allergy does not cause fever.

Common allergens in India

Perennial, year-round:

  • House dust mite, the most common, thriving in bedding, mattresses, pillows, upholstery and soft toys in humid conditions
  • Cockroach allergen
  • Pet dander from cats and dogs
  • Indoor moulds in damp areas

Seasonal:

  • Grass pollens, often March to May and again after the monsoon
  • Tree pollens in spring
  • Weed pollens including Parthenium, which is widespread, and Artemisia
  • Outdoor mould spores after rain

Irritants that worsen it without being allergens: smoke, incense, mosquito coils, strong perfume, cooking fumes, air pollution and sudden temperature change.

Diagnosis

Usually clinical. Testing is helpful when the trigger is unclear or immunotherapy is being considered: skin prick testing, or specific IgE blood tests. Total IgE alone is of limited value. Nasal endoscopy is used where polyps or structural problems are suspected.

Treatment, in order of effectiveness

1. Intranasal corticosteroid spray. The single most effective treatment for moderate or persistent symptoms, acting on blockage as well as sneezing and itching. It is not a decongestant and takes several days to a couple of weeks for full effect, so it must be used daily, not when symptoms flare. This is the most common reason people say it does not work.

Technique matters: blow the nose first, tilt the head slightly forward, use the opposite hand to spray so the nozzle points outward toward the ear rather than at the septum, and do not sniff hard afterwards. Spraying at the septum causes crusting and nosebleeds and is the usual reason people stop.

2. Oral antihistamines. Non-sedating agents such as cetirizine, levocetirizine, loratadine, fexofenadine and bilastine. Good for sneezing, itching and discharge, weaker on blockage. Older sedating antihistamines impair driving, work and school performance and should generally be avoided.

3. Intranasal antihistamine sprays, which act within minutes and combine well with a steroid spray.

4. Saline nasal irrigation. Cheap, safe and genuinely useful, washing out allergen and mucus. Use sterile, distilled, or previously boiled and cooled water, never untreated tap water.

5. Leukotriene receptor antagonists such as montelukast, mainly where asthma coexists, with awareness of reported neuropsychiatric side effects.

6. Decongestant sprays such as oxymetazoline for a maximum of three to five days. Longer use causes rebound congestion, rhinitis medicamentosa, which is a frequent and avoidable problem.

7. Allergen immunotherapy, given as injections or sublingual tablets over three to five years. It is the only treatment that modifies the underlying disease rather than suppressing symptoms, and it can prevent progression to asthma in children.

Allergen avoidance that actually helps

Dust mite measures only work when done together, not individually:

  • Mattress and pillow encasings with allergen-impermeable covers
  • Wash bedding weekly in hot water above 55 degrees, or sun-dry thoroughly
  • Remove carpets, heavy curtains and excess soft toys from the bedroom
  • Keep indoor humidity below about 50 percent where possible
  • Damp-mop rather than dry-sweep
  • Use a vacuum with a HEPA filter, with the allergic person out of the room

For pollen: keep windows closed at peak times, shower and change clothes after being outdoors, dry clothes indoors during the season, and wear wraparound sunglasses.

For pets: keep them out of the bedroom at minimum.

Associated conditions

Allergic rhinitis frequently coexists with asthma, and treating the nose improves asthma control. It also contributes to sinusitis, nasal polyps, middle ear fluid in children, and eczema. Uncontrolled rhinitis in children affects sleep, growth and schooling and sometimes dental and facial development through chronic mouth breathing.

When to see a specialist

Symptoms not controlled on a steroid spray plus antihistamine, one-sided blockage, bleeding, loss of smell, facial pain, suspected polyps, or when immunotherapy is being considered.

This is general information. Spray choice, montelukast and immunotherapy should be discussed with a doctor, particularly for children.