Hay Fever (Allergic Rhinitis)

Hay fever (also known as allergic rhinitis) is a condition that affects about 20-30% of adults and about 40% of children in the U.S. It is even more prevalent in the rest of the world. In children, it is the 3rd most common chronic condition. In adults, it is the 5th most common chronic condition. The estimated annual cost to the U.S. healthcare system is $10 billion. The prevalence of allergic rhinitis is increasing over time and is a major cause of missed days from work and school.

Types of Allergic Rhinitis

1. Seasonal: Symptoms only occur with certain seasons, such as Spring, Summer, Fall, and/or Winter. These are commonly associated with allergies to trees, grasses, and/or weeds.
2. Perennial: Symptoms can occur throughout the year. These are commonly associated with allergies to dust mites, molds, pets, and/or cockroaches.

What are the Symptoms?

The symptoms of hay fever (allergic rhinitis) classically may include runny nose, nasal congestion (stuffy nose), post-nasal drip, (mucus running down the back of one’s throat), itchy nose, decreased sense of smell, a horizontal line that runs across the lower third of one’s nose (allergic crease), sneezing, itchy eyes, red eyes, watery eyes, puffy eyes, dark circles under the eyes (allergic shiners), horizontal wrinkles or folds that occur directly below the lower eyelids (Dennie-Morgan lines), itchy throat, sore throat, itchy ears, clogged feeling of ears, earaches, sinus congestion, sinus pain, headaches, inability to concentrate, and/or fatigue. Occasionally, one may experience itchy skin and/or hives if that person comes in physical contact with an allergen such as grass, pets and animals, etc.

What is the Science behind Allergic Rhinitis?

When a sensitized individual comes in contact with a specific allergen (antigen), they have a specific IgE antibody (the “allergy” antibody) that binds to that specific allergen. When this interaction takes place, certain cells in the body release a variety of chemicals. The most commonly known chemical released is called histamine. These chemicals get into the bloodstream and cause the individual to develop the hay fever (allergic rhinitis) symptoms noted above.

What are the Common Triggers?

The most common triggers of hay fever (allergic rhinitis) are dust mites, molds, tree pollens, grass pollens, weed pollens, pets, and cockroaches. It is important to note that individuals may be allergic to one or more of the above allergens. Keep in mind that there are a variety of tree pollens (e.g., Birch, Maple, Oak), grass pollens (e.g., Timothy, Bermuda, Johnson), weed pollens (e.g., Ragweed, Lamb’s quarters, English plantain), molds (e.g., Aspergillus, Helminthosporium, Penicillium), and dust mites [e.g., American house dust mite (Dermatophagoides farina) and European house dust mite (Dermatophagoides pteronyssinus)]. Note that both types of dust mites are found in the U.S.

In the Washington, DC, Northern Virginia, and Maryland metropolitan area, the trees begin to pollinate in late February, peak in mid- to late-April, and end in late-May or early-June. The grasses begin to pollinate in late-April to early-May, peak in late-May or early-June, and end in August. Ragweed, the predominant weed to affect most sensitive individuals, generally begins to pollinate in mid-August, peak in late September, and end in late-October coinciding with the 1st frost. Pollen counts are highest on dry, warm, and windy days. The pollen counts tend to be the highest in the early mornings.

Molds in the Washington, DC area (DMV area) are always a problem. Washington, DC was built on a swamp and there are always molds in the outdoor environment no matter the time of the year. Molds tend to thrive in humid climates like the DC area. Our Summers are very humid which promotes mold growth. In the Fall, the leaves fall and decompose creating a great environment for mold growth as well. Throughout the entire year, however, the rain and snow provide the precipitation needed to cause mold to exist making it a perennial allergen in this area. It is interesting to note that molds have adapted and can even occur in very arid and/or hot climates throughout the world, such as deserts. In addition to being an outdoor allergen, molds are also indoor allergens as they tend to be found primarily in basements, bathrooms, and kitchens where the concentration of water is the highest.

Dust mites also tend to like increased humidity and low altitudes, so the Washington, DC area is also beneficial to their survival. Dust mites live indoors and are primarily found in bedding (e.g., pillows, mattresses, box springs, blankets), upholstered furniture, carpeting, plush toys, etc.

Cockroaches are everywhere but tend to be very common in urban inner city settings. Like molds, cockroaches flourish in moist warm climates, like Washington DC homes, condos, and apartments. They gather more in basements, bathrooms, closets, kitchens, and cracks in the walls. Over 75% of the dwellings in an urban location, like Washington, DC, are infested with cockroaches. Cockroaches are nocturnal and therefore are not usually seen during the daytime. For every cockroach seen in a house, condo, or apartment, there are 800 more that are not seen that also live there.

Pets are a source of allergic rhinitis that again are perennial in nature. Individuals tend to love their pets and as a result, usually do not get rid of them, which is completely understandable. In addition to being allergic to the pets themselves, pets commonly bring the outdoor pollens indoors after being outside, which can further aggravate one’s allergic rhinitis symptoms.

What are the Complications?

Besides the uncomfortable feeling that one experiences when one has symptoms of hay fever (allergic rhinitis), there are many complications that can arise if hay fever symptoms are not controlled. The following are some of the complications commonly seen:

1. Sinus infections (sinusitis): Acute, chronic, and/or recurrent sinus infections.
2. Asthma
3. Ear infections (otitis media)
4. Eustachian tube dysfunction: The feeling of clogged and/or pressure in the ears.
5. Nasal polyps: Abnormal growth of tissue arising from inflammation of the lining of the nose and sinuses.
6. High Arched Palate in Children: Developmental defect due to a child breathing through his or her
7. mouth and not the nose. This abnormality often leads to crooked teeth and subsequent malocclusion resulting in the need for expensive braces.
8. Sleep disturbance
9. Psychological Issues: Inability to concentrate, irritability, fatigue, etc.

What Other Conditions Have Similar Symptoms?

There are too many other medical problems that can cause the same symptoms as hay fever (allergic rhinitis), but a word about “non-allergic rhinitis.” Non-allergic rhinitis (also known as vasomotor rhinitis)is a condition that can have the identical symptoms as hay fever (allergic rhinitis). The major distinction is that in individuals with non-allergic rhinitis, the trigger is an irritant as opposed to an allergen. It does not involve the immune system. This means that this individual does not have an allergy to the offending agent, but rather is just bothered or irritated by it. Environmental irritants may include cigarette smoke, strong scents (e.g., perfumes, colognes), temperature changes, smog, pollution, chemicals (e.g., cleaning solutions, chlorine), newspaper print, etc. Even though non-allergic rhinitis is technically not an allergy, patients are still diagnosed and treated by board certified allergists.

What can be done to Prevent Symptoms of Allergic Rhinitis?

1. Turn air conditioning on
2. Keep sunroofs and windows closed
3. Change air filters monthly
4. Shower, wash hair, and change clothing after coming back inside
5. Avoid mowing lawns or wear a filtered mask
6. Avoid yard work or wear a filtered mask
7. Wash pets after they go outdoors
8. Re-circulate air in car so it doesn’t come in from the outside
9. Drive a car that has an air filter, if possible

Diagnosis and Treatment of Allergic Rhinitis

The diagnosis and treatment of hay fever (allergic rhinitis) are performed by board certified allergists. It is very important for the allergist to take a detailed history and perform a thorough physical examination on the patient. Diagnosis is usually made by skin testing and/or blood testing. The treatment begins with avoidance of the allergen, if possible. Decreasing the exposure to the allergen is beneficial to most everyone. Medications are commonly used and can include tablets, syrups, capsules, oral powders, and nasal sprays. Allergy shots (allergy injections or allergy immunotherapy) are very effective in treating patients with allergic rhinitis and they have been available for over 100 years. They are effective in 80-85% of patients and can be given to young children, pregnant women, and adults. Black & Kletz Allergy has been serving the greater Washington, DC, Northern Virginia, and Maryland metropolitan area for over half a century. We have 3 convenient locations in the area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have on-site parking at each location and the Washington, DC and McLean offices are Metro accessible. We pride ourselves in providing quality care in a relaxed and friendly atmosphere as we have done for generations. Please call us at your earliest convenience to schedule your appointment or you can alternatively click Request an Appointment and we will contact you within 24 hours of the next business day.

Other Reading Material

For more information on hay fever (allergic rhinitis) you may also read: What Is Hay Fever?, Tree Pollen Allergies, Grass Pollen Allergies, Ragweed Allergies, and/or Hay Fever in the Washington, DC area.