Allergic Rhinitis

Allergic Rhinitis

When spring gives you things you never asked for!' The first blooms of spring always make my heart sing.' — S. Brown Would you agree? I certainly feel we are blessed with the longer, warmer days again!  But, as spring arrives this year, approximately 15 per cent of the Australian population who are affected by hay fever would not agree. That’s around 3.75 million people. Despite its name, hay fever is not caused by hay nor does it result in a fever (ASCIA, 2019). It can, however, be debilitating to the person affected by it.

What is hay fever? Allergic rhinitis (hay fever) is a heterogenous disorder that is often misdiagnosed despite its high prevalence. The symptoms mimic cold and flu type conditions; persisting unless treated appropriately. It is caused by the nose coming into environmental allergens (pollens, dust mites, moulds, animal dander) that produce mild to severe symptoms. These symptoms can be present year-round or in specific seasons, and include:  -    sneezing  -    runny nose -    itchy nose -    itchy, watery eyes  -    congested nose -    snoring. If left untreated, recurring allergic rhinitis may increase the onset of asthma in individuals with symptoms. Some asthmatics concurrently experience allergic rhinitis. Management of symptoms has demonstrated improved asthma control in sufferers (ASCIA, 2019).  Other complications of allergic rhinitis may arise without intervention, such as: -    sleep disturbance -    lethargy during the day and reduced concentration  -    headaches  -    recurring sinus infection (adults) -    recurring ear infections (children). Prevention and management Identifying the allergen/s responsible can assist sufferers by limiting exposure to them. Salt water nasal sprays or douches and salt rooms are natural options that can be effective in relieving symptoms. Medications can be prescribed by your local GP that can provide relief of the symptoms (they do not cure the allergies). These can be in the form of: -    Antihistamines (tablets, syrups, intranasal sprays and eye drops) aid in reducing symptoms. They are often encouraged to be used upon presentation of symptoms and at the discretion of the patient. -    Intranasal corticosteroid nasal sprays (INCS) act to eliminate the nasal inflammatory process present and aid in prevention when used consistently (similar to asthma preventers). Regular use, with care to the way in which they are used, is essential. Different brands of INCS vary in strength and effectiveness so it is important to read the labels and check details with your pharmacist or doctor. -    Combination medications containing an antihistamine and intranasal corticosteroid nasal spray are available and offer the combined advantages of both medications -    Decongestant sprays unblock and dry the nose but should not be used for more than a few days as they can cause long term problems in the nose, such as tissue damage with resultant infection, and tolerance to the medication (no longer unblocks the nasal congestion) -    Decongestant tablets unblock and dry the nose. Please use with caution. They can have stimulant side effects including tremors, trouble sleeping and anxiety and can raise blood pressure. People with high blood pressure should not take decongestant tablets. -    Allergen Immunotherapy (AIT) ranges from three to five years in duration and is offered by a clinical immunologist/allergy specialist to those over five years of age suffering from a severe presentation of allergic rhinitis. This approach involves administration of regular, gradually rising amounts of the environmental allergen responsible. This can be in the form of extracts that are injected or by sublingual (placed under the tongue) tablets, sprays or drops (often under the tongue as well) (ASCIA, 2019; Skoner, 2001).How can osteopathy help? In the same way that medical approaches to allergic rhinitis cannot cure allergies, neither can osteopathy. But osteopathy can assist in management of the symptoms through the use of different techniques to address areas of the body involved. This can, in turn, provide some relief to patients and reduce the need for all those supplements and over-the-counter remedies. Sinus tapping and massage  A gentle percussive force can be applied to the maxillary and frontal sinuses. This is provided in an effort to dislodge and assist accumulated fluid to drain into the lymphatic system to be processed and eliminated. Massage strokes along the line of drainage are provided to facilitate in this combined technique option. This technique can be extremely pleasant for the sufferer with the benefit of a notable reduction in unpleasant sinus pressure afterwards. Diaphragmatic techniques For many hayfever victims, coughing or aggravation of asthmatic symptoms can be a by-product. In these instances, there is a sudden increased demand of diaphragmatic functions (especially our ability to cough and drain mucous from the upper body by creating a constant vacuum). Ensuring support of the diaphragm during this time can facilitate these functions and address resulting tightness that may be present. Optimum diaphragm function is desired while you get control of your symptoms. Considering the neck and thoracic outlet Lymph nodes are small kidney shaped glands that are components of the lymphatic and adaptive immune system. They process lymph that passes through them. Lymph is the clear fluid formed from interstitial fluid that is drawn from tissues around the body and is returned to the circulatory system. Lymphatic vessels allow passage of lymph and connect the network of lymph nodes housed around the body. Lymph is essentially comparable to plasma. It contains nutrients and waste products of cell metabolic activity. There are multiple lymph nodes and lymphatic vessels in the neck and thoracic outlet (root of the neck) regions. From increased functional demand, there can be enlargement and slight inflammation of lymph nodes, resulting in neck tenderness. Muscles within these regions may also be tight from overuse as several are accessory muscles of breathing. Asthmatics and those with a cough may experience tension here. Treatment of the musculature and ensuring adequate neck range of motion can facilitate both lymphatic drainage and assist those with symptoms associated with asthma and/or hay fever. If you experience the above signs and symptoms, speak with your GP and note the pattern of presentation. Keeping a diary of symptoms to share with your GP can be extremely helpful. Humidifiers are excellent devices to keep in your home to dampen the air. The dampened air can calm the aggravation to your nasal and throat passages (that are aggravated by your hay fever). Dry air is quite aggravating. Take care of yourselves,

Lenore Dyson REFERENCES Allergic Rhinitis (Hay Fever)? (https://www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis/allergic-rhinitis-or-hay-fever), ASCIA (2019) Skoner, D. Allergic Rhinitis: definition, epidemiology, pathophysiology, detection and diagnosis (https://www.jacionline.org/article/S0091-6749%2801%2994460-4/fulltext), The Journal of Allergy and Clinical Immunology, 2001