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Allergic Rhinitis, Hay Fever, Environmental allergies

When people suffer from any combination of symptoms like:

  • Runny nose

  • Sneezing

  • Stuffy nose or congestion

  • Itchy nose and throat

  • Post nasal drip or throat clearing

  • Itchy eyes, tearing, eye redness, dark circles under the eyes

  • Fatigue

These symptoms can be a sign of allergies.

Allergies vs. Colds

These symptoms are common for allergies or a cold.

Usually cold symptoms last only 7-14 days, whereas allergies last form weeks to

months and even years. Allergies can be seasonal, so if you get a cold that lingers for

weeks every spring it may be allergies.

Who suffers from environmental allergies?

- In US about 20 % of adults and up to 40% children have reported suffering

from allergic rhinitis

- Up to 50% of adults with allergies report that their allergies cause problems

with disturbed sleep, fatigue, and irritability and interfere with their daily


- 75-80% of patients with asthma have allergic rhinitis and these allergens will

worsen their asthma.

Predisposition to allergies is inherited with other ATOPIC DISEASES, like

food allergies, eczema – Atopic dermatitis and asthma. Infants and young

children who develop eczema or food allergies in infancy, are at higher risk of

developing allergic rhinitis and asthma during school years.

Why see an allergist?

An allergist is a physician who received extra 2-4 years of medical training in the field of

Allergy and Immunology. Once in the allergists’ office in addition to history and physical exam you will have allergy testing which can help identify the cause of your allergy


Allergy skin tests are still the most commonly used tests to diagnose allergies

to the environment. During the test a drop of allergen is placed on the skin

and the skin is scratched gently. After 20 minutes if the patient is allergic,

there is redness, itching and a small “mosquito bite” like reaction at the site of

the test. Skin tests are easy, quick, safe and inexpensive and within 20

minutes will give an answer if you have environmental allergies, like allergies

to pollen, dust mite, and pets.

What can you do about your allergies?

1) Avoidance

Avoidance depends on the specific allergens. Please see my video and blog on Indoor

and Outdoor allergens for more information.

2) Medications

Luckily there are many medications available even without prescription that are good at

controlling allergies. Here are some examples:


The most common medications are antihistamintes, which come in 2 groups.

Older sedating antihistamines, like Benadryl and Fenistyl, work well, but cause a lot of

sedation and should not be used daily. 2 nd generation antihistamines which are safe and

can be used daily for months and even years. Many are available with over the counter,

and include – Loratadine, Desloratadine and Cetirizine.

Nasal sprays:

Also readily available. The most common are

- Decongestant nose sprays. These medications act very quickly and very

effective at relieving congestion, however they can only be used for 3-5 days.

Longer use can cause dependency and septal perforation.

- Steroid nose sprays, such as fluticasone (Flonse\Avamys), and mometasone

(Nasonex) –can be used long term. They usually take time to start working.

Key about medications is that they only work when people take them. Medications are a

treatment and not a cure. If you have allergy symptoms every daily, but take your

medication only on “bad” days or once a week, you will have symptoms 6/7 days and

feel a little better on the day you take your medicine.

3 - Immunotherapy

Other possible treatment for allergic rhinitis is Immunotherapy.

Immunotherapy is available in injections (allergy shots) or sublingual tablets. This mode

of treatment changes your immune system, so that it no longer recognizes an allergen

as something foreign to wage war against.

Immunotherapy takes time to start working and needs to be continued for several years

for the treatment benefit to remain long lasting. However, at this point, it is the best

treatment we have that provides a “cure” for allergies, where people can be symptom

free for years.

“Why treat allergies, I can just suffer”

It is important to treat allergies because when left untreated they can cause asthma,

lead to asthma flares, sinus infections and chronic sinus disease.

Dr. Irena Offengenden


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