Information about allergy

Reactions to stings can cause large local swelling, which settles over a few days. However, if stings cause symptoms away from the site of the sting or make a person feel unwell, a specialist referral should be considered. Read: Insect sting allergy - the facts

Where appropriate, we offer immunotherapy (desensitisation) which is an effective treatment for bee and wasp allergy.  It is a three-year course of injections. Read: UHNM venom patient information leaflet

Hayfever is a common allergic reaction which occurs at particular times of the year. It is also known as seasonal allergic rhinitis occurring as a reaction to pollen from grass, trees and weeds during the early spring and summer months. It can affect both adults and children.

Perennial allergic rhinitis, where symptoms persist all through the year, is usually caused due to allergy to house dust mite.

For patients who suffer with severe symptoms despite the best standard of therapy, we may recommend immunotherapy (desensitisation). This is a three-year treatment programme consisting of either a daily tablet under the tongue or a course of injections. Patient Information on Immunotherapy can be found here.

Patient Information

What is allergic rhinitis?

Rhinitis is inflammation of the nose. Symptoms include sneezing, runny nose, blocked / stuffy nose, itching and 'post-nasal drip' (the sensation of mucus running down the back of the throat). It can occur in association with inflammation of the eyes or sinuses. Rhinitis can have several causes, such as infection, a reaction to medication, irritation by dusts, or allergy. When allergy causes rhinitis, the condition is called ‘allergic rhinitis’.

Allergic rhinitis can be seasonal or all year round:

How can I avoid pollen?

• Monitor pollen forecasts daily.
• Rain washes pollen from the air so pollen counts should be lower on cooler, wet days. 
• Use saline nasal rinses to remove pollen and allergens from the nose. 
• Apply a barrier/balm e.g. Vaseline®, to the entrance of the nostrils to trap/block allergens.
• On days when the pollen count is high, when getting home remove your clothing and shower. 
• Keep windows closed when indoors. Pay particular attention in early mornings when the pollen is released into the air and in the evening when the air cools and pollen begins to fall to the ground. 
• Wear wraparound sunglasses and a wide brimmed hat. 
• Avoid drying washing on an outdoor clothes line when the pollen count is high.
• Wipe a pets’ coat with a damp cloth to remove any pollen particles. 
• Try and avoid triggers or take an antihistamine before known exposure.

How can I avoid house dust mite (HDM)?

You cannot avoid house dust mite! DM are found mainly in the bed, soft furnishings and carpets.

Only limited benefit can be obtained form HDM avoidance, so try a few basic things:

• Wash bedding often and at more than 600c if possible. 
• Cover mattress and pillows in dust mite-proof covers. 
• HDM like moist warm conditions, so let the bed air during the day and leave the window open to ventilate the room.

What if I am allergic to my pet?

Most pet owners tolerate their own pets and have problems when exposed to other pets. If you have a new pet and have been found allergic, the most effective way to reduce your symptoms will be to rehome your pet.

If this is not possible, try the following: 

• Avoid close contact with your pet (e.g. cuddling, kissing, allowing to sit in your lap).
• Keep your pet away from your bedding, sofa and other areas that you frequently use. 
• Where possible, replace carpets with wooden floors to reduce amount of pet fur/dust mite in the house.

How can I use my medication most effectively?

All rhinitis medication should be taken regularly to gain the maximum benefit. It is more difficult to treat symptoms that are already well established. We recommend starting your treatments at least 2 weeks before your symptoms usually begin.

Nasal washes - Washing the nose with a saline wash can relieve symptoms and clean the nose prior to using a nasal spray. The solution can simply be sniffed up the nose, or if preferred proprietary devices are available e.g. Sinus RinseTM.

Ingredients for saline wash solution:

• 240 mls previously boiled and cooled water
• 1/4 teaspoon salt 
• 1/4 teaspoon bicarbonate of soda

Antihistamines - They are available in liquid, tablet and nasal spray form. There is a large range of antihistamines, but generally daily non-sedating antihistamines are recommended e.g. cetirizine. If one does not suit you it may be worth trying a different one. Antihistamines are available over the counter in pharmacies or on prescription.  
Steroid nasal spray - This is the most effective treatment for allergic rhinitis. 
 
Taking nasal sprays

• Shake bottle well
• Look down
• Using RIGHT hand for LEFT nostril put nozzle just inside nose and aim towards outside wall
• Squirt once or twice (2 different directions)
• Change hands and repeat for the other side
• DO NOT SNIFF HARD

Nasal sprays are available over the counter e.g. Fluticasone or on prescription.

There are several types of nasal spray so you may need to try more than one to find one that works best for you.

Eye drops -Antihistamines and nasal sprays can help to ease eye symptoms.

Sodium cromoglycate eye drops can be obtained over the counter or on prescription and can also help.

Montelukast –This is another drug that blocks chemicals that cause inflammation (like antihistamines).  It can be particularly useful in perennial rhinitis.  It is only available on prescription.

Decongestants –These drugs e.g. Otrivine should be avoided as much as possible.  If these drugs are used frequently then symptoms can get even worse and be difficult to control.

Immunotherapy –This is for patients with very severe allergic rhinitis despite taking maximum conventional medication.

Your allergy consultant or nurse will discuss this treatment with you and provide more information if they feel it is suitable in your case.

Some patients with symptoms of rhinitis do not have an allergy.

What is non-allergic rhinitis?

Non-allergic rhinitis is inflammation of the inside of the nose that isn't caused by an allergy. Rhinitis caused by an allergen, such as pollen, is a separate condition known as allergic rhinitis.

Symptoms of non-allergic rhinitis can include: 

• a blocked nose 
• a runny nose – this may be through the nostrils or down the back of the nose (catarrh) 
• sneezing – although this is generally less severe than in allergic rhinitis
• mild irritation or discomfort in and around your nose
• reduced sense of smell

These symptoms can be constant or they may come and go.

While these symptoms are similar to those of allergic rhinitis (hay fever), non allergic rhinitis is different because, unlike an allergy, it doesn't involve the immune system.

What causes non-allergic rhinitis?

There are many different causes and often it is not possible to identify one cause.

There are several factors that can be associated with non-allergic rhinitis:

• Infection 
• Irritants e.g. smoke, paint fumes 
• Change in temperature 
• Alcohol
• Spicy food 
• Stress 

Some medications:

• Some blood pressure tablets (eg. those ending with a ‘pril’ such as Ramipril)
• Aspirin, Ibuprofen and other common painkillers
• Cocaine use
• Some medication available for treating blocked nose (eg. Otrivine)
• Hormonal changes e.g. pregnancy, puberty and HRT

Overuse of drugs for ‘blocked nose’

Some sprays (such as Otrivine) unblock your nose by reducing the swelling of the blood vessels in your nose. However, if they are used for longer than five to seven days at a time, they can cause the lining of your nose to swell up again. This can happen even after the original problem has resolved. If you use more decongestants in an attempt to reduce the swelling, it is likely to make the problem worse. The medical term for rhinitis caused by the overuse of nasal decongestants is rhinitis medicamentosa.

Tissue damage

Inside your nose, there are three ridges of bone covered by a layer of tissue. These layers of tissue are called turbinates. A type of rhinitis called atrophic rhinitis can occur if the turbinates become damaged.

Most cases of atrophic rhinitis in the UK occur when the turbinates are damaged or removed during surgery (sometimes it is necessary to surgically remove turbinates if they're obstructing your airflow).

Turbinates play an important role in the functioning of your nose, such as keeping the inside of your nose moist and protecting the body from being infected with bacteria. If they are damaged or removed, the remaining tissue can become inflamed, crusty, and prone to infection.

What investigations do I need?

Sometimes the symptoms will be enough to make the diagnosis clear and no tests will be required.  However it is quite common to have some allergy tests to exclude this common cause of rhinitis.  Rarely blood tests may be carried out.

How can I use my medication most effectively?

All rhinitis medication should be taken regularly to gain the maximum benefit.  It is more difficult to treat symptoms that are already well established.

Nasal washes - Washing the nose with a saline wash can relieve symptoms and clean the nose prior to using a nasal spray. 

The solution can simply be sniffed up the nose, or if preferred proprietary devices are available e.g. Sinus RinseTM.

Ingredients for saline wash solution:

• 240 mls previously boiled and cooled water 
• 1/4 teaspoon salt 
• 1/4 teaspoon bicarbonate of soda 

Antihistamines - Surprisingly antihistamines can sometimes be helpful. 

Antihistamine nasal sprays can be obtained over-the-counter from your pharmacy or on prescription.  

Anticholinergic nasal spray - These are helpful for people with primarily a runny nose.

Steroid nasal spray - This is the most effective treatment for rhinitis. Nasal sprays are available over the counter (e.g. Fluticasone ) or on prescription. There are several types of nasal spray so you may need to try more than one to find one that works best for you.

Taking nasal sprays

• Shake bottle well
• Look down
• Using RIGHT hand for LEFT nostril put nozzle just inside nose and aim towards outside wall
• Squirt once or twice (2 different directions)
• Change hands and repeat for the other side
• DO NOT SNIFF HARD

Decongestants – Some cases of non-allergic rhinitis are caused by overusing nasal decongestant sprays. In these cases, the best treatment is to stop using these sprays. However, this can be difficult, particularly if you've been using them for some time.

Try not using the spray in your least congested nostril first. After seven days this nostril should open up, at which point you should try to stop using the spray in your other nostril.

Food allergies, unlike intolerances, are an immune response to specific food allergens. They are more common in children. Read: Food allergy information from Allergy UK

Occasionally we offer food challenges in clinic to rule out food allergies. Read Patient Information about Food Challenges here

The respiratory specialists in Royal Stoke University Hospital manage asthma. However, some asthma patients with allergies may need to be seen in our clinic. Your GPs or specialists may be able to take this decision where appropriate. 

Most reactions that occur when people take medications are caused by side effects.

Testing for drug allergy may not be straight-forward and often it is better to just avoid the drug.  When this causes a problem, a referral to the allergy clinic may be appropriate. Read the Patient Information on the Drug and Vaccine Challenge here

Patients referred with reactions after local anaesthetic generally bypass the general clinic and are seen in the challenge clinic.  Allergy to local anaesthetic is extremely rare.

Urticaria – also known as hives, wheals, welts or nettle rash – is a raised, itchy rash that appears on the skin. It may appear on one part of the body or be spread across large areas.  Sometimes it is associated with swelling called angioedema.  Less often angioedema may occur on its own 1 in 3 patients referred to the allergy service have urticaria.  Chronic urticaria, which lasts beyond 6 weeks, is unlikely to be due to allergy.

Occasionally patients on blood pressure tablets called 'ACE inhibitors', for example Ramipril, develop angioedema.  Your own doctor will be able to offer a safe and suitable alternative to these drugs. It is important that you contact your GP to change your medication if ACE inhibitors are found to cause your swelling.

For more information about urticaria go to the AllergyUk website.

Useful documents:

Urticaria activity score sheet 

DLQL 

Anxiety questionnaire

Omalizumab record sheet