Rhinitis
Related Terms
Acute rhinitis, airborne allergens, allergen, allergen immunotherapy, allergic reaction, allergic response, allergies, allergy, antihistamine, atrophic rhinitis, butterbur, choline, chronic rhinitis, corticosteroid sprays, cromolyn sodium, decongestant, ephedra, hay fever, histamine, Ig, IgE, immune, immune defense system, immune reaction, immune response, immune system, immunoglobulin, immunoglobulin E, immunotherapy, nasal allergies, nasal congestion, nasal irrigation, nasal sprays, nonallergic rhinitis, perennial rhinitis, pollen, pollinosis, postnasal drip, radioallergosorbent test (RAST?), seasonal allergic rhinitis, seasonal allergies, sinusitis, snuffles, stinging nettle, vasomotor rhinitis, vitamin E.
Background
Rhinitis is the medical term for inflammation of the nose. Viruses, bacteria, allergens, and irritants can cause inflammation of the nasal mucous membranes, which results in rhinitis. Once inflamed, the nose produces excessive mucus, which causes a runny nose, nasal congestion, and postnasal drip (when mucus drips from the sinuses, down the throat).
Allergic rhinitis is one of the most common allergies. This type of rhinitis occurs when the body's immune system overreacts to allergen (a substance that can cause an allergic reaction), in this case, an airborne substance that is normally harmless, such as mold, pollen, animal dander, or dust mites.
Once the allergen is inhaled through the nose, white blood cells of an allergic individual produce an antibody called immunoglobulin E (IgE). This immunoglobulin attaches to the allergen, which triggers the release of histamine and other inflammatory chemicals that cause allergic rhinitis symptoms, such as runny nose and nasal congestion.
Allergic rhinitis may occur as either acute (short-term) or chronic (long-term). Acute rhinitis is short-term and classified as the common cold, while chronic rhinitis is recurrent, with periods of remission in between. Chronic rhinitis lasts three months or longer.
There are two types of allergic rhinitis:
seasonal allergic rhinitis and perennial allergic rhinitis.
Seasonal allergic rhinitis, also called pollinosis, hay fever, or nasal allergies, is characterized by several symptoms, predominantly in the nose and eyes. Symptoms occur after airborne allergens like dust, dander, or pollen are inhaled. When pollens cause the allergic symptoms, the allergic rhinitis is commonly referred to as "hay fever." According to the American Lung Association, an estimated 26.1 million Americans have hay fever symptoms each year, and 14.6 million Americans have asthma, which often accompanies hay fever.
Perennial allergic rhinitis is an allergic reaction to allergens that is not seasonal. Instead, symptoms are persistent and generally less severe than seasonal allergic rhinitis.
Some individuals, especially children, may outgrow allergic rhinitis as the immune system becomes less sensitive to certain allergens. Minimizing exposure to known allergens may help prevent or reduce allergy symptoms. Treatment for allergic rhinitis depends on the severity and frequency of the symptoms. Patients may benefit from allergy medications like antihistamines, mast cell stabilizers, decongestants, leukotriene receptor antagonists, and nasal corticosteroid sprays.
Author information
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Bibliography
Al Suleimani YM, Walker, MJ. Allergic rhinitis and its pharmacology. Pharmacol Ther. 2007 Feb 28; [Epub ahead of print.] .
American Academy of Allergy Asthma & Immunology. .
American Lung Association. .
Asthma and Allergy Foundation of America. .
Centers for Disease Control and Prevention. .
Children's Hospital and Medical Center. .
Natural Standard: The Authority on Integrative Medicine. .
Pawankar R, Takizawa R. Revisiting the link between allergic rhinitis and asthma. Curr Allergy Asthma Rep. 2007 May;7(2):77-8. .
Causes
Airborne substances known as allergens cause allergic rhinitis. These allergens are usually harmless and only cause allergic symptoms in some people.
Typically, an allergic response is not triggered the first time the body encounters the allergen. The first time or several times after the body is exposed to an allergen, the immune system becomes sensitized. During this process, the body's white blood cells develop immunoglobulin E (IgE) antibodies to the allergen. Once sensitized, the antibodies quickly detect and bind to the allergens in the body. These antibodies also trigger the release of chemicals (like histamine) that cause allergic symptoms, such as runny nose and sneezing.
Common outdoor allergens, such as pollen, grass, and trees, can cause seasonal allergic rhinitis. When pollen causes allergic rhinitis, the condition is often referred to as hay fever.
Common indoor allergens, such as animal dander, mold, and dust, can cause perennial allergic rhinitis.
Symptoms
Symptoms of allergic rhinitis vary greatly among individuals. Common symptoms include cough, headache, itchy nose, itchy mouth, itchy throat, itchy skin, nosebleeds, impaired smell, watery eyes, sore throat, wheezing, fever, cross-reactivity allergy to some fruits, allergic pinkeye, nasal congestion, postnasal drip, runny nose, and swelling of the nasal tissues (which can cause headaches). Some patients, especially those suffering from vasomotor rhinitis, sneeze when transitioning from a cold room to a warmer one.
Diagnosis
General: Healthcare providers should take a careful medical history to determine whether the patient's symptoms vary depending on the time of day or season. A skin test or allergen-specific immunoglobulin E (IgE) test may be performed to pinpoint specific allergens that are causing the symptoms.
Skin test: A skin test is used to determine whether a patient is allergic to certain substances, such as mold, dust mites, or animal dander. During the test, the skin is exposed to different allergens (allergy-causing substances) and then observed for an allergic reaction. Some tests, such as the percutaneous (puncture, prick or scratch) test, detect immediate allergic reactions that develop within minutes of exposure to an allergen. Other tests, such as the epicutaneous (patch) test, detect delayed allergic reactions that develop over the course of several days. If an allergen triggers an allergic reaction to a test, the patient will develop reddening, swelling, or a raised, itchy red wheal (bump) that looks similar to a mosquito bite. The healthcare provider will measure the size of the wheal and record the results. The larger the wheal, the more severe the allergy.
Allergen-specific immunoglobulin E (IgE) test: An allergen-specific immunoglobulin E (IgE) test, commonly often referred to as radioallergosorbent test (RAST?), is a type of blood test that can help determine if a patient who experiences allergy symptoms, such as runny nose, watery eyes, and hives, is allergic to particular substances called allergens.
The in vitro test (performed outside of the body in a laboratory setting) exposes a blood sample to suspected allergens (like dust mites, pollen or animal dander) to determine whether the patient has developed allergen-specific immunoglobulin E (IgE) antibodies. Antibodies are proteins that recognize and bind to specific antigens.
During the procedure, a sample of blood is taken from the patient. The blood is then sent to a laboratory that performs specific IgE blood tests. An allergen-antigen complex is bound to a paper disc called an allergosorbent, and the patient's blood is added. If the blood contains antibodies to the specific antigen, it will bind to the "tagged" immunoglobulins.
RAST? is less accurate than a skin test. However, if the patient has a severe skin disease (such as eczema or psoriasis) that is present on large areas of skin on the arms or back, a skin test may not be possible. This is because the skin test may only be performed on the arms and back, and there may not be enough unaffected skin to perform a conclusive test. For these patients, an allergen-specific IgE test is the preferred diagnostic method. RAST? is also the preferred method of allergen-specific IgE testing for patients that have experienced an anaphylactic (life-threatening) reaction in the past.
Treatment
General: Treatment for allergic rhinitis depends on the severity and frequency of the symptoms. Patients may benefit from allergy medications like antihistamines, mast cell stabilizers, decongestants, leukotriene receptor antagonists, and nasal corticosteroid sprays. Minimizing exposure to known allergens may also help prevent or reduce allergy symptoms.
Allergen immunotherapy:Allergen immunotherapy, also known as allergy shots, is often used to treat patients who suffer from severe allergies or for those who experience allergy symptoms more than three months per year. Allergen immunotherapy involves injecting increasing amounts of an allergen into a patient over several months. Immunotherapy does not cure allergies, but it may help reduce the body's sensitivity to certain substances. During therapy, some patients may not experience any allergy symptoms.
Short-acting antihistamines: Short-acting antihistamines, such as diphenhydramine (Benadryl?), have been used to relieve mild-to-moderate allergy symptoms. Most short-acting antihistamines are available over-the-counter. These medications typically take about 15-30 minutes to take effect, and more than one dose may be taken in a single day. Most short-acting antihistamines are taken every 4-6 hours, depending on symptoms. Patients should carefully read the packaging labels and follow the directions of their healthcare providers and pharmacists.
Short-acting antihistamine medications often cause drowsiness. Many short-acting antihistamines have been shown to impair cognition (slow learning) in children, even in the absence of drowsiness. Therefore, these drugs are generally not recommended in children, unless taken under the strict supervision of their healthcare providers. Loratadine (Claritin?), which is now available over-the-counter, does not cause drowsiness or affect learning in children.
Longer-acting antihistamines: Longer-acting antihistamines, such as fexofenadine (Allegra?) or cetirizine (Zyrtec?), are available by prescription for mild-to-moderate allergy symptoms. These medications are generally taken once daily to relieve long-term allergies to allergens like pet dander.
These medications cause less drowsiness than short-acting antihistamines, and they are equally effective. While these drugs usually do not interfere with learning, they should only be used in children under the strict supervision of their healthcare providers. Common side effects may include drowsiness, dry mouth, headache, sore throat, stomach pain, vomiting, or diarrhea.
Decongestant pills or sprays: Decongestants can be used to relieve nasal congestion (stuffy nose) when the patient is not responding to other allergy medications like antihistamines or cromolyn sodium. Decongestant nasal sprays should not be used for long periods of time. Nasal spray decongestants like oxymetazoline (Afrin?) should not be used more than twice daily for three consecutive days, because rebound congestion may occur. This means that symptoms of nasal congestion will return.
Ipratropium (Atrovent?): Ipratropium is a nasal spray that has been used to relieve a runny nose. Patients who are allergic to peanuts should not use Atrovent? because some formulations are manufactured with peanut products.
Leukotriene receptor antagonists: Leukotriene receptor antagonists block the action of leukotrienes, which are also important mediators of the allergic response. New leukotriene receptor antagonists, such as montelukast (Singulair?) and zafirlukast (Accolate?), can effectively treat rhinitis without some of the common side effects like drowsiness. These long-acting medications are taken once daily.
Mast cell stabilizers:
Mast cell stabilizers like cromolyn sodium have been used to treat symptoms of hay fever. Cromolyn sodium is available over-the-counter as a nasal spray (NasalCrom?) to treat hay fever. Eye drop versions of cromolyn sodium are also available for itchy, bloodshot eyes. Cromolyn sodium does not cause rebound congestion.
Nasal corticosteroid sprays:Nasal corticosteroid sprays are the strongest medications that treat allergic rhinitis. Corticosteroid sprays reduce and control the effects of the mediators that cause inflammation of the nose. These medications have been shown to improve symptoms of allergic rhinitis, including sneezing, itching, and runny nose. Commonly prescribed nasal corticosteroids include fluticasone (Flonase?), mometasone (Nasonex?), and triamcinolone (Nasacort?). Symptoms will not start to improve for at least 12 hours after the medication is taken. Nasal corticosteroid sprays do not cause rebound congestion.
Integrative therapies
Strong scientific evidence:
Whey protein: Hydrolyzed whey protein formula may be effective in preventing certain allergies. However, additional research is needed before a definitive conclusion can be made.
Use cautiously in patients using any medications because drugs may bind to human milk whey proteins. As a result, the levels of these drugs may be changed in the blood. Since whey protein may lower blood sugar levels, caution is advised in patients with diabetes or hypoglycemia. Caution is advised in those taking drugs, herbs, or supplements that affect blood sugar, increase the risk of bleeding, lower blood pressure, or affect the immune system. Whey protein may interfere with the way the body processes certain drugs, herbs, or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of these agents may change in the blood and may cause increased or decreased effects or potentially serious adverse reactions. Avoid use of excessive doses for long periods of time, because it may cause kidney damage or bone loss. Avoid with known allergy or hypersensitivity to milk or milk products. Avoid in pregnant or breastfeeding women.
Good scientific evidence:
Bromelain: Bromelain may be a useful addition to other therapies used for sinusitis (such as antibiotics) due to its ability to reduce inflammation and swelling. Studies report mixed results, although overall, bromelain appears to be beneficial for reducing swelling and improving breathing. Better studies are needed before a firm conclusion can be made.
Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or members of the Bromeliaceaefamily. Use cautiously in those with history of bleeding disorder, stomach ulcers, heart disease, liver or kidney disease. Use caution before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.
Butterbur: Good scientific evidence suggests that butterbur may be effective for allergic rhinitis prevention in susceptible individuals. Comparisons of butterbur to prescription drugs, such as fexofenadine (Allegra?) and cetirizine (Zyrtec?), have reported similar efficacy. Additional studies are warranted before a firm conclusion can be made.
Avoid if allergic or hypersensitive to Petasites hybridus or other plants from the Asteraceae or Compositae family (such as ragweed, marigolds, daisies, and chrysanthemums). Raw, unprocessed butterbur plant should not be eaten due to the risk of liver or kidney damage or cancer. Avoid if pregnant or breastfeeding.
Galphimia glauca: Research indicates that
Galphimia glauca, alone or in combination with other agents, has been effective in the treatment of allergies due to its reduction of nasal and ocular symptoms. Additional studies are needed before a firm conclusion can be made.
Use Galphimia glauca cautiously in patients with psychiatric disorders, as feelings of confusion and lack of concentration may occur. Use Zicam? Allergy Relief Nasal Pump (a Galphimia glauca combination product) cautiously in patients who have ear, nose, and throat sensitivity or who are susceptible to nosebleeds. Use cautiously in patients taking CNS depressants. As Galphimia glauca may increase the risk of bleeding, use cautiously in patients with blood disorders or those using anticoagulants or antiplatelets. Avoid with known allergy or hypersensitivity to Galphimia glauca, its constituents, or to members of the Malpighiaceae family.
Nasal irrigation: There is good evidence from clinical studies to recommend the use of nasal irrigation in the treatment of allergic rhinitis. One study demonstrated that reflexology massage may be equally effective. However, the advantages of irrigation (i.e. inexpensive, performed at home, minimal adverse side effects) make the technique beneficial. Methodological and statistical reporting are lacking in some of these trials. A well-conducted randomized controlled trial, fully reporting data, would make the case for allergic rhinitis stronger.
Early research suggests that nasal irrigation may help treat chronic sinusitis, with improvements in sinus-related quality of life, decreases in symptoms, and reductions in medication use. Further research is needed before a conclusion can be made.
Nasal irrigation is generally well tolerated. Use cautiously in those with a history of frequent nosebleeds. If the irrigation liquid is hot, the nose may become irritated.
Probiotics: Use of probiotic
Enterococcus faecalis bacteria in hypertrophic sinusitis (sinus inflammation) may reduce the frequency of relapses and the need for antibiotic therapy. Further research is necessary before a firm conclusion can be made.
Probiotics are generally considered safe and well tolerated. Use cautiously if lactose intolerant. Avoid if allergic or hypersensitive to probiotics.
Unclear or conflicting scientific evidence:
Acidophilus: Although it has not been well studied in humans, some research has suggested that lactic acid-producing bacteria, such as
L. acidophilus, may reduce allergic responses of the immune system. There is some evidence that milk fermented with
L. acidophilus strain L-92 may relieve the symptoms of allergic rhinitis; however, immune parameters were not affected in studies examining
L. acidophilus alone as a therapy for allergic rhinitis. Further studies are needed before a conclusion can be made.
L. acidophilus is generally well tolerated, with very few side effects. Lactose-sensitive people may develop abdominal discomfort or other side effects from L. acidophilus-containing products, due to small amounts of lactose left over from the manufacturing process. Avoid in patients with weakened immune systems or milk allergies. Avoid in those with a history of injury or illness of the intestinal wall or heart valve surgery. Use cautiously in those with heart murmurs. Avoid use with immunosuppressive prescription drugs, such as corticosteroids, due to an increased risk of infection. Antibiotics or alcohol may destroy L. acidophilus. Therefore, it is recommended that L. acidophilus be taken three hours after taking antibiotics or drinking alcohol. Some individuals may use antacids, such as famotidine (Pepcid?) and esomeprazole (Nexium?), to decrease the amount of acid in the stomach one hour before taking L. acidophilus.
Acupuncture: Although some studies suggest that acupuncture may offer possible benefits to those with nonallergic rhinitis, there is currently insufficient available evidence on which to base recommendations. Additionally, further well-designed studies are needed to determine whether or not acupuncture offers benefit for sinusitis.
Acupuncture should be avoided in patients with heart disease, pulmonary disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Pregnant women, the elderly, diabetics, people with a history of seizures, those receiving radiation therapy, and those taking drugs that increase the risk of bleeding should also avoid acupuncture.
Applied kinesiology: Applied kinesiology (AK) has been used to diagnose a variety of allergies, including food intolerances, but currently there is a scarcity of strong evidence to support this application.
AK techniques in themselves are considered to be harmless. However, medical conditions should not be treated with AK alone, and using AK should not delay appropriate medical treatment. There is not enough evidence available to suggest that AK is safe for use during pregnancy and breastfeeding.
Aromatherapy: Despite its widespread use in over-the-counter agents and vapors, there is not enough scientific evidence to recommend use of eucalyptus oil as a decongestant-expectorant (by mouth or inhaled form).
Essential oils should be administered in a carrier oil to avoid toxicity. Avoid in those with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
Astragalus: According to one study, astragalus, as part of a combination formulation, decreased runny nose in patients with seasonal allergic rhinitis. Additional well-designed trials are needed to confirm this finding.
Avoid with aspirin or aspirin-containing products or herbs or supplements with similar effects. Avoid in those with inflammation or fever, stroke, transplants, or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery or dental or diagnostic procedures with a risk of bleeding, and avoid use immediately after these procedures. Use cautiously in those with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously with blood thinners, blood sugar drugs, or diuretics, or herbs and supplements with similar effects. Avoid if allergic to astragalus, peas, or any related plants, and in those with a history of Quillaja bark-induced asthma. Avoid if pregnant or breastfeeding.
Black seed: Studies in patients with allergies found that black seed decreased subjective measures of severity of allergies. The effect of black seed for allergies is still not clear, and further research is required before a conclusion can be made.
Avoid with a known allergy or hypersensitivity to black seed, its constituents, black seed oil, or members of the Ranunculaceae family. Allergic contact dermatitis has been reported after topical use of black seed or the oil from the seed.
Cat's claw: It has been suggested that cat's claw may help treat allergies and related respiratory diseases. However, there is currently limited scientific evidence to support this claim. More well-designed trials are needed to determine whether cat's claw is a beneficial treatment.
Avoid if allergic to cat's claw or Uncaria plants or plants in the Rubiaceae family, such as gardenia, coffee, or quinine. Avoid in those with history of conditions affecting the immune system (such as AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis, and lupus). Use cautiously in those with bleeding disorders or with a history of stroke, or in those taking drugs that may increase the risk of bleeding. Stop use two weeks before surgery or dental or diagnostic procedures with a bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding. Cat's claw may be contaminated with other Uncaria species. Reports exist of the potentially toxic Texan-grown plant Acacia gregii being substituted for cat's claw.
Cayenne: Limited evidence suggests that capsaicin nasal spray may help reduce nasal congestion in patients with chronic rhinitis. However, additional research is needed before conclusions can be made.
Cayenne is considered safe for most healthy people in amounts commonly found in foods. Avoid in patients with known allergy or hypersensitivity to plants in the genus Capsicum and the Solanaceae family, bell peppers, dihydrocapsaicin, tropical fruits (banana, kiwi), latex, paprika, and tree pollens. Use cautiously in patients under the following circumstances: those with acute anal fissures (or in those having just had surgery for anal fissures), addictive personalities, bleeding disorders (or in those taking agents that may increase the risk of bleeding), diabetes (or in those using blood sugar-lowering agents), gastrointestinal disorders (including ulcers), or heart disease (or in those using medications for cardiovascular (heart) disorders); or in those taking angiotensin-converting-enzyme (ACE) inhibitors (blood pressure-lowering drugs), aspirin products, or theophylline. Avoid in pregnant or lactating women.
Choline: Oral tricholine citrate (TRI) effectively relieved allergic rhinitis symptoms in limited available research. Further research is needed before a firm conclusion can be made.
Choline is generally regarded as safe and appears to be well tolerated. Avoid if allergic to choline, lecithin, or phosphatidylcholine.
Cinnamon: Preliminary evidence suggests that cinnamon may have antiallergic properties. In human research, a combination product containing
Cinnamomum zeylanicum,
Malpighia glabra, and
Bidens pilosa reduced allergic nasal symptoms in patients with allergic rhinitis. More well-designed trials are needed before a firm conclusion can be drawn.
Use cautiously in those prone to atopic reactions and in those taking cytochrome P450 metabolized agents, anticoagulants (blood thinners), insulin or blood sugar-altering medications, antibiotics, or cardiovascular agents. Avoid if allergic or hypersensitive to cinnamon, its constituents, members of the Lauraceae family, or balsam of Peru. Avoid if pregnant or breastfeeding.
Caution is advised in patients with diabetes or hypoglycemia, those at risk of diabetes, and those taking drugs, herbs, or supplements that affect blood sugar. Caution is advised when using medications that may also affect cholesterol, lower blood pressure, or increase the risk of bleeding. Use cautiously in patients with gastrointestinal disorders, heart disease, immune disorders, or skin disorders, and in those at risk for inflammatory disorders. Use cautiously in children and pregnant or breastfeeding women. Avoid in patients with liver disorders.
Elder: Elder may offer benefits for bacterial sinusitis, such as reducing excessive mucus secretion. Herbal preparations containing elder may result in less swelling of mucus membranes, better drainage, milder headache, and decreased nasal congestion.
Cyanide toxicity is possible. Avoid if allergic to elder or to plants related to honeysuckle. Some reports exist of allergies from contact with fresh elder stems. Use caution in those with diabetes, high blood pressure, or urinary problems, or with drugs used for any of these conditions. Use caution with anti-inflammatories, diuretics ("water pills" for high blood pressure), or laxatives. Avoid if pregnant or breastfeeding.
Ephedra: Preliminary research suggests that ephedrine nasal spray may help treat allergic rhinitis. Additional research is needed.
Ephedra taken by mouth may cause serious side effects, including heart attack, seizure, and stroke. Therefore, ephedrine nasal sprays should only be used in the nose. The U.S. Food and Drug Administration (FDA) has collected thousands of reports of serious toxicity linked to ephedra (including over 100 deaths). Ephedra products are banned from dietary supplements because of serious health risks, including heart attack, heart damage, breathing difficulties, and fluid retention in the lungs. Avoid in those with history of high blood pressure, abnormal heart rate, heart attack, stroke, seizure, eating disorders, anxiety, prostate disease, mental illness, kidney disease, stomach ulcers, heart disease, eye disease, depression, diabetes, thyroid disease, or sleep problems. Avoid if pregnant or breastfeeding.
Eucalyptus oil: There is currently insufficient available evidence to evaluate use of eucalyptus oil as a decongestant-expectorant. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, lung disease, or the blood condition known as acute intermittent porphyria. Use caution if driving or operating machinery. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
Green tea: Limited research suggests that
benifuuki green tea may reduce allergic reaction to the Japanese cedar tree. Additional studies are needed before a conclusion can be made.
Avoid if allergic or hypersensitive to green tea, its constituents, caffeine, tannins, or members of the Theaceae family. Use cautiously in those with diabetes or liver disease. Avoid if pregnant or breastfeeding
Honey: Currently, there is insufficient human evidence to recommend honey for the treatment of rhinoconjunctivitis.
Avoid if allergic or hypersensitive to honey, pollen, celery or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
Horseradish: Several studies suggest that some horseradish constituents may offer antibiotic activity and may help treat sinusitis. Additional high-quality clinical studies are needed before a conclusion can be made.
Avoid if allergic or hypersensitive to horseradish (Armoracia rusticana), its constituents, or members of the Brassicaceae family. Large oral doses may provoke allergic reactions. Use cautiously in those with clotting disorders, hypotension (low blood pressure), thyroid disorders, kidney disorders and inflammation, gastrointestinal conditions, and ulcers. Use cautiously if taking anticoagulants or antiplatelets (blood-thinning agents), antihypertensives (blood pressure-lowering agents), anti-inflammatory agents, or thyroid hormones. Use cautiously if undergoing treatment for cancer. Avoid medicinal amounts of horseradish if pregnant or breastfeeding; based on herbal textbooks and folkloric precedent, horseradish has been used to induce abortion.
Hypnotherapy, hypnosis: It has been suggested that hypnotherapy may be effective for allergies and may help treat hay fever. However, further research is necessary.
Use cautiously in those with mental illnesses such as psychosis, schizophrenia, manic depression, multiple personality disorder, or dissociative disorders. Use cautiously with seizure disorders.
Kiwi: Conclusive data on kiwi's therapeutic benefits for preventing lung conditions and other respiratory problems are currently lacking. Kiwi and other fruits high in vitamin C may provide benefit for lung conditions in children, especially wheezing. More research is warranted before a conclusion can be made.
Avoid if allergic or hypersensitive to kiwi, latex, birch pollen, banana, chestnut, fig, flour, melon, poppy seeds, rye grain, sesame seeds, and related substances. Kiwi is generally considered safe when taken in amounts naturally found in foods. Use cautiously with antiplatelet drugs such as aspirin, cilostazol, and clopidogrel. Use cautiously with hormone therapies or serotonergic drugs. Avoid if pregnant or breastfeeding, because clinical trials testing safety in supplemental doses are currently lacking. The amount found in foods appears to be safe in most people.
Lactobacillus GG (LGG): Preliminary research suggests that consumption of a fermented milk product containing
Lactobacillus GG (LGG) may decrease nasal congestion in patients with allergy to Japanese cedar pollen. Further research on the effect of LGG alone is required before conclusions can be made.
Avoid with known allergy or sensitivity to dairy products, if LGG is taken as part of a dairy product. LGG is possibly safe when used during pregnancy, six months before delivery, and during breastfeeding for up to six months. Use caution in pregnant mothers and infants at risk of development of atopic dermatitis, due to the risk of the children developing wheezing bronchitis. Avoid in patients with injury to the lining of the intestine and those with below-normal immune function.
Luffa (Luffa operculata): Research has shown that a combination of herbs containing
Luffa operculata may reduce symptoms of allergic rhinitis and sinusitis. However, well-designed clinical trials in support of
Luffa operculata for any use are lacking, and the effects of
Luffa operculata alone have not been determined. Further research is warranted before firm conclusions can be made.
Use cautiously in patients who suffer from nosebleeds, nasal irritation, or necrosis of the nasal pyramids, as Luffa operculata may cause nose bleeds. Avoid with known allergy or hypersensitivity to Luffa operculata or other members of the Cucurbitaceae family. Avoid in patients taking other medications or herbs via inhalation, as Luffa operculata may produce changes in the lining of the nose and sinuses, thereby changing the effect of the agents in the nasal spray.
MSM: According to preliminary clinical research, MSM reduces symptoms associated with seasonal allergic rhinitis. However, larger controlled trials are needed to confirm these findings.
Avoid if allergic or hypersensitive to MSM. The long-term effects of supplementation with MSM have not been examined. Avoid if pregnant or breastfeeding.
Omega-3 fatty acids, fish oil, alpha-linolenic acid: Population research suggests that consumption of fish once weekly or more was associated with reduced risk of child eczema. Maternal supplementation also decreased the risk of food allergy and IgE-associated eczema in the first year. Further research is required to determine the effect of omega-3 fatty acids on other symptoms of allergy.
Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, or linolenic acid or omega-3 fatty acid products that come from nuts. Use cautiously with high blood sugar levels, bleeding disorders, diabetes, low blood pressure, high levels of LDL cholesterol, tachycardia, or arrhythmia (altered heart rhythm). Use cautiously if at risk for hormone imbalance or if undergoing hormone replacement therapy. Use cautiously in patients with asthma, inflammatory bowel disease, or liver disease; in patients at risk for colon cancer; or in those using drugs or herbs or supplements that treat any such conditions. Fish oil taken for many months may cause a deficiency of vitamin E and may increase the risk of vitamin A or D toxicity. Use large amounts cautiously. Use cautiously if pregnant or breastfeeding.
Onion: Research has shown that topical application of an alcoholic onion extract significantly reduced responses to allergies. Although this is intriguing, more research is needed in this area to establish the efficacy and dosing of topical onion extracts.
Avoid if allergic or hypersensitive to onion (Allium cepa), its constituents, or members of the Liliaceae family. Use cautiously in those with hematologic (blood) disorders, diabetes, hypoglycemia (low blood sugar), or hypotension (low blood pressure). Use cautiously if taking anticoagulants or antiplatelets (blood thinners). Avoid medicinal doses if pregnant or breastfeeding.
Ozone therapy: According to limited research, irrigation of the paranasal sinuses with an ozone-oxygen mixture may help promote recovery from sinusitis. More well-designed trials are needed before a conclusion can be made.
The safety of various types of ozone therapy has not been systematically studied. Because ozone is a toxic gas, the safety of ozone therapy has been questioned. Serious side effects may occur from the introduction of ozone into the body, including shortness of breath, blood vessel swelling, poor circulation, heart problems, or stroke. A case of death has been reported due to gas embolism. Ozone therapy may lower blood sugar levels. Caution is advised when using medications, herbs, or supplements that may also lower blood sugar. Use cautiously in patients with respiratory disorders such as asthma. Ozone therapy is not recommended in pregnant or breastfeeding women, due to a lack of available scientific evidence.
Perilla: Preliminary evidence suggests some benefit of perilla extract for seasonal allergies. Further clinical trials are required before conclusions can be made.
Avoid if allergic or hypersensitive to perilla or members of the Lamiaceae or Labiatae family. Use cautiously in those with cancer, low HDL cholesterol, or immune disorders. Use cautiously if taking NSAIDs or barbiturates. Avoid if pregnant or breastfeeding.
Probiotics: Only a few types and combinations of probiotics have been studied for allergies. They have been studied mostly in children, teenagers, and young adults. Further research is necessary before a firm conclusion can be made.
Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
Reflexology: Reflexology involves the application of manual pressure to specific points or areas of the feet called "reflex points" that are believed to correspond to other parts of the body. Results from early studies are not conclusive regarding the use of reflexology for chronic sinusitis.
Avoid in those with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation before using in those with osteoarthritis affecting the foot or ankle or those with severe vascular disease of the legs or feet. Use cautiously in those with diabetes, heart disease, unstable blood pressure, cancer, active infections, past episodes of syncope (fainting), mental illness, gallstones, kidney stones, or a pacemaker. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
Shea butter: Shea butter is derived from the nut of the shea tree (
Vitellaria paradoxa), which grows in West Africa. In human research, shea butter has been shown to produce relief from nasal congestion. Additional research is needed before a definitive conclusion can be made.
Avoid with known allergy or hypersensitivity to shea butter or its constituents. Use cautiously in those with allergies to latex. Use cautiously in those taking anticoagulants. There is currently insufficient available safety evidence for use of shea butter during pregnancy or breastfeeding.
Sorrel: Research suggests that an herbal combination preparation containing sorrel, Sinupret?, may have beneficial effects in improving symptoms of sinusitis when used with antibiotics. It is not clear if these same effects would be seen with sorrel alone or what dose may be safe and effective. For allergic rhinitis, there is not enough evidence to make a conclusion at this time. More research of sorrel alone is needed.
Avoid sorrel in those with a known allergy to sorrel or any of its constituents. Avoid large doses of sorrel, because there have been reports of toxicity and death. Many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. Sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl?) or disulfiram (Antabuse?). Avoid if pregnant or breastfeeding.
Soy: Soy formulas are commonly used in infants with sensitivities to milk-based formulas. There is currently little evidence to support the use of soy formulas for preventing food allergies. Further research is needed in this field.
Avoid if allergic to soy. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there are limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore high doses are not recommended. People who experience colitis (intestinal irritation) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, like increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Patients taking blood-thinning drugs like warfarin should check with a doctor and pharmacist before taking soy supplementation.
Spirulina: The anti-inflammatory properties of spirulina may help improve symptoms of allergic rhinitis. However, further high-quality studies are needed to confirm these findings.
Avoid if allergic or hypersensitive to spirulina or blue-green algae. Use cautiously in those with phenylketonuria (a genetic disorder of a liver enzyme that disrupts normal body functions), autoimmune diseases, bleeding disorders, diabetes, or osteoporosis. Use cautiously with products containing the blue-green algae species Anabaena spp., Aphanizomenon spp., and Microcystis spp.; in underweight patients or in those taking antiobesity agents or appetite suppressants; of in those consuming a high-protein diet. Avoid in children or if pregnant or breastfeeding.
Stinging nettle: For many years, a freeze-dried preparation of
Urtica dioica has been prescribed by physicians and sold over-the-counter for the treatment of allergic rhinitis. Clinical trials demonstrating statistical significance over placebo and/or equivalence with other available treatments are needed to support the use of nettle in the treatment of allergic rhinitis.
Avoid if allergic or hypersensitive to nettle, members of the Urticaceae family, or any ingredient of nettle products. Use cautiously in those with diabetes, bleeding disorders, or low sodium levels in the blood. Use cautiously with diuretics and anti-inflammatory drugs. The elderly should also use nettle cautiously. Avoid if pregnant or breastfeeding.
Sulfur: Limited evidence suggests that a homeopathic nasal spray containing
Luffa operculata,
Galphimia glauca, histamine, and sulfur may have an effect on allergic rhinitis. Further research is needed to examine the effects of sulfur alone.
Avoid in individuals with a known allergy or hypersensitivity to sulfur or sulfonamides. Use cautiously in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Use cautiously in patients with kidney disease, sensitive skin, or gastrointestinal sensitivities. Avoid if pregnant or breastfeeding.
Thymus extract: Thymus extract may reduce symptoms of allergies due to its potential immune-stimulating effects. Nonetheless, more clinical trials are required before conclusions can be made involving thymus extract for this use.
Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously, due to a potential for exposure to the virus that causes "mad cow disease." Avoid use in those with an organ transplant or other forms of allografts or xenografts. Avoid in those receiving immunosuppressive or hormonal therapy, and in those with thymic tumors, myasthenia gravis (a neuromuscular disorder), or untreated hypothyroidism. Avoid if pregnant or breastfeeding, as thymic extract increases human sperm motility and progression.
Vitamin E: Although thought to aid in reducing the nasal symptoms of allergic rhinitis, vitamin E intake may not be effective. Current evidence is limited, however, and more studies are needed before a firm conclusion can be drawn.
Avoid if allergic or hypersensitive to vitamin E. For short periods of time, vitamin E supplementation is generally considered safe at doses up to 1,000 milligrams daily. Avoid doses higher than 1,000 milligrams daily. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders. The recommended dose of vitamin E for pregnant women of any age is 15 milligrams; for breastfeeding women of any age, the recommended dose is 19 milligrams. Use beyond this level in pregnant women is not recommended.
Whey protein: According to a limited body of evidence, whey protein may have positive benefits in the treatment of patients with atopic asthma or atopic dermatitis. Further research is required before conclusions can be made.
Use cautiously in patients using any medications, because drugs may bind to human milk whey proteins. As a result, the levels of these drugs may be changed in the blood. Since whey protein may lower blood sugar levels, caution is advised in patients with diabetes or hypoglycemia. Caution is advised in those taking drugs, herbs, or supplements that affect blood sugar, increase the risk of bleeding, lower blood pressure, or affect the immune system. Whey protein may interfere with the way the body processes certain drugs, herbs, or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of these agents may change in the blood and may cause increased or decreased effects or potentially serious adverse reactions.
Avoid long-term excessive intake, because it may cause kidney damage or bone loss. Avoid with known allergy or hypersensitivity to milk or milk products. Avoid in pregnant or breastfeeding women.
Fair negative scientific evidence:
Grape seed: Grape seed has been used to treat immune system disorders due to its antioxidant effects. However, a well-designed human study of allergic rhinitis sufferers showed no improvement in allergy symptoms with administration of grape seed extract ingredients.
Avoid if allergic or hypersensitive to grapes or other grape compounds. Use cautiously if taking blood thinners such as warfarin, aspirin, NSAIDs, or antiplatelet agents. Use cautiously in those with bleeding disorders or in those taking drugs that may increase the risk of bleeding. Use cautiously with drugs processed through the liver's cytochrome P450 enzyme system. Use cautiously with blood pressure disorders or if taking ACE inhibitors, such as lisinopril (Zestril?) and ramipril (Altace?). Avoid in those with disorders that increase the risk of bleeding or with active bleeding disorders (stomach ulcers, bleeding into the brain, etc.). Avoid if pregnant or breastfeeding.
Prevention
Avoid exposure to known allergens. If allergic to pollen, remain indoors in the morning and evening, when outdoor pollen levels are highest.
Individuals who cannot avoid exposure to known allergens may benefit from preventive allergy medications, such as antihistamines.
Keep windows closed and, if possible, use the air conditioner in the house and/or car.
Do not dry clothes outside.
Avoid unnecessary exposure to environmental irritants, such as insect sprays, tobacco smoke, air pollution, and fresh tar or paint.
Regularly wash the hands and face to remove pollen.
A humidifier may help remove some of the allergens from the air.
There is evidence that infants who are exposed to airborne allergens, such as dust mites and animal dander, may be less likely to develop related allergies.
Consider installing central air conditioning with a high-efficiency particulate air (HEPA) filter attachment. The HEPA filter can trap airborne allergens (such as mold spores, dust mites, and pollen) from outdoor air, preventing them from circulating in the air inside.
Consider using a vacuum cleaner with a double-layered microfilter bag or a HEPA filter.
Non-allergic types of rhinitis
Atrophic rhinitis: Atrophic rhinitis is a chronic inflammation of nose. It causes the nasal mucosa, including the glands, turbinate bones, and nerves in the nose, to atrophy (shrink). It may also cause a foul-smelling nasal discharge. Patients may experience nosebleeds and may lose their sense of smell. This condition may be the result of a sinus surgery or prolonged bacterial infection of the nose.
Snuffles: Patients born with syphilis (a sexually transmitted disease) may experience rhinitis. When syphilis is the cause of the symptoms, the condition is called snuffles.
Vasomotor rhinitis: Vasomotor rhinitis, also known as non-allergenic rhinitis, is thought to be the result of nerve disorders. Vasomotor rhinitis, unlike allergic rhinitis, does not involve the immune system. Instead, this form is caused by oversensitive or excessive blood vessels in the nasal membrane. The body overreacts to stimuli such as changes in weather, temperature, barometric pressure, chemical irritants, aerosol sprays, psychological stress, or certain types of medication. The exact cause of vasomotor rhinitis is not well understood. It is possible for patients to suffer from vasomotor rhinitis and allergic rhinitis at the same time.
Complications
Infection: A secondary bacterial infection may occur in tissues like the mucous membranes of the nose, throat, sinuses, or the ear. Common secondary infections related to hay fever include ear infections and sinus infections. In children, hay fever is often a contributing factor to middle ear infections.
Prolonged sinus congestion caused by hay fever may increase an individual's susceptibility to developing a sinus infection.
Allergic conditions: Patients who have hay fever have an increased risk of developing more serious allergic conditions like asthma. It is common for hay fever and asthma to occur at the same time. Patients suffering from hay fever may also have eczema, a skin disorder that causes red, dry, flaky skin.
Other: Additional complications of allergic rhinitis include nosebleeds, decreased lung function, and enlarged lymph nodes in the nose and throat.
Nonallergic types of rhinitis
Atrophic rhinitis: Atrophic rhinitis is chronic inflammation of the nose. It causes the nasal mucosa, including the glands, turbinate bones, and nerves in the nose, to atrophy (shrink). It may also cause a foul-smelling nasal discharge. Patients may experience nosebleeds and may lose their sense of smell. This condition may be the result of a sinus surgery or prolonged bacterial infection of the nose.
Snuffles: Patients born with syphilis (a sexually transmitted disease) may experience rhinitis. When syphilis is the cause of the symptoms, the condition is called snuffles.
Vasomotor rhinitis: Vasomotor rhinitis, also known as nonallergenic rhinitis, is thought to be the result of nerve disorders. Vasomotor rhinitis, unlike allergic rhinitis, does not involve the immune system. Instead, this form is caused by oversensitive or excessive blood vessels in the nasal membrane. The body overreacts to stimuli such as changes in weather, temperature, barometric pressure, chemical irritants, aerosol sprays, psychological stress, or certain types of medication. The exact cause of vasomotor rhinitis is not well understood. It is possible for patients to suffer from vasomotor rhinitis and allergic rhinitis at the same time.