Published on 4 October 2021

    If you are averse to flowers, kittens and soft toys because they trigger a clogged nose and itchy eyes, you very likely have a case of allergic rhinitis.

    This condition happens when the immune system is overactive and mistakes typically harmless things, such as dust, pollen, dander or fur for dangerous pathogens and triggers a response to attack them. The immune response inflames the lining of your nasal passages, sinuses, and eyelids in a bid to fend off, trap or and expel the perceived ‘enemy’. This can cause sneezing as well.

    Dr Kristel Low from Queenstown Polyclinic, National University Polyclinics (NUP), explained that this part of the body’s defence mechanism, “Sneezing is a normal body’s response to the irritation of the respiratory mucosa of the nose.”

    Allergic rhinitis is a chronic condition and affects about 13% of people in Singapore; it is especially common in children. About one in four pre-schoolers are affected, while the prevalence of allergic rhinitis among school children is around 44%.

    Dr Low said, “Most children do not outgrow allergic rhinitis but their symptoms may improve with time.” And while the condition is not life-threatening, allergic rhinitis is associated with asthma and other forms of sensitivities and allergies that can affect the quality of life.  Dr Low pointed out the need for good management of allergic rhinitis is even more important in those with asthma, “Poorly controlled severe persistent allergic rhinitis can worsen asthma control.”

    Keeping a lid on the reaction

    If allergic rhinitis is suspected, it is advisable to see a doctor for early diagnosis and management, especially if symptoms affect the quality of life and school or work performance. According to Dr Low, the treatment will depend on the severity of symptoms and whether there are other associated conditions such as asthma and headache, as well as the goal and expectation of each patient. 

    Because allergic rhinitis is triggered by common allergens- such as dust mites, cockroaches, animal dander, moulds and pollen- avoidance of these common allergens is recommended. Allergy testing may be considered if the condition persists despite initial treatment.

    The first line of treatment is steroid nasal sprays. This medication moderates the body’s reaction to allergens when used continuously. Another type of treatment is to use drugs that block the enzyme responsible for producing an inflammatory response.

    For symptom relief, antihistamines and decongestants can be used. Dr Low pointed out that treatment options should be discussed with a doctor and that the use of regular decongestants exceeding five to seven days is not recommended because of rebound congestion.

    For short-term, non-drug symptom relief, nasal irrigation can also be used to remove allergens and clear blocked nasal passages.

    All of these treatment options including their side effects should be discussed with a doctor beforehand.

    Another treatment approach is immunotherapy, a process of exposing patients to allergens in small, incremental doses under medical supervision. This works like a vaccine to increase an ‘immunity’ or tolerance to the allergen.

    Surgery may also be recommended to suitable patients. Surgery does not cure the underlying allergy, but its goal is to improve nasal obstruction by correcting structural defects and improving the delivery of medication.

    If you are considering immunotherapy and/or surgery, you should speak with your doctor about a referral to a specialist. You may be referred to specialists for management, such as Otolaryngologists (Ear, Nose and Throat doctors), Immunologists or Dermatologists.

    In consultation with Dr Kristel Low, Queenstown Polyclinic, NUP.

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