RESPIRATORY. Allergic: to be or not to be? Rhinitis

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Marianna Frederica Cummings
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1 RESPIRATORY Allergic: to be or not to be? Rhinitis

2 page 2 Rhinitis: a simple cold? Summary Rhinitis: a simple cold? p. 2 How can I suspect I have an allergic rhinitis? p. 5 Can a doctor help me? p. 6 Is it possible to avoid allergens? p. 7 Shall I have to take drugs? p. 9 Isn t it too heavy a treatment for such a common condition? p. 11 The term rhinitis literally means inflammation of the nose. The condition is characterised by sneezing, a runny nose and/or nasal blockage. Furthermore, it is frequently accompanied by conjunctivitis (itchy, red and watery eyes) and perhaps throat irritation. Population persons 23% suffer from Allergic Rhinitis 70% patients self aware 30% patients unaware 45% not diagnosed Adapted from DURHAM S.R. et al. European Journal of Allergy and Clinical Immunology. 2002; 57: : S73. 55% with medical diagnostic 47% not medicated 53% medicated

> The proportion of allergic rhinitis has tripled in 25 years When repeatedly having rhinitis, many people just think that they keep getting colds and simply accept them as part of life.

3 > The proportion of allergic rhinitis has tripled in 25 years When repeatedly having rhinitis, many people just think that they keep getting colds and simply accept them as part of life. However, troublesome symptoms like the ones mentioned should never be neglected even if they only seem to be minor daily nuisances. They can be signs of allergic disease and must be treated. Indeed, allergy is becoming more and more common, and allergic rhinitis is the most frequent allergic disease. In nearly every industrialised nation, the number of persons suffering from allergic rhinitis has risen dramatically and continuously over the last thirty years. Nowadays, 23% of our Western population suffer from allergic rhinitis. 30% of them are unaware of that. 45% mistake their allergy symptoms as harmless, don t consult their doctor, and remain undiagnosed. Half of the other ones don t follow any treatment for their disease.

page 4 Rhinitis: a simple cold? Allergic rhinitis remains an underdiagnosed and undertreated disease. Do you belong to those people unaware of their allergy?

4 page 4 Rhinitis: a simple cold? Allergic rhinitis remains an underdiagnosed and undertreated disease. Do you belong to those people unaware of their allergy? Are you right to consider any treatment unnecessary? A runny nose, sneezing, watery eyes all signs which often lean you to believe you have a cold or flu. Red, stinging or watery eyes these frequently bring to mind thoughts of infectious conjunctivitis. Your suspicions may indeed prove to be true, but such symptoms could also be caused by an unsuspected allergy, which may be exacerbated if non treated.

5 > Should you recognize yourself in the above situations, maybe then you have an allergic rhinitis without being aware of it. Consult your doctor. He is the only one who can make the diagnosis! How can I suspect I have an allergic rhinitis? 1- Did you notice the existence of an allergic disease in your close family? We mean: your father and mother, your brothers and sisters, and your children. If they complain from atopic dermatitis, urticaria, intolerance to specific foods, hay fever, allergy to animals or to house dust, you probably have inherited their predisposition to allergy. It has been observed that the risk as a child out of a non-allergic family to become allergic stands at 5-15%. This risk increases to around 50% if one parent is allergic, and is close to 90% if both parents are. 2- Did you hear about long-lasting digestive or cutaneous problems during your first years of life? Were you said to be allergic to cow s milk, or to hen s eggs? 3- Can t you suddenly refrain from sneezing and blowing your nose every time you go and visit friends who have a cat? Do you have more colds in summer time than during the winter? Are you condemned to a runny nose and watery eyes every year during your final school exams? Is your sleep frequently interrupted because of nasal obstruction? Is the video Allergic: to be or not to be?... Rhinitis illustrating common situations of your daily life?

6 page 6 Can a doctor help me? The doctor knows that the nose acts as a personal air conditioner. It filters, warms and humidifies 10,000 litres of air daily. It is a specialised structure permanently clearing the air from every particles with a diameter larger than 10 µ. Pollen grains, house dust, spores from moulds or animal hairs are then deposited in the nasal mucus. Each one of these particles can behave as an allergen (i.e. an allergyprovoking agent) in an allergic patient. Once your allergen(s) identified, ask your doctor or your local pharmacist to give you some practical tips for helping you to limit your exposure to this or these allergens. So, you will become able to control your symptoms through highly targeted behaviours without being suspicious against everything. Rhinitis symptoms are triggered by a direct contact of nasal mucosa with a specific allergen. A heavy charge of allergens in the air provokes severe symptoms, as well as a long exposure. Repeated contact will increase the sensitivity of the nasal mucosa. Thus, avoiding prolonged contact with a high level of allergens is mandatory. The first goal of your medical doctor will be to identify the specific allergen triggering your allergy. Don t be afraid. Allergen identification is a simple procedure, based on blood plasma analysis and/or skin prick testing. Nothing time-consuming, nor expensive, nor painful.

> The main allergen inside is house dust mite. Outside are airborne pollens from trees, grasses and weeds. Is it possible to avoid allergens? Pollens are tiny microscopic cells of flowering plants.

During the hottest part of the day, the pollen rises to a height of 500 m and can travel several kilometres at that altitude, depending on the speed of the wind.

7 > The main allergen inside is house dust mite. Outside are airborne pollens from trees, grasses and weeds. Is it possible to avoid allergens? Pollens are tiny microscopic cells of flowering plants. Each type of pollen is abundant in the air at a certain time of the year. Symptom severity in the eyes and nose correlates with the pollen count, which is highest in sunny, dry, windy weather. During the hottest part of the day, the pollen rises to a height of 500 m and can travel several kilometres at that altitude, depending on the speed of the wind. You should avoid being outdoors when the pollen count is high. Allergy to pollen - some basic tips Keep your car air-conditioning closed Do not hang clothes outside to dry Stay indoors when possible during peak pollen periods of the day Take your holidays at the seaside or in the mountains

8 page 8 Is it possible to avoid allergens? Mites breed in mattresses, carpets and upholstered furniture, i.e. an environment protecting them against cold temperature, dry air and light. The presence of people and animals are important for the proliferation of dust mites because they feed on the skin scales of humans and pets. Because sleep favours a close and prolonged contact with house dust mites, most avoidance recommendations focus on the bedroom. Allergy to house dust mites - some basic tips Make a bedroom dust-free, i.e. hospitalstyle Keep your bedroom cool and dry Do not immediately make the bed as soon as you get up You should maintain allergenic avoidance as long as the symptoms last. Two types of allergic rhinitis exist: intermittent and persistent rhinitis. Symptoms last less than 4 weeks during intermittent rhinitis: in this case, pollens and fungal spores are the most likely triggers. Symptoms last more than 4 weeks, they can even exist yearlong, during persistent rhinitis: those permanent symptoms typically include house dust mites or pet allergy, and even pollens in regions with a long season of pollination.

There are no more house dust mites above 1800 m altitude in the mountains, but this is not very practical for mite-allergy sufferers.

9 Shall I have to take drugs? Avoiding allergens may not always be completely achieved, even if there are several things everyone can do. For instance, the level of pollens is weak on the sea-side but all allergic patients cannot live there. There are no more house dust mites above 1800 m altitude in the mountains, but this is not very practical for mite-allergy sufferers. Even avoidance of dogs and cats may be ineffective because pet allergens can be transported on the clothing of other people who had previous contact with an animal. Both dog and cat allergens have been found in schools and other public buildings where no animal has ever been, probably transported there on the clothing of pet owners. So, because it is not possible in daily life to avoid allergens totally, or to avoid them anytime, you probably will have to take drugs.

10 page 10 Shall I have to take drugs? Furthermore, allergic disease is progressive: allergen exposure leads to inflammation in the nose, which leads to more symptoms on further exposure, then to more inflammation, and so on. The underlying inflammation is now considered as the driving force behind the allergic process, and disregarding it will inevitably have an effect on disease progression. Allergic rhinitis can lead to more severe conditions such as asthma. There is a need for a global therapeutic strategy for allergic rhinitis that should be targeted as well to this nasal minimal persistent inflammation as to rhinitis symptoms. In that respect, first experimental data tend to prove that a continuous treatment is better than an ondemand one. Nowadays, effective and safe treatments exist to control symptoms and/or nasal inflammation. International guidelines recommend to start the treatment with an antihistaminic drug, and surveys show that the majority of patients consider the most recent antihistamines to be effective and nonsedating. Depending on the severity of the case, a stepwise approach of the treatment of allergic rhinitis is proposed, adding topical corticoïds, immunotherapy and other drugs.

> Isn t it too heavy a treatment for such a common condition? Remember Night-time symptoms can affect your child s sleep making it difficult to concentrate the next day.

11 > Isn t it too heavy a treatment for such a common condition? Remember Night-time symptoms can affect your child s sleep making it difficult to concentrate the next day. This can lead to irritability and behaviour problem, and may affect your child s results at school, particularly when the pollen season happens during the final school exams. As an adult, trying to work if you are suffering from a runny nose can be very debilitating, and being kept awake at night by a blocked nose is not the best way to prepare for an important meeting. Your concentration may be poor and this can lead to mistakes you would not normally make. A number of recent studies and surveys, based on the evaluation of quality of life rather than on symptoms only, have clearly shown that allergic rhinitis, particularly of the persistent type, leads to as much, if not more, impairment of a patient s quality of life than mild or moderate asthma. So, allergic rhinitis can make life a misery. A well-conducted drug treatment is often required. Rhinitis symptoms may seem minor ones, but they should never be underestimated.

12 THE UCB INSTITUTE OF ALLERGY Division of UCB S.A., The UCB Institute of Allergy (IOA) is an independent, European and not-for-profit organisation, created in 1987 to combat allergy. In response to the international epidemic of this disease, the Institute s objective is to implement all the resources necessary to raise awareness of allergy as a major health issue amongst the general public, patients, health care professionals and public authorities. Under the supervision of a Scientific Advisory Board made up of eminent European specialists in the field of allergy, IOA has initiated many actions. These aim to inform and educate about allergy, to improve prevention, to promote research, to analyse the current situation and to define key actions to be taken over the coming years. Moreover IOA favours cooperation between various allergy related organisations. The Institute is present all around Europe with 20 national sections and in South Africa. The Institute s web site ( and central membership library provide members with current relevant information and publications about allergy. For the general public, schools and children, IOA has produced videos (e.g. Who s sleeping in your pillow?, Allergic: to be or not to be?...rhinitis ), educational games and other information material. IOA also organises and holds meetings, symposia, conferences, panel discussions and offers Travel Grants & Scholarship Awards to young researchers. As a result of these activities, The UCB Institute of Allergy hopes to forestall the sobering prediction of certain epidemiologists: In 30 years time, everyone may be allergic... Unless we act now! RESPIRATORY The IOA thanks for their active collaboration: Professor C. Bachert: Dept. of Oto-Rhino-Laryngology, University Hospital, Ghent, Belgium Professor P. Van Cauwenberge: Dept. of Oto-Rhino-Laryngology, University Hospital, Ghent, Belgium Dr. E. Valovirta: EFA Past-President (European Federation of Allergy and Airways Diseases Patients' Associations) The UCB Institute of Allergy Allée de la Recherche, 60 B-1070 Brussels (Belgium) UCB IOA - 09/03 - Ph. Corbis, Image Source, Phovoir, Photonica, Goodshoot.

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