"Allergic rhinitis" is the medical term for allergy affecting the mucous membrane of the nose. Seasonal allergic rhinitis is often called hay fever, while year-round nasal allergy is called perennial allergic rhinitis. People with allergic rhinitis often feel that their problem is sinus trouble, though as described below the sinuses become secondarily involved due to the nasal swelling. Most people develop allergic rhinitis before age 40, though it can come on at any age. An estimated 13 million Americans suffer from hay fever--primarily due to ragweed pollen allergy.

Symptoms: Allergic rhinitis can cause many symptoms, including stuffy nose, postnasal drip, sneezing, red/itchy and watery eyes, swollen eyelids, itching of the mouth/throat/ears and face, sore throat, dry cough, feelings of fullness and buzzing in the ears, partial loss of the senses of hearing, smell, and taste, and headaches. Seasonal allergic rhinitis can cause more general symptoms, such as fatigue.

Allergic rhinitis is often mistaken for a cold, but whenever the symptoms occur repeatedly throughout the year, allergy should be suspected. The discharge from the nose in allergic rhinitis is usually thin and clear, whereas with a cold, it is usually thicker and yellowish due to infection. Unfortunately, when the membrane of the nose becomes irritated by allergy, it is easier for germs and viruses to invade and multiply making it common for a person to have both allergic rhinitis and infection.

Persons with allergic rhinitis often have dark circles under their eyes. This is due to pooling of blood upstream from the congested nasal area. To relieve an itchy nose, children, especially, may develop the habit of pushing the nose up with the palm of the hand. After a few years, this can cause a crease to appear across the nose. Also, the mid-part of the nose may broaden from the pressure of swollen tissue underneath. The mouth may be open continually so the person can breathe better. Children may develop a variety of other mannerisms, which parents find annoying, but which are caused by allergies.

Symptoms classically occur in the spring (tree and grass pollen) or summer/fall (weed pollen), but here in Florida the pollinating seasons are much longer. Grass pollen, for instance is present nearly year round. Symptoms due to outdoor mold are worse in the fall, whereas house dust, indoor molds and animal dander produce year round problems.

The Allergic Reaction: Allergic rhinitis usually results from allergy to a variety of things including pollen, dust, mold, and food. The nose is especially reactive because it contains many cells filled with histamine, which become sensitized and release the histamine upon contact with an allergen.

The symptoms of allergic rhinitis result from the action of histamine and other chemicals released in the allergic reaction. These chemicals cause swelling and a resulting decrease in size of the nose opening, making breathing more difficult. They also stimulate the inner lining of the nose to secrete watery mucus, causing a runny nose or postnasal drip. These discharges irritate nerve endings, which causes sneezing and also possibly sore throat. When the mucus discharge travels from the throat up the tube going to the ear (eustachian tube), it causes a feeling of fullness and buzzing. When it goes up the sinuses, it causes a pressure headache.

Complications: If allergic rhinitis is not treated, symptoms of both allergy and infection can develop in the throat, ears, and sinuses because these are lined with the same kind of membrane as the nose. Tonsils and adenoids may become enlarged and diseased, and growths called polyps may develop in the nose. Fluid can also build up in the ear -- a condition called serous otitis media. This condition is particularly common in babies and young children. Sinus problems following allergic rhinitis are more common in older children and adults. Post-nasal drip can lead to cough in normal individuals and bronchospasm in patients with asthma.

Treatment: Allergies can affect anyone at any time in his or her life. While allergies are not preventable, they can be controlled either by limiting your exposure to allergens, using medication (see below) or taking allergy shots. The cornerstone of effective therapy is establishing the right diagnosis. Allergic rhinitis is suspected based of the patient's description of symptoms as outlined above and then confirmed by careful allergy skin testing. Skin testing is less expensive and more accurate than blood tests as a means of identifying the allergens to which you are sensitive.

Environmental control measures to reduce allergen exposure can be effective therapy, particularly if you're sensitive to indoor allergens. If further therapy is needed, the choice between medication and allergy shots is made with the consideration of personal preference, severity of disease (shots for the more severe) and, sometimes, trial and error with drugs offered initially. Allergic rhinitis if properly diagnosed with skin testing should respond nicely to management by your allergist.

Drug treatment involves a combination of nasal saline, antihistamines (for sneezing, itchy and watery symptoms), oral decongestants (over the counter nose spray decongestants can cause worsening congestion if used regularly), intranasal cromolyn and intranasal corticosteroids (do not have side effects found with oral steroids). Nasal saline soothes irritated nasal mucosal tissue, liquefies thick mucus, augments natural flow of nasal secretions, reduces nose bleeding and improves the sense of smell. Saline can be administered as follows: