Allergic Rhinitis or Hay Fever

Allergic Rhinitis or Hay Fever

The body responds to the germs such as virus, bacteria, or other foreign matter by generating antibodies. However, the immune system may respond to some substance that has no danger and cause the inflammation or symptoms of allergy. Allergic Rhinitis or Hay Fever caused by respondent of the immune system to stimulation from allergen in the air that has higher numbers than usual, causing symptoms on the nose and eyes. 

 

Table for assessing the frequency and severity of allergic rhinitis
Frequency	Severity
Symptoms occur intermittently	Has mild symptoms
Symptoms occur intermittently, less than four times per week, or persist continuously but not exceeding four weeks	The symptoms not affected to the daily routines (Sleeping, working, studying), Has no irritating symptoms
Has continuously symptoms	Has medium to high severity
Symptoms occur intermittently, more than 4 times per week, or persist continuously for 4 weeks	The symptoms affected to the daily routines (Sleeping, working, studying), Has irritating symptoms

 

Protection

• Try to seek and avoid the stimulating factor of causing allergic rhinitis both inside of the house and workplaces, including drugs, food, drink or any tools or equipment. 
• May reduce doing outdoor activities at the time with good weather, low humidity, and strong wind. And also close the door tightly to protect from contact with pollen that may stimulate the symptoms.
• Wear a face mask or protection while doing housework. 
• Eliminate allergens in the home, adjust humidity to an appropriate level to prevent mold growth
• Use the pillow shams and bed sheets that protect the dust mites and wash with warm water, including always cleaning the mat by vacuuming.  
• Avoid smoking or get close to the smoking people. May consider consulting with the doctor for quitting smoking. 
• Eat the food with good and healthy nutrition and regularly do exercise to strengthen the immunity.  

Management

• Clean the nose with saline solution to soothe the symptoms at nose.
• Should take the medicine at the onset of allergic rhinitis symptoms and use it regularly, especially when it has high symptoms or can’t avoid the stimulating factors.
• Drink 8-10 glasses of water daily to protect from excretion in the cavity and neck. 
• Raise the head a little bit to reduce the symptoms.
• Using the humidifier with aromatic oil to soothe the symptoms of stuffy nose or headache. 

Referring out

• The severity of allergic rhinitis, irritating the daily routine and not responding to the drug when taking a treatment for 7 days. 
• Has tightness at the chest
• Has a pain at sinus and ears
• Eye pain, pink eyes and sticky eye flecks
• Has difficulty in breathing and wheezing breath 

Treatment option

Anti-allergic and antihistamine medication

• Antihistamine medication (1st and 2nd generation) soothes the allergy from blocking the type 1 histamine receptor.
• 1st generation antihistamine is the medication that is greatly dissolvable in oil, making it circulate to the brain, causing the sleepy feeling, lowered efficiency and speed in working. So, be cautious in using this medication while working, driving a vehicle. Additionally, it should be avoided or reduced the size of dosage of medication in some patients such as elderly, closed angle glaucoma and enlarged prostate patients.

·        Dosage & Administration:

Medication	Dosage in adult	Medication	Dosage in adult
Brompheniramine	D: 4 mg for every 4-6 hours Highest dosage: 24 mg/day   A:Consume when empty stomach or after the meal	Diphenhydramine	D: 25-50 mg 3-4 times a day Highest dosage: 300 mg/day   A:Consume when empty stomach or after the meal
Chlorpheniramine	D: 4 mg for every 4-6 hours Highest dosage: 24 mg/day   A:Consume when empty stomach or after the meal	Oxatomide	D: 30 mg 2 times a day   A:Consume with the meal
Cyproheptadine	D: Initiate dosage: 4 mg, 3 times a day Highest dosage: 32 mg/day   A: Consume when empty stomach or after the meal
D- dosage A- administration mg- milligram

 

• The 2nd generation antihistamine may cause drowsiness, dry mouth, and dry throat less than the first-generation, and it is taken less frequently due to its longer duration of action.

• Rupatadine should be used with caution in individuals with QTc prolongation, low blood potassium levels, and when used concomitantly with other medications that may prolong QTc or inhibit the activity of CYP3A enzymes.

• Dosage & Administration

Medication	Dosage in adult	Medication	Dosage in adult
Fexofenadine	D: 60 mg twice daily or 180 mg once daily. A: Consume when empty stomach. Do not consume it with juice.	Bilastine	D: 20 mg once daily A:  If it possible, should be consumed an hour before or after the meal
Cetirizine	D: 10 mg once daily A: Consumed before or after the meal	Loratadine	D:10 mg once daily or 5 mg twice daily A:Consume when empty stomach or after the meal
Desloratadine	D: 2.5-5 mg once daily A: Consume when empty stomach or after the meal	Rupatadine	D: 10 mg once daily A: Consume when empty stomach or after the meal
Levocetirizine	D: 2.5-5 mg once daily A: Consume when empty stomach or after the meal
D- dosage A- administration mg- milligram

 

·        Instruction: Should be advised with the patients to avoid drinking alcohol while taking this type of medication. 

• Allergen Immunotherapy is used for long-term disease control when the allergens are identified and is suitable for patients with moderate to severe persistent symptoms that do not respond to medication. By administering small amounts of allergens to the patient, gradually increasing the quantity. Which can be achieved through subcutaneous immunotherapy (SIT) or sublingual immunotherapy (SLIT), stimulating the patient to gradually develop tolerance or cessation of allergic reactions. The method is effective in inhibiting allergic reactions to pollen, dust mites, and animal dander. Treatment must be closely monitored by a physician and may take up to a year before significant results are seen and continuous treatment for 3-5 years may be necessary to achieve maximum benefits. After 2-3 years of treatment, some patients may no longer have symptoms, while others may still require ongoing treatment for symptom control.

Nasal Decongestants & Other Nasal Preparations

• Corticosteroid nose spray such as beclometasone, budesonide, ciclesonide, fluticasone, mometasone and triamcinolone, have anti-inflammatory properties and treat allergy symptoms by reducing the number of mast cells, leads to a decrease in mucus secretion and tissue swelling in the nasal passages. The use of these nasal sprays allows for localized effects, minimizing unwanted side effects compared to systemic corticosteroid administration. 

• Patients should be informed that the effects of medication will become noticeable at a minimum of 2 weeks of treatment is required for clear results. Therefore, In using this medication, it should be done before contact with allergen or when the patients have an allergy and should be taken continuously when the symptoms get well and it can also reduce the dosage of medication. 

• Dosage and administration : Please study the dosage information from the leaflet for each medicine.

• Antihistamine nose spray such as azelastine may be used in allergic rhinitis treatment.

• Dosage and administration : Please study the dosage information from the leaflet for each medicine.

• Nasal Decongestants are divided into topical decongestants such as naphazoline, oxymetazoline, tetrahydrozoline and xylometazoline. And oral decongestants such as ephedrine, pseudoephedrine and phenylephrine. It may be found in singular medication or combination with antihistamine. This group of medication can rapidly relieve the stuffy nose. 

• It should be considered to avoid in patients with closed angle glaucoma, asthma, high blood pressure, heart disease or enlarged prostate gland that can not control the symptoms.

• Dosage and administration : Please study the dosage information from the leaflet for each medicine.

• Instruction: topical decongestants should not be used 5 days consecutively (except from the instruction from the doctor) because it will cause a stuffy nose after stop using the medication. This side effect is not found in oral decongestants or has fewer effects, in the case of topical decongestants with formula adjustment for longer action periods. 

• Cromolyn Sodium Spray has the effect of blocking the release of histamine and other chemical substances that are released from mast cells so it can prevent allergic rhinitis and may be accompanied with oral antihistamine to control the symptoms until the effects of cromolyn sodium are shown. 

• Dosage and administration : nasal spray with 4% concentration (administering 5 milligrams per spray): Spray in both nostrils (one spray per side) 2-4 times daily.

• Saline solution in form of drops or spray may help relieve the inflammation and dryness of nasal septum of allergic rhinitis patients. Saline spray could help clean the pollen or dust mites from the cavity and prevent the contact between allergen and nasal septum which help reduce the occurrence of allergic rhinitis. 

 

• Oral decongestants such as pseudoephedrine may be considered to be used in those who have severe symptoms which do not respond to the oral antihistamine or corticosteroid. However, it should be avoided in patients with abnormal heart rhythms, closed angle glaucoma, clotted urinary tract, and high blood pressure, it should be combined with consuming monoamine oxidase inhibitors type medication. However, oral pseudoephedrine will only be administered by the doctor.

Asthma and chronic obstructive pulmonary disease (COPD) treatment medication

• Leukotriene receptor antagonists medication such as montelukast, suits those who have accompanied symptoms of asthma which can be used as single medication or combined with antihistamine. 
• Anticholinergic such as ipratropium bromide helps relieve the runny nose but not reduce sneezing and stuffy nose, it suits for patients with gustatory rhinitis.
• Mast cell stabilizers such as ketotifen, block secretion of allergen from the cell specifically. 

Corticosteroid

• Oral corticosteroids such as dexamethasone, methylprednisolone, prednisolone, and triamcinolone, used in prevention of rhinitis with medium severity continuously. This group of medication can help reduce inflammation and stimulation from allergens in both acute and last stages of disease.

Eye drop

• Anti-allergic eye drops such as antazoline, ketotifen, olopatadine, and pemirolast help relieve itchy eyes in rhinitis patients. Should be avoided using this medication in patients with high blood pressure, heart disease. Additionally, this medication group can cause the reaction with other medicine.