Rhinitis: runny nose

Allergic rhinitis is characterized by repeated sneezing, “runny nose”, itchy nose, watery eyes and eye irritation. When caused by pollen, it is called seasonal rhinitis or, more commonly, hay fever.

Find out more about this disease in this sheet.

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What is allergic rhinitis?

These symptoms result from an abnormal sensitization and an overreaction of the immune system towards a substance foreign to the body called an allergen. Depending on the person, it may be plant pollen, mold, substances on animal hair or skin, or other particles. When this substance comes into contact with the eyes or respiratory tract of the allergic person, the immune system sets in motion an inflammatory reaction. Histamine and other inflammatory substances are then “unnecessarily” released. This reaction leads to the dilation of blood vessels and increased secretions linked to the appearance of symptoms of allergic rhinitis.

Allergic rhinitis usually appears between the ages of 5 and 20. According to the Canadian Allergy, Asthma and Immunology Foundation, 20% to 25% of Canadians suffer from allergic rhinitis. The symptoms tend to be more pronounced than before, according to the observation of several doctors. This phenomenon could be explained, among other things, by the increase in greenhouse gas emissions. These would in particular have the effect of increasing the production of pollen from plants and trees2.

Hay fever or persistent rhinitis?

Seasonal rhinitis: hay fever

Often called hay fever or « hay fever », it appears periodically, most often in the spring and summer, when the allergenic plant blooms.

In early spring, tree pollen is frequently the cause, while in July, it is more grasses (grass meadows, hay and lawn). People allergic to ragweed (Ambrosia artemisiifolia) suffer from it in late summer when the plant flowers. Note that moulds, which are more important during snowmelt and lawn maintenance, can also trigger allergic rhinitis.

Symptoms of seasonal rhinitis are usually aggravated by country trips as well as exposure to the outdoors. People with allergies suffer less when it rains (the rain knocks pollen down to the ground) and when they stay indoors, with doors and windows closed.

What about “hay fever”? The expression originated at the beginning of the 19th century. At the time, doctors observed the symptoms especially in peasants, after the haying season. It was called fever because those who had it became restless. Anciently, restlessness was considered one of the characteristics of fever. Note: patients with allergic rhinitis do not have a fever.

Persistent rhinitis

The majority of people with persistent rhinitis have a condition called vasomotor rhinitis that is non-allergic. It usually appears after the age of 20, and often occurs in stressful situations. It is triggered by changes in temperature or humidity, in the presence of smoke, dust, strong chemical odors or in response to medication or hormonal changes.

Persistent rhinitis can also be caused by allergenic substances permanently present in the person’s environment, at home or at work. The affected person seems to have a constant cold. Dust, animals and certain molds are all possible triggers. The crisis often starts when you wake up and can repeat itself several times a day.

Dust mites are a very common cause of persistent allergic rhinitis. These are microscopic mites that feed on the scales of human skin. They like warm and humid environments. They are found in mattresses, pillows, sofas, carpets and dust. People who react to dust mites are actually allergic to their droppings.

Symptoms of allergic rhinitis

Symptoms persist as long as the person is exposed to allergens. Although hay fever symptoms reappear each year as the plant flowers, they tend to diminish with age. On the other hand, some people develop pollen allergies only in adulthood.

Itchy, runny nose and very liquid secretions;
itchy, watery and red eyes;
serial sneezing;
nasal congestion;
tension in the sinus region;
sore throat, hoarse voice or cough;
itching in the throat or palate;
impaired taste, smell and hearing (especially in children);
fatigue, irritability and insomnia, when symptoms last for several days.

The causes of rhinitis

We do not know the exact causes of allergic rhinitis, but the genetic background would be a fairly important factor. Of a person who, by his genes, is more sensitive to allergies, we say that he has an “atopic terrain”. In other words, it overreacts to contact with normally commonplace and harmless allergens. This can lead to different manifestations: allergic rhinitis, asthma, hives, eczema, food allergies, conjunctivitis, etc. They can appear in isolation, simultaneously or successively, depending on the person.

Pollens are involved in seasonal allergic rhinitis. In Canada, ragweed remains the most important source of pollen. This is why public health authorities are conducting public awareness campaigns to eradicate this plant31. Quebecers are also advised to pull ragweed before it blooms in August.

Sources of pollen
Spring (mid-March to end of June)	Trees and shrubs
Summer (late May to mid-October)	Grasses (turf, hay, rye, wheat, corn)
Late summer (late July to October)	Ragweed

Consult the Allergies fact sheet to learn more about the factors responsible for the increase in cases of allergies in recent decades.

Allergic rhinitis: people at risk

Heredity seems to play an important role in the onset of allergies, including allergic rhinitis. When both parents have an allergy (it does not matter which), the risk for the child of suffering from allergic rhinitis is all the higher;
men are more at risk than women, for unknown reasons;
the eldest of the family.

Allergic rhinitis: risk factors

Repeated exposure to airborne allergens;
Exposure to cigarette smoke, particularly during the first year of life ²⁸ ;
Exposure to air pollution and other respiratory irritants (smoke from fireplaces, airborne pollutants) ^29,43-44 ;
The abuse of topical (aerosol) decongestants can worsen the condition of the mucous membranes of the nose and, consequently, cause medicamentous (non-allergic) rhinitis.

Allergic rhinitis: possible complications

Even if symptoms are mild, untreated allergic rhinitis can worsen and lead to chronic sinusitis. Persistent rhinitis is often linked to asthma, regardless of the intensity of the symptoms. Finally, in children, allergic rhinitis increases the risk of otitis media.

When to consult for allergic rhinitis?

It is better to consult a doctor if:

symptoms are persistent and affect quality of life;
symptoms are not relieved by over-the-counter medications;
the side effects of the drugs are poorly tolerated.

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Allergic rhinitis: how to diagnose it?

It is sometimes possible to discover the allergen that is causing the rhinitis. The doctor takes a history of the symptoms: when they appear and how. The allergens present in the person’s environment (home, office, school) are then listed. By trial and error, we can find out which elements are actually allergenic. When the allergen is difficult to find or when the medication does not work, a skin or blood test is carried out.

Skin test: the skin is exposed to very small doses of purified allergenic substances. These substances can be pollen from various plants, mold, animal dander, dust mites, bee venom, latex, penicillin, etc. We then observe the signs of allergic reactions (redness or small bump similar to an insect bite) after about twenty minutes.

Blood test (or RAST for radioallergosorbent test): a blood sample is subjected to different allergens. If the patient is allergic, for example to birch pollen, the antibodies (IgE) specific to birch pollen will bind to this allergen. This test also provides information on the concentration of antibodies present in the blood in reaction to the allergen. Although more expensive, this technique has the advantage of being risk-free since it does not expose the person directly to allergens.

At the moment, the only recognized basic preventive measure is to avoid smoking and second-hand smoke.

More details on these preventive measures in this sheet.

Allergic rhinitis: how to prevent it?

Can we warn?

Once allergic rhinitis has set in, there is no known treatment to get rid of it. However, sometimes it goes away on its own.

At the moment, the only recognized basic preventive measure is to avoid smoking and second-hand smoke. Tobacco smoke irritates the airways, creating a breeding ground for respiratory disease. Otherwise, there is no known measure that will definitely prevent allergic rhinitis. Nevertheless, the medical community is exploring various avenues of prevention. They could especially be of interest to parents with allergies, who want to reduce the risk that their child will also suffer from them. To find out about them, see our Allergies sheet.

Measures to reduce the frequency and intensity of symptoms

When you have allergic rhinitis, it is possible to reduce or prevent the worsening of symptoms by various means.

Reduce exposure to allergens

Pollen and mold

avoiding activities that expose you to large amounts of pollen, such as lawn mowing, mowing and weeding;
provide indoor ventilation using an air purifier equipped with a high-efficiency particulate filter or an electrostatic filter rather than opening the windows;
during hot summer days, use an air conditioner if necessary;
ensure adequate ventilation if heating with wood;
avoid drying clothes outside, as pollen may settle there;
keep the humidity level below 50%. Use a dehumidifier in an unfinished or damp basement to prevent mold growth;
keep plants to a minimum and eliminate clay pots to limit mould.

Note: the times when the amounts of pollen in the air are the lowest are from 10 a.m. until sunset, as well as during a rain or after.

Acarians

wash bedding frequently in hot water (at least 54°C or 130°F);
cover the mattress with an anti-mite cover and obtain washable synthetic foam pillows;
keep the humidity level below 50%;
clean rugs and carpets using a vacuum cleaner fitted with a good quality filter;
avoiding rugs and heavy draperies in the bedroom;
there are aerosol acaricides. After spraying the product on the mattresses, carpets, armchairs, ventilate the room thoroughly for several hours before staying there again;
to destroy mites and mite larvae lodged in plush toys, they can be put in the freezer for 72 hours. Repeat the operation every 3 months.

Animals

do not keep animals in the house, as much as possible. Cats are the most allergenic pets. There are no non-allergenic dogs or cats, but some breeds are worse than others. Animals with a woolly coat cause fewer reactions;
bathe your pet every week;
remove pet hair from the floor as often as possible;
keep the animal out of the bedroom.

Food

Some people who suffer from seasonal allergies are prone to a particular form of allergy to fruits, fresh vegetables or nuts. This reaction is called oral allergy syndrome. Depending on the case, the ingestion of the food or its contact with the mouth causes itching on the lips, tongue, palate and throat. Sometimes swelling of the lips, tongue, and uvula occurs.

A person allergic to birch pollen can have allergic reactions when eating a raw apple or carrot, while a person allergic to ragweed pollen can have this type of reaction when eating melons, bananas or raw cucumbers. These cross-reactions occur because the allergens contained in these pollens and these foods are chemically similar.

Symptoms of this type of food allergy usually remain mild. They only occur with raw foods. It is advisable to refrain from consuming them, especially during allergy season.

Other Irritating Factors May Make Symptoms Worse

tobacco smoke and fireplaces;
the perfumes ;
air pollution ;
wind or drafts;
temperature differences.

Measures to prevent complications

Treating the symptoms of allergic rhinitis as soon as they appear helps prevent complications, such as otitis media, asthma and chronic sinusitis.

Stopping exposure to known allergens is the first step in allergy treatment. Eliminating the allergen is not always possible, as in the case of pollen allergies.

Check out other rhinitis treatments below.

How to treat rhinitis?

Stopping exposure to known allergens is the first step in allergy treatment. Eliminating the allergen is not always possible, as in the case of pollen allergies.

Medications

Different medications can alleviate the symptoms of rhinitis. Some are taken by mouth, others are nasal sprays or eye drops (eye drops). If over-the-counter products do not work, the doctor may prescribe others that work differently.

Antihistamines

They work by blocking the production of histamine, a substance that causes allergy symptoms. They relieve sneezing, runny nose, and itchy eyes and throat. First-generation antihistamines caused drowsiness (Benadryl®). There are now, over the counter in pharmacies, antihistamines that do not have this side effect (Claritin®, Allegra®, Zyrtec®).

Decongestants

They quickly decrease the swelling of the nasal tissue. They are often used in combination with antihistamines. They are found in the form of syrups, tablets (Sudafed®, Actifed®) and nasal sprays (Néo-Synephrine®). They contain pseudoephedrine. Topical decongestants (in the form of sprays) should not be used for more than 3 consecutive days, as they may cause rebound rhinitis. It is therefore a temporary measure which should not be abused.

Rinsing the nasal passages

Rinsing the nasal passages with salt water is a simple, inexpensive, and effective method for relieving nasal congestion. A good rinse flushes mucus and allergens out of the nasal passages. Get a saline solution available in pharmacies or prepare your homemade solution with ¼ tsp. salt in 2 cups (500 ml) warm water. Use a nasal spray or syringe.

Nasal corticosteroids

These are anti-inflammatory drugs that block the allergic reaction (Flonase®, Nasacort®, Nasonex®). They are usually prescribed when antihistamines do not offer relief, more often in people who suffer from persistent rhinitis. They are administered directly into the nose, using a vaporizer. They can, however, cause irritation of the mucous membranes of the nose.

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Oral corticosteroids

They are sometimes used to relieve severe allergy symptoms. However, they are prescribed for a short period of time, as their long-term use can cause serious side effects.

Antidegranulants (sodium cromoglycate)

They act by preventing the release of histamine and other chemical mediators, initiators of allergic reactions. Products like Cromolyn®, Opticrom® and Nasalcrom® are used as nasal sprays or eye drops. Particularly effective in children and well tolerated, they seem to play a preventive role vis-à-vis allergic reactions when taken before the onset of symptoms. However, they must be administered several times a day.

Antileukotrienes

These prescription drugs (Singulair®, Accolate®) block the effects of leukotrienes. These are produced by the immune system during an allergic reaction and contribute to the onset of symptoms. Antileukotrienes are often used when a nasal spray is not well tolerated.

Progressive desensitization treatment

When the cause of the allergy is well defined and drug treatments are not effective, it is possible to consider desensitization or immunotherapy treatment. It consists of injecting, over a period of 3 to 5 years, increasing doses of the allergenic substance.

This treatment is only available for common allergens, such as pollens, cat and dog dander, dust mites and molds. It is particularly effective in case of allergies to pollen and dust mites. According to a meta-analysis of data from 16 clinical studies, 1 in 2 people obtain an improvement in their symptoms thanks to the desensitization treatment, compared to 1 in 4 for a placebo treatment ³⁰ .

Desensitization can also be done by taking daily drops or tablets that are allowed to melt under the tongue. This technique is called sublingual desensitization or SLIT (sublingual immunotherapy). Several studies and meta-analyses have found a decrease in symptoms compared to taking a placebo33-39.

However, no study has compared this technique to injection-based immunotherapy. Sublingual desensitization is commonly used in Europe, but is not permitted in Canada.

Surgery

If drug treatment is insufficient or in case of anatomical abnormalities of the nasal cavities, surgical treatment may be considered. Surgery is indicated for deviation of the nasal septum, for nasal polyps or to drain infected sinuses. The main purpose of surgery is to facilitate breathing, but in no case will it prevent an allergy from manifesting itself.

To unblock a baby’s or young child’s nose, remove some of the mucus using a syringe or nasal bulb. A drop of lukewarm saline water is then placed in each of the nostrils, placing the child so that the drop flows towards the back of the nose. The child is straightened as soon as the drop has entered the nose.

In the case of allergic rhinitis, certain complementary approaches make it possible to treat it in a more natural way.

Check out the full list below.

Allergic rhinitis: what complementary approaches to treat it?

Pétasite (Petasites hybridus)

Clinical trials tend to show that butterbur reduces the symptoms associated with seasonal allergic rhinitis4-10. The research comes from the Petasites Study Group, Switzerland. Moreover, the Swiss company Zeller has launched Tesalin® (also called Ze339), a butterbur extract sold only by prescription11.

Tesalin® was approved for the treatment of allergic rhinitis by the Swiss authorities in 2003. According to experimental research, butterbur has anti-inflammatory and anti-allergic properties.

See the Butterbur data sheet for more information.

Dosage: take 50 mg of standardized extract, 2 times a day.

Homeopathy

Homeopathy is one of the most studied unconventional approaches for the treatment of seasonal rhinitis. According to homeopaths, there would be a way to carry out an in-depth desensitization with homeopathy, but it is a very complex work which must necessarily be undertaken with a homeopathic allergist.

According to Mireille de Feytaud, herself an allergist and homeopath, such desensitization is often very effective: the same products are used as for conventional desensitizations, but in the form of homeopathic dilutions ⁴⁰ .

The results of clinical trials are promising, particularly with the product called Galphimia glauca, made from a plant. A meta-analysis including 7 double-blind clinical trials with placebo focused on this homeopathic product18. Overall, homeopathic treatment was found to be more effective than placebo for symptoms related to the eyes and nose, with a 79% success rate.

However, experts consider that studies of better methodological quality are necessary to be able to come to a conclusion about the effectiveness of homeopathy ¹⁹ . Other studies have focused on isopathic remedies, that is to say, prepared from high dilutions of the same substances that cause allergic reactions (pollen for example). Some studies support their effectiveness, while others do ^not . So far, no studies have compared the effectiveness of homeopathy to that of commonly used drugs to treat allergic rhinitis.

Acupuncture

Several case studies report beneficial effects21-23. However, a randomized clinical trial, conducted for 12 months with 40 subjects24, did not observe any difference between the subjects of a group treated with acupuncture and those of another treated with placebo acupuncture.

In addition, another study conducted later on 52 people with seasonal allergic rhinitis indicates that Chinese medicine treatments, including acupuncture, reduce the intensity of symptoms more effectively than placebo treatments ²⁵ . A review of 7 placebo-controlled clinical trials found no convincing evidence of the effectiveness of acupuncture for treating allergic rhinitis ³² .

Quercetin

Quercetin, a flavonoid from plant sources, would inhibit the production of histamine ^13-16 . It is believed that quercetin may reduce the inflammatory reactions of allergic rhinitis. Clinical trials will have to be undertaken in order to evaluate its real effectiveness in relieving the symptoms associated with these allergies.

Vitamin C

Vitamin C is sometimes suggested for the treatment of respiratory allergies. However, the studies carried out so far are preliminary and have obtained contradictory results ¹⁷ .

Stinging nettle (Utica dioica)

Nettle has traditionally been used to cure the symptoms of allergic rhinitis. A double-blind, placebo-controlled study in 69 subjects indicates that a freeze-dried extract of nettle leaves can significantly relieve the symptoms of allergic rhinitis12.

Dosage: consult the Nettle sheet.

bee pollen

Referring to the positive results of the desensitization treatment offered in conventional medicine against seasonal rhinitis, therapists recommend that people with allergies take bee pollen. This should preferably be produced locally so that it contains the pollens that cause the allergies suffered by those who live in a given region.

To our knowledge, no clinical trials have been conducted to verify the effectiveness of bee pollen in this regard. The great variability of the various commercially available pollen products and the difficulty of precisely dosing the administration of allergens in particular limit the use of bee pollen in immunotherapy. Especially since, even administered at low doses, this product has already caused serious allergic reactions in some patients.

Hypnotherapy

Hypnotherapy may reduce or completely prevent allergic reactions and help the immune system relearn how to respond well to the offending ^substances .

Chinese pharmacopoeia

The Jie Min Tang is a decoction which allows to constrain the allergy. The preparation Yu Ping Feng San (Wan) is also used in Chinese medicine in case of allergic rhinitis.

According to Traditional Chinese Medicine, allergic rhinitis is induced by an external Wind which causes the typical symptoms of nasal congestion (nasal pruritus, sneezing, clear, fluid and abundant rhinorrhea, etc.). However, this external pervert always attacks the Lung under the influence of a Void. This Void comes mainly from 3 organs: the Lungs, the Spleen and the Kidneys.

Dietary recommendations

According to Dr. Andrew Weil, allergies can disappear thanks to certain modifications of the living environment in order to reduce exposure to the allergen in question, but also by dietary changes26,41,42. For example, he recommends following a low-protein diet.

An excess of proteins would keep the immune system in a state of hyper-reactivity. In addition, he advises eliminating milk and dairy products (except yogurt) from his diet.

relaxation techniques

Observe whether the allergy is influenced by the degree of stress. Dr. Andrew Weil has already observed that people who have eliminated a major source of stress have seen their chronic allergy disappear26,42. Any approach that promotes relaxation can be beneficial.