By: Tara Harris, MSN, DNP, FNP-BC

Spring is here and with it comes runny/congested noses as well as watery/itchy eyes. Seasonal allergic rhinitis, commonly known as hay fever, affects both children and adults. According to the American Academy of Allergy, Asthma, and Immunology (2021), about 8% of Americans 18 years of age and older are affected annually. Worldwide between 10% and 30% of the population are affected.

Seasonal allergies typically occur from exposure to outdoor pollen. The immune response is triggered during the blooming season causing over-production of IgE antibodies and an allergic response. Symptoms most commonly seen include congestion and rhinorrhea, watery and itchy eyes, itchy sinuses, throat, or ear canals, ear congestion, and postnasal drainage. These symptoms can range from mild to severe, depending on other risk factors the patient may have, such as asthma. If the patient has both allergic rhinitis and asthma, precautions should be taken as an asthma attack can also be triggered.

The current treatment recommendations include reducing exposure to allergens as well as pharmacologic therapy. Pharmacologic treatments include antihistamines (intranasal and oral), decongestants (intranasal and oral), corticosteroids (intranasal and oral), intranasal cromolyn, intranasal anticholinergics, and oral leukotriene receptor antagonists (LTRAs) (Croke, 2018). Allergen immunotherapy has also proven its benefit to allergy sufferers. Numerous well-designed controlled studies demonstrate allergen immunotherapy is efficacious in the treatment of allergic rhinitis, allergic conjunctivitis, allergic asthma, and stinging insect hypersensitivity (Cox et al, 2011).

Treatment recommendations differ for children. The Joint Task Force on Practice Parameters (2017) provides the following recommendations based on a systematic literature review and patient oriented outcomes:

• Patients 12 years and older should be treated with intranasal corticosteroid monotherapy over combined intranasal corticosteroid and oral antihistamine therapy to treat seasonal allergic rhinitis.
• Combined intranasal corticosteroid and intranasal antihistamine therapy can be considered for allergic nasal symptoms for patients 12 years and older.
• For patients 15 years and older, an intranasal corticosteroid is preferred over a leukotriene receptor antagonist.

Seasonal allergies usually occur during a specific time of the year. With proper assessment and evaluation, adequate treatment can help patients enjoy their outside activities.

 

References

Coker, L. (2018). Treatment of Seasonal Allergic Rhinitis: A Guideline from the AAAAI/ACAAI Joint Task Force on Practice Parameters. American Family Physicians, 97(11):756-757.

Cox, L., Nelson, H., & Lockey, R. (2011). Allergen immunotherapy: A practice parameter third update. Journal of Allergy and Clinical Immunology,127(1):S1-S55. 

AAAAI (2021). Allergy Statistics. American Academy of Allergies, Asthma and Immunology. Retrieved from https://www.aaaai.org/about-aaaai/newsroom/allergy-statistics

Dykewicz, M.S., Wallace, D.V, and Baroody, F. (2017). The Joint Task Force on Practice Parameters. Treatment of seasonal allergic rhinitis: An evidence-based focused 2017 guideline update. Annuals of Allergy, Asthma, and Immunology.119(6):489–511. Retrieved from http://www.annallergy.org/article/S1081-1206(17)30656-7/fulltext