Amy Bain MSN, ARNP, CPNP
Pediatric Asthma & Allergy
175 1st Pl NW
Issaquah, WA 98027
Telephone: (425) 651 - 4044
Fax: (425) 651 – 4033
Email: amy@breathepediatrics.com
Appointments: www.breathepediatrics.com
Allergic Rhinitis
What is Rhinitis?
Rhinitis is a term used to describe 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 and they are
often associated with itching of the eyes.
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. When mucus production is excessive it can
flow from the front as a runny nose or become
noticeable in the back of the throat as a “post-nasal
drip”. When post-nasal drip is excessive or thick,
cough is the natural response for clearing the throat.
The nasal tissues congest and decongest
periodically. Nasal congestion occurs when the
tissues lining the nose are swollen, which is due to
inflamed blood vessels. Severe congestion can
result in facial pressure and pain as well as dark
circles under the eyes.
puffiness around the eyes. Allergic rhinitis is
common and affects almost 30% of adults and 40%
of children.
During the physical examination patients are often
found to have the following signs of allergies:
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Nasal crease: A horizontal crease across the
lower half of the bridge of the nose; caused
by repeated upward rubbing of the tip of the
nose by the palm of the hand. Also called
an “Allergic Salute”
Nose: Swollen and pale nasal tissue or
turbinates; Thin, watery nasal secretions.
Ears: Middle ear fluid
Eyes: Swollen and red eyelids, red and
inflamed whites (conjunctiva) of the eyes
with excess tear production; Dennie-Morgan
lines (extra skin folds or creases from the
inner-bottom eyelid); and dark circles
around the eyes (also known as “allergic
shiners”)
Mouth/Throat: "Cobblestoning," which is
streaks of lymphoid tissue on the back of the
throat that has a cobblestone appearance;
enlarged tonsils
What is Allergic Rhinitis?
The most common kind of rhinitis is allergic
rhinitis, which is usually triggered by airborne
allergens. An allergen is a material that can cause
an allergic reaction such as pollen and dander. In
addition to the symptoms noted above, allergic
rhinitis may cause additional symptoms such as
headache, fatigue, malaise, and cognitive
impairment. The allergens may also affect the eyes,
causing watery, reddened, or itchy eyes and
What Causes the Sneezing, Itchy Eyes and Other
Symptoms?
Allergic rhinitis occurs when an allergen is inhaled
by an individual with a sensitized immune system
and the body’s immune system reacts abnormally
with the allergen and triggers allergen-specific
immunoglobin E (IgE) antibody production. These
allergic antibodies bind to mast cells, which are
located within the nose tissues and contain
histamine. When the allergen is inhaled into the
nose the mast cells are stimulated and histamine
(and other chemicals) are released, which causes
runny nose, watery eyes, itching, swelling, and
mucus production. Symptoms outside of the nose,
including fatigue, sleepiness, and malaise, can occur
from the inflammatory response. These symptoms
often contribute to impaired quality of life.
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Nasal antihistamine sprays – Locally
inhibits histamine release in the nose helping
to control allergic symptoms
Non-prescription saline nasal sprays – Help
to counteract symptoms of dry nasal
passages or thick nasal mucus and may be
used as often as needed.
2) Controlling Dust Mites in the Home
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 IgE blood test. A positive skin test mirrors
the type of reaction going on in the nose.
Can Allergic Rhinitis Lead to Additional Health
Problems?
If allergies are not treated complications can occur
such as: Ear infections, sinusitis, recurrent sore
throats, cough, headache, altered sleep patterns,
fatigue, irritability, poor school performance and
worsening asthma.
Dust mites can be a major health concern to people
with indoor allergies. There is no way to completely
eliminate dust mites, but controlling them can
reduce a person’s risk of suffering from the health
problems associated with them. While you sleep,
dust mites are lurking in your mattresses and bed
sheets.
There are several things that can be done to reduce
the dust mite population in your bedding and home
and include the following:
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What is the Treatment for Allergic Rhinitis?
1) Medications
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Antihistamines – The most inexpensive and
commonly used treatment for rhinitis.
These medications counter the effects of
histamine. They do not cure allergic
rhinitis, but help relieve the symptoms
associated with it. The most effective way
to use them is before symptoms develop.
Sometimes people complain that “the
medication didn’t work,” but that is most
likely due to inconsistent use. If the
medication had been taken regularly for 3-4
days and built up in the blood levels, it
would have been effective. Therefore
people with chronic allergies usually benefit
from taking a daily antihistamine. The most
common side effect is drowsiness, but many
of the newer antihistamines do not have
drowsiness side effects.
Nasal corticosteroid sprays – Reduces the
swelling occurring from the allergic
trigger(s)
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Wash your bedding weekly (blankets,
covers, sheets) – It is the simplest solution to
controlling dust mites. Use the washing
machine with the “Hot” water setting (130
degrees).
Pillows – It is recommended that you
replace feather and down pillows with those
that have synthetic materials as a filling, and
encase the pillows with zippered dust-proof
covers under the regular pillow cases.
Blankets – It is recommended that you
replace wool blankets with cotton or nylon.
There are mite proof duvet covers that can
encase “big blankets/comforters”. Avoid
down comforters.
Mattresses – Using dust-proof or dust mite
allergy mattress covers help prevent a dust
mite infestation. Research also shows that
covering your mattress with fitted sheets
helps slow the accumulation of skin scales.
Flooring and Carpeting – Carpeting is one of
the most common breeding grounds for dust
mites. There are potentially tens of
thousands of dust mites that can live in a
square yard of carpet! It is recommend that
carpeted areas are vacuumed regularly with
a vacuum equipped with a HEPA (high
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energy particulate air) filter. A HEPA filter
removes 99.7 percent of the airborne
particles that are 0.3 micrometers or larger.
A more drastic approach to combating dust
mites is to replace carpeting with vinyl or
wood flooring.
Air – Dust mites thrive in high humidity
conditions, but this can be reduced to under
50% humidity by using de-humidifiers and
air conditioners. If using a humidifier in the
winter, avoid over-humidification. Mites
grow best at 75-80% relative humidity and
cannot live at under 50% humidity. Use a
humidity gauge to monitor levels. To
remove dust mite allergen from the air,
researchers suggest an air filtration system,
especially ones that use a HEPA filter.
De-clutter Bedroom – Remove all (or
majority) of the stuffed toys from the
bedroom and sleeping areas. If unable to
remove all stuffed toys, buy toys that are
machine washable and wash in HOT water
every 1-2 weeks. Remove upholstered
furniture and replace with wooden, plastic,
vinyl, leather, or cloth furniture constructed
with an additional allergen barrier. Avoid
heavy curtains and venetian blinds; use
window shades instead. If curtains are used,
launder them regularly. Avoid wall
pennants and other dust collectors.
3) Avoidance
 Pollen: Since pollen is seasonal it does not
cause symptoms year round. During
different times of the year various pollens
“peak” (pollinate) and depending on the
climate they can cause problems for 4-6
months of the year for many people (see
pollination table). While it is difficult to
escape pollens, here are some ways to lessen
the exposure:
 Keep windows closed and use air
conditioning in the summer if
possible. A HEPA filter may help
clean pollen from indoor air.
 Don’t hang clothes out to dry as
pollen may cling to towels and
sheets.
 The outdoor air is most heavily
saturated with pollen and mold
between 5 – 10am, so early morning
is a good time to limit outdoor
activities.
Pollen Calendar Pacific NW
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Try to stay indoors when the pollen
count is high, and on windy days
when dust and pollen are blown
about.
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 Mold: Mold can be both an indoor and outdoor
concern. In the Pacific NW outdoor mold allergies
are not as common as in other parts of the U.S.
because when it is damp outside it is also generally
cold. However, any house can develop a mold
problem given the right conditions. Mold requires
2 factors to grow: moisture and something to grow
on. Moisture can occur from humidity above 50%,
leakage from pipes or foundation, and air
conditioning.
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Decrease moisture in the home. This is also
helpful for mites, since they cannot live if
humidity is less than 50%. Do not use (or
over use) vaporizers or humidifiers.
Use bleach (1 part bleach to 9 parts water),
or Tilex for visible mildew on bathroom
grouting or window frames.
Avoid compost piles, hay, and piles of raked
leaves.
 Dogs: Dogs also are a common indoor allergen.
For patients with prick positive reactions, it is best
to keep the animal out of the house. Even with
removing the dog from the home, it will take
between 6-18 months to completely remove dog
dander, unless carpets and upholstered furniture
are replaced at the same time. There is no truly
allergenic free dog, but some breeds tend to cause
fewer problems for allergy sufferers. These
include: Poodle and Labradoodles, Schnauzer,
Portuguese Water Dog, Soft-Coated Wheaten
Terrier, Maltese, Lhasa Apso, Yorkshire Terrier,
Shih Tzu, Irish Water Spaniel, and Kerry Blue
Terrier.
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Keep the dog 100% out of the bedroom.
Limit the dog to rooms with hard surfaces
for easier cleaning. Hard surface floors are
best, since carpets become a huge reservoir
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for animal dander. Leather furniture
accumulates far less allergic protein than
upholstered furniture.
Washing the dog weekly may reduce the
allergic protein that would otherwise be
deposited throughout the home.
Wash your hands thoroughly after direct
contact with the dog so that you don’t spread
the dog dander from your fingernails to
yourself afterwards.
Consider purchasing a room HEPA filter
that can diminish dog dander from the air.
 Cats: Cat allergen comes from a protein present
in the dander, saliva, sebaceous glands (oil), urine
and feces of cats. It is microscopic in size and can
easily be inhaled into the nose or lungs to cause
allergic symptoms. Male cats shed more allergen
than female cats. At least 2% of the population is
allergic to cats, and 1/3 of these people have a cat
in the house. There are a few breeds thought to be
less allergenic. These include Rex breeds, Sphynx
Cats and Siberian Cats. The following steps can
be taken to reduce the level of cat allergen in the
home:
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Remove the cat entirely from the home.
If this is not possible, keep the cat outdoors
all or some of the time.
Limit an indoor cat to a single area of the
house, preferably an uncarpeted room. This,
in addition to vacuuming, air filtration and
cat washing can reduce the cat dander by
90%. Keep the cat out of the bedroom of
the allergic patient.
Keep the house well ventilated. An energy
efficient house actually traps animal dander
inside. A HEPA filter can reduce the level
of airborne cat allergen by about 50%.
Shampoo the cat in warm water for 10 to 15
minutes once a week to remove much of the
surface allergen. Express as much water as
possible before towel drying the cat. You
can dry the cat further with a blow dryer set
to its lowest setting. Cats bathed from a
young age usually do not mind being
washed. A significant decrease in allergen
does not occur for 3 to 8 months.
Remove rugs, carpeting, stuffed animals,
and fabric-upholstered furniture as cat
dander adheres to soft furnishings. Vertical
surfaces, such as walls, also collect cat
dander. House cleaning should include
washing the walls at several month intervals.