Allergic rhinitis, what to do?

Spring is felt first of all in the air and immediately puts everyone in a good mood. Almost all of them.

Many people know that the merit of the “friccichìo” (or guilt, depending on the point of view) is also of the pollen.

And for them will begin itching and runny nose, sneezing, burning eyes and sleepless nights. Almost one in five Italians suffers from allergic rhinitis, according to a survey promoted by Assosalute, the National Association of Self-medication Drugs.

The “hay fever” interferes in the same way in the daily life of men and women: but the most annoyed are the former, who feel less concentrated and more susceptible (one man in three, against one woman in four), to the point that almost 12 percent give up sports, against only 2.4 percent of women (who, however, close themselves more at home, 27.2 percent against 19.7 percent for men).

An abnormal response of the organism

“Allergy is an abnormal response of the body when it comes into contact with foreign substances that are harmless to most of us,” explains Lorenzo Pignataro, UOC Director of Otolaryngology and Cervical Facial Surgery of the IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano Foundation.

«Some predisposed people, however, after contact develop ad hoc “weapons”, specific antibodies (immunoglobulins E). At the next encounter with the allergen, the immune system will trigger a defensive reaction, with the release of histamine, an inflammatory substance responsible for allergy symptoms. Allergic rhinitis (due to pollen, but also to dust, cat hair …,) is among the most frequent: according to the World Health Organization 500 million people suffer from it. Even in Italy it is widespread: it affects both adults and children, affecting 15 to 25 percent of the population, and it is estimated that in the last decade the allergic population has grown every year by 5 percent».

The causes are still to be clarified

The reason is not clear: “There is a complex interaction between genetic makeup, environmental factors and the age of exposure to these environmental factors. Pollution, and in particular fine particles, increase the predisposition: in fact, allergic rhinitis is more widespread in the city than in the countryside, in northern Italy than in the south and in the Western world more than in the Eastern one».

Although it is not a genetic disease, allergic rhinitis certainly has a strong family predisposition: “In other words, children who have allergic parents have a good chance of being allergic in turn,” explains Lorenzo Pignataro.

“This, together with an overactivity of the nose, can make one suspect the predisposition: there is a cytological examination (a nasal swab) that goes in search of particular cells (eosinophils) that are more numerous in the allergic patient. In this case, it is possible to implement a strategic prevention with nasal spray drugs that, in addition to improving the symptoms, can prevent the child from developing a frank allergy, preventing complications (sinusitis, headache, earache …)»

Anti-sneeze tips

What to do? “It is a good idea to always keep an eye on the pollen calendar so as not to be found unprepared by an early flowering and use a mask and sunglasses for allergy sufferers. Surely you should avoid as much as possible the environments in which you are exposed to allergens. In addition, the mucous membrane of the respiratory tract of patients with allergic rhinitis in the acute phase is more “permeable”, so the reactions worsen if there are other irritants in the air, such as tobacco, fumes, particulates, very intense odors and even if the air is simply cold”, answers Professor Pignataro.

“It is useful to close the windows, use the air conditioning, shower and wash your hair daily (pollen trapped at night can settle on the pillow worsening the situation), do not go out on windy days but also immediately after a storm (water breaks the pollen granules into smaller fragments that easily reach the airways and deeper). In general, it is good to consult your doctor or specialist to plan a therapy to reduce symptoms or, if possible, avoid their onset.

The “gold standard” of therapy for allergic rhinitis is the vaccine, which from the age of 4 can also be done to children.

The expert explains: “It is able to modify the history of the disease, giving prolonged relief to the symptoms even at the end of therapy. However, immunotherapy (in sublingual, subcutaneous or oral form) is very effective for patients who have symptoms caused by a single allergen (for example, only grass pollen, only parietarie…), while it is not so effective in polysensitized patients, for which studies are still underway».

In severe cases, for example if the patient is asthmatic, cortisone-based therapies should be prescribed by the doctor.

In all others, self-medication drugs (over-the-counter, i.e. without the obligation of the prescription, recognizable by the red dot on the package) are very useful to get rid of the most annoying symptoms: «Antihistamines and antiallergics for local use (nasal sprays and eye drops) or systemic, that is, taken orally (diphenhydramine, dimethindene, cetirizine, loratadine, levocabastine, azelastine hydrochloride, the newer ones do not give drowsiness), and vasoconstrictor drugs (ephedrine, naphazoline nitrate…) that are associated with nasal hygiene products (isotonic and hypertonic saline solutions)’.