Cindy Heller asked:

Rhinitis during pregnancy can be due to allergic rhinitis, sinusitis, or non-allergic rhinitis. If the woman has had allergic rhinitis prior to pregnancy, this could worsen, stay the same, or even improve. This change in symptoms may be dependent upon many factors, including the presence of seasonal allergens and increase in pregnancy hormones.

Non-allergic rhinitis in pregnancy may also be due to an increase in pregnancy hormones, leading to nasal congestion, runny nose and post nasal drip. This is called “rhinitis of pregnancy”. The symptoms may mimic allergies, but since they are non-allergic in nature, do not respond to anti-histamines.

The pregnant woman with rhinitis may be concerned about the safety of medications during pregnancy, and therefore avoid taking medications.

If avoidance of allergic triggers is not possible or successful, medications may be needed to control symptoms.

Diagnosis of Allergic Rhinitis During Pregnancy

Allergy testing includes skin testing or blood tests, called a RAST. In general, allergy skin testing is not done during pregnancy, given the small chance of anaphylaxis which may occur. Anaphylaxis during pregnancy, if severe, could result in a decrease in blood and oxygen to the uterus, possibly harming the fetus. Therefore, allergy testing is usually deferred during pregnancy, although a RAST would be a safe alternative if the results are needed during pregnancy.

Safety of Allergy Medications During Pregnancy

According to the Food and Drug Administration (FDA), no drugs are considered completely safe in pregnancy. This is because no pregnant woman would want to sign up for a medication safety study while she is pregnant. Therefore, the FDA has assigned risk categories to medications based on use in pregnancy.

Pregnancy category “A” medications are medications in which there are good studies in pregnant women showing the safety of the medication to the baby in the first trimester. There are very few medications in this category, and no asthma medications.

Category “B” medications show good safety studies in pregnant animals but there are no human studies available.

Pregnancy category “C” medications may result in adverse effects on the fetus when studied in pregnant animals, but the benefits of these drugs may out weight the potential risks in humans.

Category “D” medications show clear risk to the fetus, but there may be instances in which the benefits outweigh the risks in humans. And finally, category “X” medications show clear evidence of birth defects in animals and/or human studies and should not be used in pregnancy.

Before any medication is taken during pregnancy, the doctor and patient must have a risk/benefit discussion. This means that the benefits of the medication should be weighed against the risks – and the medication should only be taken if the benefits outweigh the risks.

Treatment of Rhinitis During Pregnancy

Nasal saline. Rhinitis of pregnancy tends not to respond to anti-histamines or nasal sprays. This condition seems to respond temporarily to nasal saline (salt water), which is safe to use during pregnancy (it is not actually a drug). Nasal saline is available over the counter, is inexpensive, and can be used as often as needed. Generally 3 to 6 sprays are placed in each nostril, leaving the saline in the nose for up to 30 seconds, and then blowing the nose.

Anti-histamines. Older anti-histamines, such as chlorpheniramine and tripelennamine, are the preferred agents to treat allergic rhinitis during pregnancy, and are both category B medications. Newer anti-histamines such as over-the-counter loratadine (Claritin/Alavert and generic forms) and prescription cetirizine (Zyrtec) are also pregnancy category B medications.

Decongestants. Pseudoephedrine (Sudafed, many generic forms) is the preferred oral decongestant to treat allergic and non-allergic rhinitis during pregnancy, although should be avoided during the entire first trimester, as it has been associated with infant gastroschisis. This medication is pregnancy category C.

Medicated nasal sprays. Cromolyn nasal spray (NasalCrom, generics) is helpful in treating allergic rhinitis if it is used before exposure to an allergen and prior to the onset of symptoms. This medication is pregnancy category B and is available over the counter. If this medication is not helpful, one nasal steroid, budesonide (Rhinocort Aqua), recently received a pregnancy category B rating (all others are category C), and therefore would be the nasal steroid of choice during pregnancy.

Immunotherapy. Allergy shots can be continued during pregnancy, but it is not recommended to start this treatment while pregnant. Typically the dose of the allergy shots is not increased, and many allergists will cut the dose of the allergy shot by 50 percent during pregnancy. Some allergists feel that allergy shots should be stopped during pregnancy, given the risk of anaphylaxis and possible danger to the fetus as a result. Other than anaphylaxis, there is no data showing that the allergy shots themselves are actually harmful to the fetus.

Juliet Cohen asked:

Nonallergic rhinitis is a syndrome resulting from nasal inflammation that encompasses several distinct diagnoses. Nonallergic rhinitis may be diagnosed by means of clinical evaluation or by means of allergen skin testing or radioallergosorbent testing. This type of rhinitis is not as well understood. Although not triggered by allergy, the symptoms are often the same as seen with allergic rhinitis. The symptoms of nonallergic rhinitis are similar to those of hay fever (allergic rhinitis), but no allergy is involved. Nonallergic rhinitis affects approximately 17 million people in the U.S.- both children and adults. The distinction between allergic and nonallergic rhinitis can be difficult to distinguish clinically, but the distinction may be important for prognosis and treatment decisions. Many symptoms of nonallergic rhinitis are similar to allergic rhinitis, but are more chronic, occurring year-round, and are often worse in winter. Irritants such as fumes, fresh newsprint, strong odors, smoke and various types of dust may bring on symptoms. A diagnosis of nonallergic rhinitis is made after an allergy cause is ruled out. This often requires allergy skin or blood tests. A physical examination, allergy testing and a CT scan of the nose and sinuses are often used to assess and diagnose the condition of nonallergic rhinitis.

Causes of Nonallergic rhinitis

The common causes and risk factor’s of Nonallergic rhinitis include the following:

Blood vessels in your nose expanding (dilating), filling the nasal lining with blood and fluid.

Inflammation of the lining of the nose.

Smoke and other irritants.

Temperature or atmospheric changes.

Alcohol.

Psychological and Emotional factors.

Prolonged use of decongestant nasal drops or sprays.

Exposure to irritants.

Symptoms of Nonallergic rhinitis

Some sign and symptoms related to Nonallergic rhinitis are as follows:

Stuffy nose.

Congestion.

Mucus (phlegm) in the throat (postnasal drip).

Sneezing.

Postnasal drainage.

Itchy nose, throat, eyes, and ears.

Treatment of Nonallergic rhinitis

Here is list of the methods for treating Nonallergic rhinitis:

Use an over-the-counter nasal saline spray or homemade saltwater solution to flush the nose of irritants and help thin the mucus and soothe the membranes in your nose.

Antihistamines help to reduce the effects of histamine, which can decrease the symptoms of itching, sneezing, or runny nose.

Turbinate reduction is also used.

If your symptoms aren’t easily controlled by decongestants or antihistamines, your doctor may suggest a prescription corticosteroid nasal spray, such as budesonide (Rhinocort), fluticasone (Flonase), mometasone (Nasonex) or triamcinolone (Nasacort).

Pseudoephedrine-containing drugs (Sudafed, Actifed, others) and phenylephrine.

Surgery has a limited role.

Melanie Simcock asked:


Evenings are getting lighter – leaves on the trees are unfurling – the promise of summer is in the air!

Most of us look forward to the arrival of the warmer weather but for some unlucky people the season brings misery in the form of hay fever and seasonal allergic rhinitis often caused by pollens from trees and grass.

Proteins in the pollens irritate the delicate membranes of the nose and eyes causing inflammation. Symptoms include red, itchy, watery eyes and runny or congested nose.

Not all hay fever sufferers react to the same pollen therefore the timing of symptoms should be noted. Generally tree pollen is present from February to May with the peak time being in April. Grass pollens are prevalent in June and July and weed pollens (eg nettle) will be worse in July and August. Hay fever that begins in late summer and continues into the autumn may be a mould allergy. It is possible to have allergy testing to pinpoint which plant pollens you are sensitive to – consult your GP or nutritional therapist.

So what can be done to alleviate the symptoms? As always being forewarned is forearmed: some simple preparations now can reduce the severity of attacks later in the season.

If you are lucky enough to be able to buy honey produced locally, take a teaspoon every day. It has been suggested that ingestion of tiny molecules of pollen in local honey is believed to help build resistance to pollens when they appear in full force later in the season.

Amongst various natural remedies butterbur is a herb that has undergone scientific trials showing a substantial health benefit for relieving hay fever.

Butterbur (Petasites hybridus) has been shown to relax blood vessels and various smooth muscles in the body. It contains chemicals that are also known to reduce inflammation, as demonstrated in human studies. Some studies have also shown that butterbur extract performed as well as a common antihistamine drug taken by hay fever sufferers, but without causing drowsiness.

Bioflavanoids are plant compounds that have shown anti-allergic and anti-inflammatory activity. Along with Vitamin C, these supplements can help prevent the formation of histamine – the chemical that causes the common reactions of streaming, itchy eyes and runny nose. Foods rich in the bioflavanoid quercitin include onions, garlic, green tea, red wine and dark chocolate (70%+ cocoa solids). Vitamin C is found in broccoli, green peppers, citrus fruits, strawberries, kiwi, cabbage and cauliflower.

Plant sterols (phytosterols) are fats found naturally in plant foods. Phytosterols are highly versatile substances that have been shown to be useful in the management of several conditions include immune disorders. Phytosterols inhibit the release of prostaglandins (hormone-like substances) thus reducing the production of histamine and its attendant symptoms such as itchy eyes and sneezing. Plant sterols are present in all plant foods with soy and whole grains, particularly whole oats, being rich sources.

Omega 3 fatty acids found in flaxseeds and cold water fish such as salmon and mackerel, can affect chemical pathways in the body to help ease allergy symptoms and reduce inflammation.

Vitamin E taken during the pollen season alongside other anti-allergy treatments has been shown to reduce the severity of hay fever symptoms by 23%. Good sources of dietary Vitamin E include cold pressed wheatgerm and sunflower oils, hazelnuts, sweet potato, avocado and spinach.

A strong immune system is essential to help fight off allergic symptoms. The Vitamins A, C, D, E and minerals zinc and selenium are all antioxidant supplements that can help immune function.

Vitamin A is found in calves liver, egg yolk, watercress, squash and oily fish such as mackerel and herring. Likewise, top sources of Vitamin D include mackerel, herring, sardines, as well as eggs and cheddar cheese.

Zinc can be obtained from pumpkin seeds, wholemeal bread and red meats. Eating just four to five brazil nuts daily can provide your recommended intake of selenium but other sources include fresh tuna, sunflower seeds, wholemeal bread and cashew nuts.

There are other measures to help ward off the worst effects of pollen:

• A thin layer of petroleum jelly around and just inside the nostrils can trap minute pollen particles and prevent them from being inhaled and starting an allergic reaction.

• Steam inhalations help to reduce the “blocked nose” feeling.

• Most national weather forecasts now include a pollen count so take note and keep windows and doors shut to reduce the chances of pollens invading your house!

If you are taking any medication, always check with your GP or health practitioner before taking any herbal or vitamin supplements.

Eric Morgan asked:

Here are some basic answers to questions you may have regarding allergen immunotherapy, also known as “allergy shots.”

Allergen immunotherapy is a treatment designed to decrease nasal allergies (also known as allergic rhinitis), allergic asthma and reactions caused by insect stings. Specific allergens are identified through allergy testing, so the allergist first knows what is causing the allergy symptoms, in order to effectively treat them. After the culprit has been identified, allergen immunotherapy involves getting injections of increasing amounts of specific allergens over the course of several months.

Does Immunology Work?

Aside from decreasing allergy symptoms like sneezing, runny nose and congestion, Immunotherapy can help prevent the development of new allergies. In children, Immunotherapy can help prevent allergic rhinitis from progressing into asthma. Even after the treatments have stopped, allergen immunotherapy often leads to long-lasting relief of allergy symptoms.

Many studies have shown that immunotherapy is effective for the treatment of nasal allergies, for both adults and children. A review of 18 published studies involving nearly 800 patients concluded that immunotherapy is highly effective in the treatment of allergic rhinitis. An extensive review of immunotherapy as a treatment for allergic rhinitis in children, showed that the only treatment able to affect the natural cause of the disease is immunotherapy. Studies showing the effectiveness of immunotherapy suggest that roughly 8 out of 10 allergy patients benefit significantly from immunotherapy.

Immunotherapy may also prevent the onset of asthma, and a review of multiple studies showed that allergen immunotherapy is also an effective treatment for asthma. These studies have indicated that treatment with immunotherapy results in reduced symptoms of asthma and improved pulmonary functions, and at the same time, reduces the need for asthma medications.

For individuals with a previously demonstrated allergic susceptibility to insect stings, immunization with insect venom is an extremely effective treatment for preventing future allergic reactions. A review of nine published studies indicates that a course of immunotherapy is highly effective in the management of insect sting allergy. Immunology can be a great alternative if you have any of the following concerns:

Poor response to medications

Impractical or impossible to avoid the offending allergens

Negative medication side effects

Wanting to avoid long-term medications or reduce the cost of medications

Coexisting allergic rhinitis and asthma

Possible prevention of asthma in children

Individuals with allergic asthma

If Immunotherapy Works Why Doesn’t Everyone Do It?

People who have very light symptoms or have found an effective medication that eliminates symptoms, may not need immunotherapy. For others, the time and commitment involved in starting and undergoing immunotherapy can be seen as an obstacle, especially when looking for a “quick fix”. In time however, more and more patients are realizing that the long-term benefits of immunotherapy are much better than having to be on medications for the rest of their life.

Who Is a Good Candidate for Receiving Immunotherapy?

Immunotherapy is recommended for those with allergic asthma, allergic rhinitis (involving various nasal symptoms) and conjunctivitis, or stinging insect allergy. It may be the best option for those who have difficulty controlling symptoms through avoidance or medication. Other considerations are that you do not like the side effects of allergy medication, the allergy medications are inconvenient, or having to take multiple medications in order to control symptoms. Immunotherapy is not recommended for those with food allergies. The best treatment for severe food allergies is to strictly avoid the offending food. The decision to begin immunotherapy will be based on several factors including:

Length of allergy season and how severe symptoms are.

How well medications and/or environmental controls take care of the allergy symptoms.

Wanting to avoid long-term reliance on medication.

Immunotherapy will require a significant time commitment-are you willing to make the commitment to the therapy?

Cost: may vary depending on insurance coverage.

Will Insurance Pay For Immunology?

Most insurance companies and HMOs will pay for immunotherapy, especially if your primary care doctor refers you to an allergist and the allergist recommends immunotherapy as part of your treatment. Even patients with milder symptoms may be recommended immunotherapy to avoid worsening of symptoms, particularly if they cannot always avoid the things they are allergic to, such as a family pet, bee stings, or specific native plants.

Who Is a Good Candidate for receiving immunotherapy?

Immunotherapy is recommended for those with allergic asthma, allergic rhinitis (involving various nasal symptoms) and conjunctivitis, or stinging insect allergy. It may be the best option for those who have difficulty controlling symptoms through avoidance or medication. Other considerations are that you do not like the side effects of allergy medication, the allergy medications are inconvenient, or having to take multiple medications in order to control symptoms. Immunotherapy is not recommended for those with food allergies. The best treatment for severe food allergies is to strictly avoid the offending food. The decision to begin immunotherapy will be based on several factors including:

Length of allergy season and how severe symptoms are.

How well medications and/or environmental controls take care of the allergy symptoms.

Wanting to avoid long-term reliance on medication.

Immunotherapy will require a significant time commitment-are you willing to make the commitment to the therapy?

Cost: may vary depending on insurance coverage.

How Is the Treatment Administered?

A very small hypodermic syringe is used to inject commercial allergen extracts. The injections are usually at the site of the loose tissue over the back of the upper arm, between the shoulder and elbow. This area is the least painful site for injection as there are very few nerve endings. Injections are given under the skin (”subcutaneous”). When administered correctly, the injections should only be slightly uncomfortable. They are not usually painful, and are well tolerated by adults, teenagers and most children. You may be advised to take an antihistamine a few hours before each injection to reduce the likelihood of any local allergic reaction and other side effects.

Can Young Children Receive Immunotherapy?

Children over the age of 5 may be good candidates for the therapy. Very young child will likely have difficulty cooperating with the immunotherapy regimen. However, immunotherapy can be a good option for children in general. Studies suggest that immunotherapy treatments may prevent the development of new allergies in children, and may help prevent the development of asthma in children who have rhinitis.

Is There an Age Limit to Receiving Immunotherapy?

Not really. Anyone from age 5 on up may benefit from receiving immunotherapy. With elderly persons, consideration should be given to the overall health and chronic medical conditions (such as cardiac disease), which could potentially cause problems. However most healthy children and adults can benefit from Immunotherapy treatments.

Where Does the Immunotherapy Take Place?

Ideally, immunotherapy should always be given in the prescribing allergist/immunologist’s office/clinic. If this is not possible for some extenuating circumstance, your allergist/immunologist should provide the supervising physician with all needed information about your specific treatment. Either way, you must always be in the care of an appropriate medical professional, who is qualified to administer Immunotherapy.

Bryan Morris asked:


Approximately 50 million Americans have asthma, hay fever or other allergy related conditions.

You can spot them from across the room – tissue in hand, sneezing, sniffling, blowing their nose, tearing, and rubbing their eyes. This is a common presentation for millions of children and adults who suffer from the misery of allergies. If fortunate, these symptoms are but a minor inconvenience, but, if severe, they can significantly affect one’s quality of life.

Allergies involving the nose (rhinitis) and eyes (conjunctivitis) are almost always caused by contact of an offending “allergen” to the mucous membrane lining of the nose or eyes. Constant exposure for the allergic individual can cause daily symptoms, resulting in what your physician would diagnose as persistent, chronic, or perennial allergic rhinitis. Common allergens responsible for these chronic symptoms may include house dust mites, mold spores, indoor pets, cockroach allergen, or feathers.

Symptoms of allergic rhinitis can also be acute or intermittent, presenting only when one is exposed to a relevant allergen. One of the most common presentations of allergies is seasonal allergic rhinitis or “hay fever”. As its name implies, symptoms will present during the pollen seasons, most typically in the spring during the tree and grass pollinating times, and in the fall when ragweed and other weed pollens are present.

You may want to consider a visit to an allergist if the following symptoms are present on a daily basis or seasonally:

• Itchy, swollen, red, tearing eyes

• Itching of the nose, ears, eyes, or throat

• Runny nose

• Sneezing

• Nasal congestion

• Persistent post-nasal drip

Allergic rhinitis is actually one of the easiest diagnoses for your physician to make. If the medical history suggests allergic rhinitis, an allergist will likely perform allergy testing in order to confirm the diagnosis, identify the offending allergen(s), and ascertain the severity of the allergy. The preferable testing method by most allergists is skin testing. This method allows the testing of multiple allergens simultaneously, with the results being immediately available. Alternatively, similar results can be obtained through a blood test called RAST or ImmunoCap.

Once the relevant allergens have been identified, an allergist will recommend a comprehensive treatment plan. This plan may include one or all of the following:

• Environmental control – minimizing exposure to allergens that you are sensitive to

• Pharmacotherpy – medicines including antihistamines, steroid nasal sprays, and other non-steroidal blockers of inflammation

• Immunotherapy or desensitization – extracts of allergens (pollens, dust, molds, etc.) are introduced into the body to induce an immunologic response, resulting in the eventual reduction or elimination of the allergic reaction. Historically, this form of treatment was available only by injection. Recent advances now allow the desensitization process to be given, in selected patients, by taking drops under the tongue, a process called sublingual immunotherapy (SLIT).

The most severe allergic reaction is called anaphylaxis. The most common causes of anaphylaxis include the ingestion of a highly allergenic food, such as peanuts, tree nuts, and shell-fish, or a medicine. The sting of a yellow jacket, wasp, hornet, or honeybee, or the bite of a fire ant can also result in a severe allergic reaction in a susceptible individual.

The symptoms of anaphylaxis vary from person to person. For some, they may be mild and include only generalized itching and urticaria (hives). In more severe reactions, however, they can include involvement of the respiratory, circulatory, and digestive systems, and can be fatal if not treated quickly and aggressively by the administration of epinephrine. Epinephrine can be self injected with the use of an EpiPen or Twinject.

Symptoms of full blown anaphylaxis may include:

• Difficulty breathing

• Hives or swelling

• Tightness of the throat

• Hoarse voice

• Nausea

• Vomiting

• Abdominal pain

• Diarrhea

• Dizziness

• Low blood pressure

• Cardiac arrest

• Shock

Those who have had anaphylaxis or are at risk for anaphylaxis should be evaluated by a board certified allergist for confirmation, identification of the allergen(s), and education regarding prevention, recognition, and self treatment of anaphylaxis.

There are many preventative measures allergy sufferers can take to protect themselves from potentially dangerous allergic reactions. Education is the best medicine. And, consider consulting an allergist for the most complete and up-to-date treatments available.

More detailed descriptions of common allergies and asthma can be found on the website, allergymedsites.com.