Allergic Rhinitis (Hay Fever and Rose Fever) and Chronic Nasal Congestion

Description

Alternative Names

Prognosis

Seasonal allergic rhinitis tends to diminish as a person ages. The earlier the symptoms start the greater the chances for improvement. People who develop hay fever in early childhood are likely not to have the allergy in adulthood. In one study, over half of allergic subjects reported that by 40 years of age their symptoms had decreased, and 23% were symptom-free. In some cases, allergies go into remission for years and then return later in life. Those who develop it after age 20, however, tend to continue to have hay fever at least into middle age.

People with allergic rhinitis may be at higher risk for other allergies, including potentially serious food or latex allergies.

Effect On Quality of Life

Although allergic rhinitis is certainly not considered a serious condition, it nonetheless can interfere with many important aspects of life. People with allergic rhinitis, particularly those with perennial allergic rhinitis, may experience sleep disorders and daytime fatigue. Often they attribute this to medication, but studies suggest congestion may be the culprit in these symptoms. In addition, a 2002 study indicated that patients with seasonal allergies experience hundreds of brief, subtle awakenings, called "microarousals", each night. In such cases, people are not aware that they wake up, but such events can cause fatigue the next day.

Higher Risk for Asthma

Asthma and allergies often coexist, and the allergic response plays a strong role in childhood asthma. About 70% to 85% of children with asthma have allergies, with the risk being higher from seasonal allergies (e.g., hay fever) than perennial allergies (e.g., indoor allergies). It should noted, however, that, allergies are very common, and studies report that only 1% to 20% of children with allergic rhinitis actually develop asthma.

Aggressive treatment of allergies in children with asthma can lower the risk for asthma attacks in patients with both conditions. Treating seasonal allergies may even help prevent the onset of asthma in children with only allergies.

Chronic Swelling In the Nasal Passages (Turbinate Hypertrophy)

Any chronic rhinitis, whether allergic or nonallergic, can cause swelling in the turbinate, which may become persistent (turbinate hypertrophy). The turbinate is a tiny shelf-like bony structure that protrudes in the nasal passageways. It helps warm, humidify, and clean the air as it passes over. If turbinate hypertrophy develops, it causes persistent nasal congestion and in some cases pressure and headache in the middle of the face and forehead. It is not reversible without surgery.

Complications of Chronic Rhinitis in Children

• Children with severe allergies may have a higher risk for behavioral problems than those without allergies. Some research suggests that allergic rhinitis is responsible for two million missed school days each year.
• There have been reports that 30% to 45% of people with allergic rhinitis also suffer from ear infections (otitis media).

• Chronic nasal obstruction from year-round allergies can affect a child's appearance. If a child can only breathe through the mouth, the continual force of air passing through the oral cavity can change facial development. Such changes may include an elongated face and an overbite from teeth coming in at an abnormal angle.
• Chronic rhinitis can cause headaches and also affect a child's sleep, concentration, hearing, appetite, and growth.

Associations with Other Disorders

Depression. Some evidence has linked some cases of depression with allergies. A 2002 study, for example, found that people with depression reported a higher rate of allergic disorders (71%) compared to nondepressed individuals (43%). And during allergy season, allergic individuals were more likely to experience mood changes, including sadness, lethargy, and mental fatigue, than at other times. Some evidence suggests that specific immune factors in the allergic response can cause depressive symptoms. Other research indicates that both may have a common cause.

Chronic Fatigue Syndrome (CFS). Some, although not all, studies have reported that a majority of CFS patients have allergies to foods, pollen, metals (such as nickel or mercury), or other substances. One theory is that allergens, like viral infections, may trigger a harmful overreaction of the immune system that can cause fatigue, joint aches, and fever as well as hormone and brain chemical disturbances. (Most allergic people, in any case, do not have CFS.)