Seasonal Allergic Rhinitis

The thought of spring lightens the hearts of many, but to some it heralds the onset of misery. Seasonal allergic rhinitis, sometimes known as 'hay fever', is a common condition, particularly in developed countries. It affects 10 to 20% of the population, and is characterized by sneezing, nasal congestion, rhinorrhea, and itching of the eyes and nose. Other symptoms may include eye soreness, tearing, periorbital swelling or darkness under the eyes. It affects both sexes equally, particularly those in their adolescence or early-adulthood. Seasonal allergic rhinitis is the result of an IgE medicated hypersensitivity reaction, leading to the release of mediators (e.g., histamine, chemokines, cytokines) that enhance the inflammatory process. The allergens that prompt this process are seasonal in nature, and include pollen from trees, grasses, and weeds, along with mold and mildew spores.

Pollen-sensitive patients are typically affected during May to June, while July to September are the troublesome months for those with spore-sensitivity. The symptoms can range from being mild and merely aggravating, to very severe and affecting quality of life. Allergen avoidance is encouraged to limit the impact of this condition (e.g., closing outside windows, avoid cutting grass, limit camping and picnicking activity). However, total avoidance of triggers is almost impossible, necessitating pharmaceutical intervention.

Options for the treatment of seasonal allergic rhinitis include antihistamines, decongestants, mast cell stabilizers (e.g., sodium cromoglycate), and nasal or oral corticosteroids. The selection depends on the symptoms being treated, whether topical or oral therapy is desired, along with the severity and duration of the disease. Typically for mild disease, antihistamines with possible short courses of nasal decongestants, as required, are utilized. These products are available over the counter, and a pharmacist can assist in selecting an appropriate agent. Those patients with more moderate to severe disease may require corticosteroids, as prescribed by their medical provider. Some patients are instructed to commence prophylactic treatment (e.g., sodium cromoglycate, nasal corticosteroids) slightly prior to allergen season (i.e., 2-3 weeks), to minimize the individual's response to pollen exposure.

In those who have more severe diseases where pharmacotherapy is not sufficient, immunotherapy may be attempted. This involves the administration of standardized extracts of allergens, with the goal of reducing their ability to induce a sensitivity reaction. Due to the nature of the procedure, it should only be conducted by a specialist in a controlled setting.

For more detailed information on rhinitis, the Joint Council of Allergy & Immunology has posted practice parameters on the treatment of this condition. Their Web site may be accessed at www.jcaai.org