Health Talk: Allergic rhinitis causes major headaches for sufferers | Maryland Gazette (HometownGlenBurnie.com)

Some may have the salute and the transverse crease that it usually causes, and some may not, despite having all the other features that go along with the allergic salute. Either way, 20 percent of adults in the general population are suffering from allergic rhinitis.

The symptoms of allergic rhinitis develop when inhaled allergens cause bridging of antibodies present on mast cells - cells in the inner nasal lining. These cells then release granules containing histamine which is responsible for causing the symptoms.

In addition to the allergic salute, nuisance nasal symptoms of sneezing, clear nasal discharge and congestion are predominant. Eye symptoms also occur frequently, with irritation, redness and excessive tearing. The quality of life of patients is affected by symptoms such as loss of sleep, fatigue and headache. Significant postnasal drip can cause nausea and dry cough. Continuous exposure to allergens leads to persistent inflammation with swelling of the nasal passages, which can block the sinus openings, predisposing to bacterial infection (sinusitis). Ear infection is another important complication.

Allergic rhinitis is broadly classified as seasonal and perennial. Seasonal allergic rhinitis typically occurs at specific times of the year. A good history by your doctor usually helps to identify the inciting agent. Pollen from trees, such as maple, oak and birch, is the predominant allergen found in the early spring. In the late spring and summer, grass pollen is predominant. Late summer and fall produce ragweed pollen. Occasionally, the primary allergen is from airborne fungus spores.

Perennial allergens are mostly indoors and include animal dander (shed skin), fungi and house dust - which are a mongrel of cockroach fragments, excreta, house dust mites, etc.

Apart from the embarrassing symptoms of allergic rhinitis, it does costs us financially as well. Think of the lost work days, the cost of drugs and the doctors' visits. The good news, however, is that this nuisance disease can actually be successfully managed. Avoidance is key. The pollen count is usually at its lowest in the morning just before sunrise, highest at midday and begins to decrease at sunset. Readers can check on the pollen count daily in the local newspaper, on TV and online.

General avoidance measures include: Staying indoors as much as possible at the peak of the pollen count, showering and changing clothes after staying outside; keeping windows closed; using air conditioning to reduce humidity indoors; changing AC filters; using air purifiers; and using saline nasal spray to help decrease pollen deposit load on nasal lining. Other measures include covering pillows and mattresses with plastic covers and removal of dust-collecting fixtures, such as drapes, carpets and bedspreads.

Complete elimination of symptoms is not always possible, so the goal of treatment is to reduce symptoms to the level that allows a patient to function normally. There are several effective medications on the market, some over the counter. These include Antihistamines (the mainstay of treatment), oral and intranasal decongestants, and intranasal steroids. Because of the incidence of significant adverse effects, drug interactions and intolerance to some of these medications, it is very important to work closely with your doctor to develop a comprehensive plan of management.

In difficult-to-treat cases, identification of allergens by allergy skin testing is done. It is prudent for your primary care doctor to refer you to an allergist at that point. In selected cases, allergy shots have helped some patients to give up the salute, and to reach for the tissue less often.

Dr. Dodoo specializes in internal medicine and is on staff at Baltimore Washington Medical Center. To reach Dr. Dodoo, please call 410-590-3424.