Allergic Rhinitis / Hay Fever can be classified as intermittent or persistent which may in turn be mild or moderate-severe.
Mild rhinitis does not interfere with sleep, sport or leisure activities while moderate-severe rhinitis affects sleep , work , sport and leisure activities.
1. Diagnosis
Diagnosis of the causative allergens causing the rhinitis can be done via SPT (skin prick test) or blood test (phadiatop)and will diagnose the allergy in over 80 %of cases. Occasionally rhinitis may be worsened by foods. Non IgE mediated food induced rhinitis appears to be more common than was previously thought. Some adverse reactions may be due to preservatives.
2. Treatment
In more than 60% of cases the first line of treatment may be the pharmacist. Pharmacists and health care professionals should be educated on the diagnosis of allergic verus infective conditions. Symptoms of a cold include sore throat, low grade fever, headache and malaise while allergy symptoms present with itchy eyes, itchy throat, runny /stuffy nose, no fever.
New generation antihistamines like desloratidine, levocetirizine and fexofenadine are available in South Africa and are safe and non sedative and have no cardiac side effects like the old generation antihistamines.
Intranasal steroids are the most potent all round anti inflammatory medications for the management of allergic rhinitis patients. However proper use is essential for them to be effective.
Leukotriene receptor antagonists like montelukast are available and have beneficial effects in allergic rhinitis and asthma.
Specific allergen immunotherapy is the only form of therapy that can change the course of the disease and potentially cure patients. In the sublingual route patients are given increasing concentrations of the allergen held under the tongue for two minutes before swallowing for an initial build up phase of one month followed by a maintenance course of 2 to 3 years. Immunotherapy is highly successful for house dust mite allergies and grass pollen allergies.
