How many types of allergic rhinitis are there ?

There are two main types of allergic rhinitis: seasonal allergic rhinitis and perennial allergic rhinitis. 'Occupational Allergic Rhinitis’, which is caused by allergens in the working environment, can be added to these.

How does allergic rhinitis (AN) occur ?

Allergic rhinitis occurs as a result of an 'overreaction' of the immune system, when the body becomes sensitive to certain substances called allergens.

What are the symptoms of AN ?

The most important symptoms of AN can be listed as prolonged sneezing, runny nose, itching in the nose and nasal congestion. These patients may also have olfactory dysfunction.

What is the frequency of AN in the community ?

It is known that AN is seen in approximately 10-20% of the population.

Is there a hereditary transmission of allergies ?

The likelihood of allergies increases in a child whose mother or father has allergies. This possibility increases even more if both parents are allergic.

Can AN be associated with other allergic conditions ?

As a result, if a person has an 'allergic body', some other allergic conditions such as urticaria and asthma may occur as well as allergic rhinitis. While approximately 55-60% of patients with asthma have AN, it has been reported that approximately 15-20% of those with AN have asthma.

How is the diagnosis of AN made ?

The most important diagnostic tool in the diagnosis of AN is the history. In other words, whether the patient's complaints are seasonal or all year, whether they occur after moving, changing city or acquiring a pet such as a cat, whether allergies are triggered by certain foods and occupational factors should be carefully questioned. A clinical diagnosis of AN is made if a clear runny nose and post-nasal discharge, swollen and pale nasal flesh are detected in the patient's examination, along with complaints such as sneezing, nasal itching, eye itching, and nasal congestion. Skin tests and blood tests may also be used to support the diagnosis.

How is the skin test done ?

The skin test is a test performed by opening small spots on the skin of the forearm with a special applicator or a pointed tool called a lancet, and giving extracts of the substance responsible for the most common allergy from these points. A rash and hardness occur on the skin against the substance to which the allergy is made. By measuring the diameter of this hardness, an idea about the size of the allergy is obtained. This test is not applied in very young children. Likewise, some drugs such as antihistamines and imipramine should not be used before this test.

What is checked in blood tests ?

A substance called 'Total IgE' can be checked in the blood test. However, its diagnostic value is not high. For example, parasites can also cause this value to increase. With a test called the 'RAST test', which is used to detect 'specific IgE', it can be determined which substances cause allergies by using blood taken from the patient. However, this test is a very expensive test.

When is the RAST test done ?

When skin testing is not possible and the detection of the allergen is important, the RAST test can be used.

When is it important to detect the allergen by skin test or RAST test ?

When it is determined that the person is allergic to which allergen (allergic substance), it may be possible to avoid that allergen or if vaccine treatment is planned, these tests may become important. For example, if a patient who is allergic to tomatoes knows this and avoids tomatoes, he may not have allergic reactions in his body. However, if you are allergic to house dust mites, it may not be so easy to avoid. By determining which substance the person is allergic to, vaccination treatment can be initiated against that substance.

The skin test was negative. Does this mean I'm not allergic?

A positive skin test supports that the person is allergic, while a negative test does not mean that he or she is not allergic.

Can't I be treated without a skin test ?

As I mentioned before, the most important factors in the diagnosis of AN are the patient's complaints and examination findings. If the aforementioned signs and symptoms suggest AN and the patient makes the treatment choice in favor of drug therapy, drug therapy can be applied without a skin test.

What methods are there in the treatment of AN ?

The first step in the treatment of AN is the patient's avoidance of the allergen. However, this can often be difficult or not possible. For example, it is very difficult to avoid this allergen, no matter how 'meticulous' a patient who is allergic to house dust mites is, and no matter how much he cleans his house with 'special' vacuum cleaners sold in the market. Likewise, it is difficult to avoid the pollen scattered in the air in the spring while walking on the street. When the situation is explained to the patient who is allergic to cat hair, most of the time, the love of cats will outweigh and the patient will not want to leave his cat. At least, I have not seen anyone who leaves their cat in my professional life! The next two treatment methods can be roughly summarized as drug treatment and vaccine treatment.

What is used in drug therapy ?

The basis of drug therapy can be summarized as suppressing the effects of some substances such as histamine and leukotriene, which play a role in the allergic reaction, and eliminating or reducing the 'inflammatory' condition in the nose. The main drugs here are antihistamines, drugs called cortisone and leukotriene antagonists.

Antihistamines are usually used in pill form. While the antihistamines used in the past can cause sedation and distraction in the patient, the new generation antihistamines have very little effect on causing sleepiness in this way. However, these antihistamines, which are known as ‘non-sedative’, may still cause a tendency to sleep in some patients due to structural differences, and in this case, they can be switched to another antihistamine. Antihistamines are also available in spray form.

Nasal sprays containing cortisone can be used for a long time. The word 'cortisone' here should not frighten patients. Since the aforementioned cortisone is not in the form of pills or injections, it can be used safely for a very long time when used correctly under the supervision of a doctor. The correct way of spraying the spray should be shown to the patient by the physician. Side effects of these sprays, such as nosebleeds and perforation of the septum of the nose, have been reported rarely, and most of them are due to misuse. Another important issue is to wash the nose daily with nasal sprays containing sea water or other saline solutions to minimize these side effects. Cortisone in pill form may be needed very rarely, for example, in a patient with allergies and nasal polyps.

Leukotriene antagonists are drugs that have become popular in recent years. They can be used in combination with asthma-AN or in very severe cases that cannot be controlled with antihistamine-cortisone spray treatment, in cases with nasal polyps, or in the maintenance treatment by replacing them with antihistamines.

What is immunotherapy ?

Immunotherapy is the attempt to provide a desensitization to the substance in question by administering the substance that is determined to cause allergy to the body at regular intervals. The substance is administered as injection or sublingually. Immunotherapy be tried in appropriate cases who do not want drug treatment. The success of this treatment decreases if there is more than one allergen. It is a long-term treatment that can take years. Its cost is relatively high and there is no guarantee of success. Although it is rare, a situation called 'anaphylactic reaction', can occur, and even can be fatal if emergency intervention is not performed. Itis recommended to be administered in a health institution where emergency intervention can be made when necessary.

What is 'sublingual therapy' ?

'Sublingual therapy' is a treatment based on desensitizing the body to the allergen, which is applied by dripping the allergen substance under the tongue, not with a needle, or by absorbing it with a sugar. It has become popular in recent years due to the fact that the probability of developing an 'anaphylactic reaction' is much lower than injection therapy, it can be applied by itself at the patient's home, and it is easy to apply in children compared to injections. Results close to vaccine therapy have been reported, but there is no guarantee of success as with vaccine therapy.