What are perennial allergies

Visit a GP if the symptoms of allergic rhinitis are disrupting your sleep, preventing you carrying out everyday activities, or adversely affecting your performance at work or school.

A diagnosis of allergic rhinitis will generally be based on your symptoms and any possible triggers you may own noticed.

If the cause of your condition is uncertain, you may be referred for allergy testing.

Find out more about diagnosing allergic rhinitis

What causes allergic rhinitis

Allergic rhinitis is caused by the immune system reacting to an allergen as if it were harmful.

This results in cells releasing a number of chemicals that cause the inside layer of your nose (the mucous membrane) to become swollen and too much mucus to be produced.

Common allergens that cause allergic rhinitis include pollen (this type of allergic rhinitis is known as hay fever), as well as mould spores, home dust mites, and flakes of skin or droplets of urine or saliva from certain animals.

Find out more about the causes of allergic rhinitis


Nasal inflammation is the hallmark symptom of perennial allergic rhinitis.

You may own some or a combination of the following symptoms:

  1. nasal obstruction or stuffiness
  2. itching
  3. runny nose
  4. congestion

If your condition has progressed to sinusitis or the growth of abnormal tissue you may also experience the following symptoms:

  1. headaches
  2. facial pain or fullness
  3. fatigue
  4. toothaches
  5. postnasal drip
  6. bad breath
  7. your runny nose may be foul-smelling or an abnormal color
  8. decreased sense of smell

Symptoms of allergic rhinitis

Allergic rhinitis typically causes cold-like symptoms, such as sneezing, itchiness and a blocked or runny nose.

These symptoms usually start soon after being exposed to an allergen.

Some people only get allergic rhinitis for a few months at a time because they’re sensitive to seasonal allergens, such as tree or grass pollen. Other people get allergic rhinitis every year round.

Most people with allergic rhinitis own mild symptoms that can be easily and effectively treated.

But for some people symptoms can be severe and persistent, causing sleep problems and interfering with everyday life.

The symptoms of allergic rhinitis occasionally improve with time, but this can take numerous years and it’s unlikely that the condition will vanish completely.


The actual prevalence of perennial allergic rhinitis may be understated, as this condition can often be undiagnosed.

In childhood, boys are more likely than girls to experience perennial allergic rhinitis, however, in adulthood, differences by gender tend to vanish. While the prevalence varies depending on the study some research shows it could be fairly high (up to 23 percent of the population).

You may also discover that you own other disorders if you suffer from perennial allergic rhinitis. Asthma is one of the most common problems that you may experience.These other conditions may often co-exist with perennial allergic rhinitis:

If left undiagnosed or untreated perennial allergic rhinitis can lead to other conditions such as chronic sinusitis or abnormal growths such as polyps in the nasal cavities or sinuses.


Perennial allergic rhinitis can be diagnosed by a primary care physician but may be best diagnosed by a doctor who specializes in disorders of the ear, nose, and throat (an otolaryngologist).

Your doctor will talk to you about your medical history and enquire you about the symptoms you are experiencing. You may also be questioned about things that you ponder might trigger your symptoms, as well as your family's medical history.

This may be followed by a physical exam, specifically, your ears, nose, and throat will be examined for conditions such as deviated septum or fluid in the ears. If, after your history and physical, your doctor suspects perennial allergic rhinitis some of the following diagnostic tests may be ordered:

  1. blood or skin testing to diagnose specific allergies
  2. CT or MRI scans to glance for chronic sinusitis, nasal polyps, etc…


Several treatment options exist for the management of perennial allergic rhinitis. If a specific allergy has been identified, avoiding the substance you are allergic to may be helpful in managing your symptoms.

You may desire to work on decreasing the prevalence of allergens in your home. To do this, you may desire to try:

  1. adding a dehumidifier (if you are allergic to dust mites)
  2. get rid of pets or limit their access to bedrooms
  3. regular cleaning
  4. occasional deep cleaning with carpet cleaning, steam cleaning, or dry cleaning or better yet replace carpet with another type of flooring

If you are unable to eliminate allergens from your home or environment, medications or immunotherapy may be options for treating allergies.

Medications commonly used for controlling allergy symptoms include the following antihistamines:

  1. diphenhydramine
  2. cetirizine hydrochloride
  3. loratadine
  4. fexofenadine

While these medications are available over-the-counter they should only be used under the direction of your doctor. Make certain your doctor or pharmacist knows every the medications you are taking to avoid interactions and inform them of any medication allergies you might own. Older antihistamines such as diphenhydramine are known to cause drowsiness.

Immunotherapy, or allergy shots, may be an option for some people with perennial allergic rhinitis.

Immunotherapy is a long-term treatment option that involves giving you little amounts of the substance you are allergic to and gradually increasing the quantity you are given over time. This can change your body's immune response to that substance. It is not available for every types of allergies and can be a time-consuming process since at least the first dose, and commonly subsequent doses, need to be given under medical supervision.

Allergy shots are generally not used in children under the age of 5. Your response to allergy shots may vary and could range from a finish cure of your symptoms to no response at every.

In general, studies show this treatment to be beneficial and cost-effective.

In addition to antihistamines for controlling your allergies, other medications may be used to control symptoms. Numerous of these medications are available over-the-counter and may include decongestants and nasal sprays. Intranasal steroids are often used in addition to antihistamines.

Decongestant nasal sprays can be associated with a condition called rebound congestion (also referred to as nasal spray addiction) when used longer than three days.

Some prescription nasal sprays are less likely to cause rebound congestion. It is a excellent thought to talk to your doctor about rebound congestion and your options for nasal decongestants.

Nasal irrigation using a neti pot may be helpful in controlling nasal symptoms including congestion. A humidifier may also be beneficial in helping with congestion, however, if you are allergic to dust mites you should be aware that high humidity levels can increase the number of dust mites in your environment.

If your condition has progressed to chronic sinusitis or if you own structural abnormalities such as deviated septum or nasal polyps additional treatments may be necessary.

While antibiotics are sometimes used to treat chronic sinusitis this condition often requires surgery. This is especially true if you own a deviated septum, enlarged turbinates, or nasal polyps. Nasal sinus surgery is common in the United States and is generally done endoscopically in a same day surgery setting.

A Expression From Verywell

Perennial allergic rhinitis is a chronic condition that left untreated may cause a variety of side effects.

The first step in your treatment should be to attempt and eliminate the allergens from your home.

What are perennial allergies

If you are still unsuccessful in having a resolution from your allergies, then the treatments described above may be extremely helpful in reducing your symptoms.

Last month we took a closer glance at pollens, the instigators of seasonal allergies. But there are more allergy-causing elements in the world than just trees, weeds and grasses. A host of commonly occurring substances, such as animal dander, dust mites, insect detritus and various indoor molds can elicit allergic reactions that include allergic conjunctivitis. What’s more, these allergens elicit these allergic signs and symptoms year-round. The subsequent one-two punch of seasonal and perennial allergies has a substantial health impact.

Annual costs for allergy prescription medications alone exceeded $6 billion as recently as 2002,1 and although that dollar quantity may own declined in the past decade as numerous of the most favorite drugs went from prescription to generic to over-the-counter status, disease prevalence continues to rise. An estimated 50 to 60 million Americans suffer from seasonal or perennial rhino-conjunctivitis.2 Of these, between 60 and 90 percent experience ocular symptoms including hyperemia, pruritus or chemosis.2,3

This month we’ll describe the similarities and differences between perennial allergens and seasonal pollens, and explore their critical impact on the growing numbers of patients who suffer from ocular allergy year-round.

The Usual Suspects

Allergens are often classified as either indoor or outdoor varieties.4 Indoor (perennial) allergens, such as those present in the home, can be further classified according to their specific source.

Pets and domestic animals bring their dander, while dust mites, cockroaches and molds provide allergens in form of feces, spores and other debris. Among the most common allergies are those to cats, dogs and other domesticated animals. These are the allergies that particularly highlight the higher prevalence of atopic diseases in modern societies.5 Both dogs and cats produce multiple allergenic proteins expressed in the discarded skin fragments that constitute their dander. Cat allergies are particularly common, and show the most significant association with more serious and chronic allergy, including allergic forms of asthma.

The number one perennial allergy source is the dust mite.

On average, a mattress in an American household is home to about 5 million of these tiny creatures.

On the surface it would seem that perennial allergies would be simple to contain with avoidance measures, particularly when compared to seasonal allergens such as pollens. But it’s not as simple as giving the cat up for adoption. There are more than 80 million pet cats in the United States, and cat allergens are widely distributed even in places such as schools, public buildings and homes without cats.5To a lesser extent the same is true for dog allergens, although they don’t appear to be as allergenic as those from the cat, particularly the Fel d 1 allergen.

In fact, the high levels of environmental cat allergens are offset, at least to some degree, by the tolerance that develops in numerous sensitized individuals. Unlike most other perennial allergens, high levels of exposure to Fel d 1 can lead to tolerance, as demonstrated by studies showing that up to half of children who live with cats develop a robust antibody response without exhibiting signs or symptoms of rhino-conjunctivitis.5Similar studies with other perennial allergens do not show this tendency.

Among every categories of perennial allergen sources, the dust mite is king.6,7 These invisible (about 200 µm in length) members of the spider family are found in abundance in virtually every put where humans live.

While their name implies that the levels of mite allergens can be controlled by frequent, rigorous cleaning, maintenance of a lower humidity is at least as significant as conscientious use of a vacuum. As numerous as 14 dust mite allergens own been identified,8 with Der p 1 and Der p 2 demonstrating positive skin tests in the highest percentage of allergy sufferers.7 Dust mite allergens, particularly Der p 1, are especially noteworthy in that they exhibit proteolytic activity capable of causing damage to ocular, nasal or alveolar epithelial cells.9

While they are less pervasive than dust mites, cockroaches are also significant contributors to the allergen burden, especially in urban localities.

The dominant allergens from members of the genus Blattella and Periplaneta, including Bla g 2, Bla g 5, and Per a 10, exhibit proteolytic activity similar to the enzyme activity reported for Der p 1.8 The urban setting can exacerbate the effects of these allergens when they combine with components of industrial pollutants, as has been shown for seasonal allergens.10

Another major source of perennial allergens is indoor and outdoor molds.11 Numerous molds, such as Alternaria, Cladosporium and Aspergillus grow indoors and outdoors, but it’s thought that the primary sensitization to mold allergens is due to indoor spore exposure.

In some respects molds can be considered seasonal, as the spore production in most temperate regions peaks in the drop. Despite this, molds persist in indoor environments year-round, as do the allergic reactions they initiate. The allergens present in mold spores are fairly diverse from other allergen sources. Mold allergies are among the most common type of allergy, with estimates of 3 to 10 percent incidence worldwide, and skin test reactivity in 10 to 30 percent of patients with allergic rhinoconjunctivitis.11

Table 1.

Common Perennial Allergens

Origin Source Major allergen(s) Classification/function
Cat (Felis domesticus) dander Fel d 1 uteroglobin
Dog (Canis familiarus) dander Can f 1 lipocalcin
Rodents (Mus, Rattus sp.) urine Mus m 1;
Rat n 1
Cattle (Bos domesticus) dander Bos d 2 lipocalcin
Horse (Equus caballus) saliva Equ c 1 lipocalcin
Dust mite (Dermatophagoides sp.) feces Der p 1
Der p 2
Cockroach (Blattella germanica) frass,saliva Bla g 2
Bla g 5
Mold (Alternaria alternata) spores Alt a 1
Mold (Cladosporium herbarum) spores Cla h 8 dehydrogenase
Mold (Aspergillus fumigatus) spores Asp f 1 nuclease


It’s not surprising that patients with perennial allergies experience more severe allergic symptoms; unlike seasonal disease, they are typically exposed to the offending allergens year-round.

But other factors also contribute to the severity of their disease.12Chronic exposure to allergens is likely to cause damage to the ocular surface, and the subsequent immune response that is established creates a constant state of inflammation.13Atmospheric contaminants such as ozone, nitric oxides and hydrocarbon exhaust own the potential to act directly on the ocular surface, or indirectly on airborne allergens to further enhance this effect.10These challenges can eventually lead to compromising the corneal and conjunctival epithelial layer which functions as the barrier to environmental assault.

The attack on the ocular surface that results from prolonged allergen exposure can lead to proteolytic breakdown of key epithelial proteins, especially those involved in maintenance of the cellular tight junctions such as the cadherins, keratins and occludins.14,15 Disruption of the cell-cell contact points increases access of inflammatory cells to the ocular surface and promotes secretion and activity of pro-inflammatory cytokines.

This combined assault has been described as “urban eye allergy syndrome,”16 but this descriptor is misleading in that it implies that the disease is limited to large metropolitan areas. A number of studies own suggested that co-morbidity of seasonal and perennial allergy may be enough to tip the scales, overwhelm both natural barriers and traditional antihistamine therapies and lead to a chronic, inflammatory allergic state. In clinical trials, patients with perennial allergy are more likely to experience chronic disease in response to seasonal allergens.17 Other studies own shown that damage to the epithelial barrier function persists even in the absence of allergens, placing these individuals at greater risk for more severe disease in future allergic responses.14 As our knowledge of allergens expands, it’s becoming evident that allergic disease results from both the familiar IgE/mast cell effects and a second, more direct assault on the ocular surface from the combination of environmental toxins and allergen-based degradative enzymes.

Therapeutic Responses

It’s clear that therapies developed and tested on patients with seasonal conjunctivitis may not be sufficient to treat more chronic disease that can happen with perennial allergens.

As with most inflammatory disorders, the natural tendency is to reach for the corticosteroids, and these drugs, especially topical formulations, are effective in treating inflammation associated with chronic allergy.

Hygiene Hypothesis Revisited
In 1989 a paper in the British Medical Journal described a study showing that the incidence of rhino-conjunctivitis in children who were followed from birth until adulthood was inversely proportional to the number of siblings in their families.21 The author, David Strachan, MD, PhD, suggested that this could be due to an increased rate of neonatal infections in children who shared a household with “unhygienic siblings.” What may own seemed love significant conjecture at that time has since become a generally accepted explanation for the disparity in rates of allergic disease between developed and developing countries.

Allergies, it seems, are a price we pay for a clean, healthy childhood and the associated increases in longevity.

What are perennial allergies

While genetics clearly plays a role in atopy, early exposure to an array of allergenic stimuli somehow acts to dampen subsequent immune system activity. Since Dr. Strachan’s landmark paper, research has focused upon possible mechanisms of such an effect. For a time bacterial and viral infections in early life were thought to shift the balance between Th1 and Th2 immunity (favoring a less atopic Th1) but more recent reports propose that it may be helmenthic infections that drive the immunological balance away from the tendency for atopy.22,23 The boom in probiotics may represent the biggest single result of the hypothesis, even though evidence for probiotic effects in therapy of allergic diseases remains equivocal.

Recent reports establishing a role for cytokines involved in the Th1-Th2 balance, such as IL-10, may hold promise. Stay tuned.


Recent studies propose that some topical antihistamines may also act to reduce ocular surface damage associated with chronic disease.15 Overall, however, it appears that there is a growing need for new treatment approaches to address the needs of patients with chronic ocular allergy.

This is particularly true as our patient population matures, adding co-morbidities such as dry eye into the therapeutic equation. At the recent Tear Film & Ocular Surface Society Asia symposium, Paul Gomes of Ora Inc. presented results of a survey showing 60 percent of patients being treated for dry eye also reported signs and symptoms of chronic ocular allergy.

In order to develop new therapies, it’s critical to adopt appropriate clinical protocols that specifically address the treatment of chronic allergy. This can involve adaptations to either traditional allergen challenge methods or modified selection criteria to either CAC or environmental studies.

In either case, it’s necessary to carefully, clearly identify patients with significant levels of chronic disease if one hopes to identify effective new therapies.

Several prospective therapies show specific promise as treatments for chronic allergy. As with any allergy therapy, the mast cells are the primary targets for intervention. In mast cells (and basophils) the coupling of antigen binding to the release of histamine and other allergic mediators is critically dependent upon the action of a number of intermediate enzymatic steps.

Among these are the protein phosphorylations catalyzed by a tyrosine kinase originally identified in spleen cells (Spleen tyrosine kinase, or Syk).18 Inhibitors of Syk own been shown to provide potent, long-duration attenuation of mast cell degranulation, and so are ideal candidates for treatment of allergy, both acute and chronic. Another promising new class of drugs is the partial glucocorticoid agonists, drugs designed to retain the anti-inflammatory effects of corticosteroids without their dose-limiting adverse effects on intraocular pressure.19 Examples of both of these classes of drugs own been effective in preclinical models of chronic allergy, and they should be moving toward human studies in the near future.

Immunotherapy for allergies has always been a treatment of final resort, but the combination of increased prevalence and severity of disease suggests that it deserves consideration as a therapeutic option, albeit on an individual patient basis.

What are perennial allergies

The limitation of IT is that it is allergen specific, as demonstrated by a recent study of patients with grass and mite allergies treated with allergen-specific therapy over a three-year period.20 Results showed a 16- to 30-fold decrease in allergen sensitivity, but that decrease didn’t cross over to the untreated allergen. Since the majority of patients own multiple allergen sensitivities, therapy would necessarily focus on the worst of the offenders, or involve multiple allergen immunizations.

As in any conflict, you arm yourself with both tools of combat and knowledge of your adversary.

What are perennial allergies

Therefore, a knowledge of pollens and perennial allergens is vital when developing a battle plan against ocular allergies. REVIEW

Dr. Abelson is a clinical professor of ophthalmology at Harvard Medical School and senior clinical scientist at the Schepens Eye Research Institute. Dr. McLaughlin is a medical author at Ora Inc.

1. Stempel DA, Woolf, R. The cost of treating allergic rhinitis. Curr.Allergy Asthma Reps.2002;2:223-230.


Van Cauwenberge P, De Belder T, Vermeiren J, Kaplan A. Global resources in allergy (GLORIA): Allergic rhinitis and allergic conjunctivitis. Clin Exper Aller Rev 2003;3:46-50.

3. Blaiss M. Allergic rhinoconjunctivitis: Burden of disease. Allergy Asthma Proc 2007;28:393-7.

4. Platts-Mills TA. Indoor allergens.

What are perennial allergies

In: E Middleton Jr, ed. Allergy: Principals and Practices, 5th edition. St Louis: Mosby, 1998:393-409.

5. Erwin EA, Woodfolk JA, Custis N, Platts-Mills TA. Animal Danders. Immunol Clin N Am 2003;23:469-481.


What are perennial allergies

Arlian LG, Morgan MS, Neal JS. Dust mite allergens: Ecology and distribution.

What are perennial allergies

Current Allergy Asthma Reports. 2002;2:401-411.

7. Bessot JC, Pauli G. Mite allergens: An overview. Eur Ann Allergy Clin Immunol 2011;43:141-156.

8. Http://www.Allergen.org. Accessed 29 March 2012.

9. Chapman MD, Wünschmann S, Pomés A. Proteases as Th2 adjuvants. Curr Allergy Asthma Rep 2007;7:363-7.

10. Riediker M, Monn C, Koller T, Stahel WA, Wüthrich B. Air pollutants enhance rhinoconjunctivitis symptoms in pollen-allergic individuals. Ann Allergy Asthma Immunol 2001;87:311-8.

11. Hamilos DL. Allergic fungal rhinitis and rhinoconjunctivitis.

Proc Am Thorac Soc 2010;7:245-252.

12. Wong AH, Barg SS, Leung AK. Seasonal and perennial allergic conjunctivitis. Recent Pat Inflamm Allergy Drug Discov 2009;3:118-27.

13. Choi SH, Bielory L. Late-phase reaction in ocular allergy. Curr Opin Allergy Clin Immunol 2008;8:438-444.

14. Hughes JL, Lackie PM, Wilson SJ, Church MK, McGill JI. Reduced structural proteins in the conjunctival epithelium in allergic eye disease.

Allergy 2006;61:1268-1274.

15. Ono SJ, Lane KJ. Comparison of effects of alcaftadine and olopatadine on conjunctival epithelium and eosinophil recruitment in a murine model of allergic conjunctivitis. Drug Design, Development and Therapy 2011;5:77–84.

16. Leonardi A, Lanier B. Urban eye allergy syndrome: A new clinical entity? Curr Med Res Opin 2008;24:2295-2302.

17. Gomes P, Abelson MB, Mandell K. Perennial allergen skin sensitivity as a predictor of seasonal allergic rhinoconjunctivitis severity. Journal of Allergy and Clinical Immunology 2010; 125S:AB172.


Riccaboni M, Bianchi I, Petrillo P. Spleen tyrosine kinases: Biology, therapeutic targets and drugs. Drug Discov Today 2010;15:517-30.

19. Baiula M, Spartà A, Bedini A, et al. Eosinophil as a cellular target of the ocular anti-allergic action of mapracorat, a novel selective glucocorticoid receptor agonist. Mol Vis 2011;17:3208-23.

20. S. Dreborg S, Lee TH, Kay AB, Durham SR.

Immunotherapy is allergen-specific: A double-blind trial of mite or timothy extract in mite and grass dual-allergic patients. Int Arch Allergy Immunol 2012;158:63-70.

21. Strachan DP. Hay fever, hygiene, and household size. Brit Med J 1989;299:1259-1231.

22. Wills-Karp M, Santeliz J, Karp CL. The germless theory of allergic disease: Revisiting the hygiene hypothesis. Nature Rev Immunol 2001;1:69-75.

23. Mekhaiel DN, Daniel-Ribeiro CT, Cooper PJ, Pleass RJ. Do regulatory antibodies offer an alternative mechanism to explain the hygiene hypothesis? Trends in Parasitology 2011;27:523-529.


The first approach in managing seasonal or perennial forms of hay fever should be to avoid the allergens that trigger symptoms.

Outdoor exposure

  1. Stay indoors as much as possible when pollen counts are at their peak, generally during the midmorning and early evening (this may vary according to plant pollen), and when wind is blowing pollens around.
  2. Avoid using window fans that can draw pollens and molds into the house.
  3. Wear glasses or sunglasses when outdoors to minimize the quantity of pollen getting into your eyes.
  4. Wear a pollen mask (such as a NIOSH-rated 95 filter mask) when mowing the lawn, raking leaves or gardening, and take appropriate medication beforehand.
  5. Don’t hang clothing outdoors to dry; pollen may cling to towels and sheets.
  6. Try not to rub your eyes; doing so will irritate them and could make your symptoms worse.

Indoor exposure

  1. Keep windows closed, and use air conditioning in your car and home.

    Make certain to hold your air conditioning unit clean.

  2. Reduce exposure to dust mites, especially in the bedroom. Use “mite-proof” covers for pillows, comforters and duvets, and mattresses and box springs. Wash your bedding frequently, using boiling water (at least 130 degrees Fahrenheit).
  3. To limit exposure to mold, hold the humidity in your home low (between 30 and 50 percent) and clean your bathrooms, kitchen and basement regularly. Use a dehumidifier, especially in the basement and in other damp, humid places, and empty and clean it often. If mold is visible, clean it with mild detergent and a 5 percent bleach solution as directed by an allergist.
  4. Clean floors with a damp rag or mop, rather than dry-dusting or sweeping.

Exposure to pets

  1. Wash your hands immediately after petting any animals; wash your clothes after visiting friends with pets.
  2. If you are allergic to a household pet, hold the animal out of your home as much as possible.

    If the pet must be inside, hold it out of the bedroom so you are not exposed to animal allergens while you sleep.

  3. Close the air ducts to your bedroom if you own forced-air or central heating or cooling. Replace carpeting with hardwood, tile or linoleum, every of which are easier to hold dander-free.


Many allergens that trigger allergic rhinitis are airborne, so you can’t always avoid them. If your symptoms can’t be well-controlled by simply avoiding triggers, your allergist may recommend medications that reduce nasal congestion, sneezing, and an itchy and runny nose.

They are available in numerous forms — oral tablets, liquid medication, nasal sprays and eyedrops. Some medications may own side effects, so discuss these treatments with your allergist so they can assist you live the life you want.

Intranasal corticosteroids

Intranasal corticosteroids are the single most effective drug class for treating allergic rhinitis. They can significantly reduce nasal congestion as well as sneezing, itching and a runny nose.

Ask your allergist about whether these medications are appropriate and safe for you. These sprays are designed to avoid the side effects that may happen from steroids that are taken by mouth or injection. Take care not to spray the medication against the middle portion of the nose (the nasal septum).

The most common side effects are local irritation and nasal bleeding. Some older preparations own been shown to own some effect on children’s growth; data about some newer steroids don’t indicate an effect on growth.


Antihistamines are commonly used to treat allergic rhinitis. These medications counter the effects of histamine, the irritating chemical released within your body when an allergic reaction takes put.

Although other chemicals are involved, histamine is primarily responsible for causing the symptoms. Antihistamines are found in eyedrops, nasal sprays and, most commonly, oral tablets and syrup.

Antihistamines assist to relieve nasal allergy symptoms such as:

  1. Sneezing and an itchy, runny nose
  2. Eye itching, burning, tearing and redness
  3. Itchy skin, hives and eczema

There are dozens of antihistamines; some are available over the counter, while others require a prescription.

Patients reply to them in a wide variety of ways.

Generally, the newer (second-generation) products work well and produce only minor side effects. Some people discover that an antihistamine becomes less effective as the allergy season worsens or as their allergies change over time. If you discover that an antihistamine is becoming less effective, tell your allergist, who may recommend a diverse type or strength of antihistamine. If you own excessive nasal dryness or thick nasal mucus, consult an allergist before taking antihistamines. Contact your allergist for advice if an antihistamine causes drowsiness or other side effects.

Proper use: Short-acting antihistamines can be taken every four to six hours, while timed-release antihistamines are taken every 12 to 24 hours.

The short-acting antihistamines are often most helpful if taken 30 minutes before an anticipated exposure to an allergen (such as at a picnic during ragweed season). Timed-release antihistamines are better suited to long-term use for those who need daily medications. Proper use of these drugs is just as significant as their selection. The most effective way to use them is before symptoms develop. A dose taken early can eliminate the need for numerous later doses to reduce established symptoms. Numerous times a patient will tell that he or she “took one, and it didn’t work.” If the patient had taken the antihistamine regularly for three to four days to build up blood levels of the medication, it might own been effective.

Side effects: Older (first-generation) antihistamines may cause drowsiness or performance impairment, which can lead to accidents and personal injury.

Even when these medications are taken only at bedtime, they can still cause considerable impairment the following day, even in people who do not feel drowsy. For this reason, it is significant that you do not drive a car or work with dangerous machinery when you take a potentially sedating antihistamine. Some of the newer antihistamines do not cause drowsiness.

A frequent side effect is excessive dryness of the mouth, nose and eyes.

Less common side effects include restlessness, nervousness, overexcitability, insomnia, dizziness, headaches, euphoria, fainting, visual disturbances, decreased appetite, nausea, vomiting, abdominal distress, constipation, diarrhea, increased or decreased urination, urinary retention, high or low blood pressure, nightmares (especially in children), sore throat, unusual bleeding or bruising, chest tightness or palpitations. Men with prostate enlargement may encounter urinary problems while on antihistamines. Consult your allergist if these reactions occur.

Important precautions:

  1. Follow your allergist’s instructions.
  2. Alcohol and tranquilizers increase the sedation side effects of antihistamines.
  3. Do not use more than one antihistamine at a time, unless prescribed.
  4. Know how the medication affects you before working with heavy machinery, driving or doing other performance-intensive tasks; some products can slow your reaction time.
  5. While antihistamines own been taken safely by millions of people in the final 50 years, don’t take antihistamines before telling your allergist if you are allergic to, or intolerant of, any medicine; are pregnant or intend to become pregnant while using this medication; are breast-feeding; own glaucoma or an enlarged prostate; or are ill.
  6. Keep these medications out of the reach of children.
  7. Some antihistamines appear to be safe to take during pregnancy, but there own not been enough studies to determine the absolute safety of antihistamines in pregnancy.

    Again, consult your allergist or your obstetrician if you must take antihistamines.

  8. Never take anyone else’s medication.


Decongestants assist relieve the stuffiness and pressure caused by swollen nasal tissue. They do not contain antihistamines, so they do not cause antihistaminic side effects. They do not relieve other symptoms of allergic rhinitis. Oral decongestants are available as prescription and nonprescription medications and are often found in combination with antihistamines or other medications.

It is not unusual for patients using decongestants to experience insomnia if they take the medication in the afternoon or evening. If this occurs, a dose reduction may be needed. At times, men with prostate enlargement may encounter urinary problems while on decongestants. Patients using medications to manage emotional or behavioral problems should discuss this with their allergist before using decongestants. Patients with high blood pressure or heart disease should check with their allergist before using. Pregnant patients should also check with their allergist before starting decongestants.

Nonprescription decongestant nasal sprays work within minutes and final for hours, but you should not use them for more than a few days at a time unless instructed by your allergist.

Prolonged use can cause rhinitis medicamentosa, or rebound swelling of the nasal tissue. Stopping the use of the decongestant nasal spray will cure that swelling, provided that there is no underlying disorder.

Oral decongestants are found in numerous over-the-counter (OTC) and prescription medications, and may be the treatment of choice for nasal congestion. They don’t cause rhinitis medicamentosa but need to be avoided by some patients with high blood pressure. If you own high blood pressure or heart problems, check with your allergist before using them.

Leukatriene pathway inhibitors

Leukotriene pathway inhibitors (montelukast, zafirlukast and zileuton) block the action of leukotriene, a substance in the body that can cause symptoms of allergic rhinitis.

These drugs are also used to treat asthma.


Immunotherapy may be recommended for people who don’t reply well to treatment with medications or who experience side effects from medications, who own allergen exposure that is unavoidable or who desire a more permanent solution to their allergies. Immunotherapy can be extremely effective in controlling allergic symptoms, but it doesn’t assist the symptoms produced by nonallergic rhinitis.

Two types of immunotherapy are available: allergy shots and sublingual (under-the-tongue) tablets.

  1. Allergy shots: A treatment program, which can take three to five years, consists of injections of a diluted allergy extract, istered frequently in increasing doses until a maintenance dose is reached.

    Then the injection schedule is changed so that the same dose is given with longer intervals between injections. Immunotherapy helps the body build resistance to the effects of the allergen, reduces the intensity of symptoms caused by allergen exposure and sometimes can actually make skin test reactions vanish. As resistance develops over several months, symptoms should improve.

  2. Sublingual tablets: This type of immunotherapy was approved by the Food and Drug istration in 2014.

    Starting several months before allergy season begins, patients dissolve a tablet under the tongue daily. Treatment can continue for as endless as three years.

    What are perennial allergies

    Only a few allergens (certain grass and ragweed pollens and home dust mite) can be treated now with this method, but it is a promising therapy for the future.

Nasal sprays

Nonprescription saline nasal sprays will assist counteract symptoms such as dry nasal passages or thick nasal mucus. Unlike decongestant nasal sprays, a saline nasal spray can be used as often as it is needed. Sometimes an allergist may recommend washing (douching) the nasal passage.

There are numerous OTC delivery systems for saline rinses, including neti pots and saline rinse bottles.

Nasal cromolyn blocks the body’s release of allergy-causing substances. It does not work in every patients. The full dose is four times daily, and improvement of symptoms may take several weeks. Nasal cromolyn can assist prevent allergic nasal reactions if taken prior to an allergen exposure.

Nasal ipratropium bromide spray can assist reduce nasal drainage from allergic rhinitis or some forms of nonallergic rhinitis.

Eye allergy preparations and eyedrops

Eye allergy preparations may be helpful when the eyes are affected by the same allergens that trigger rhinitis, causing redness, swelling, watery eyes and itching.

OTC eyedrops and oral medications are commonly used for short-term relief of some eye allergy symptoms. They may not relieve every symptoms, though, and prolonged use of some of these drops may actually cause your condition to worsen.

Prescription eyedrops and oral medications also are used to treat eye allergies. Prescription eyedrops provide both short- and long-term targeted relief of eye allergy symptoms, and can be used to manage them.

Check with your allergist or pharmacist if you are unsure about a specific drug or formula.

Treatments that are not recommended for allergic rhinitis

  1. Antibiotics: Effective for the treatment of bacterial infections, antibiotics do not affect the course of uncomplicated common colds (a viral infection) and are of no benefit for noninfectious rhinitis, including allergic rhinitis.
  2. Nasal surgery: Surgery is not a treatment for allergic rhinitis, but it may assist if patients own nasal polyps or chronic sinusitis that is not responsive to antibiotics or nasal steroid sprays.

Allergic rhinitis is inflammation of the inside of the nose caused by an allergen, such as pollen, dust, mould or flakes of skin from certain animals.

It’s a extremely common condition, estimated to affect around 1 in every 5 people in the UK.