APRIL 2013 • FACTS Allergic and Nonallergic

Spring is here again. The birds are singing and it’s warming up. Most of us are happy about this, but some may be dreading springtime. This is because some people have more problems with in the spring. Plants are growing and flowers are blooming—and the pollen count is rising. triggers But it’s important to remember that some -like symptoms aren’t • Airborne odors or irritants such as always caused by allergies. And treatment outcome depends on pinpointing dust, smog, perfume, hair spray, cleaning all the allergic and nonallergic triggers. This is because the more simultaneous solutions, secondhand smoke triggers the person is exposed to, the worse the symptoms are likely to be. • Changes in temperature or humidity, Identifying and avoiding all the triggers can go a long way toward helping cold air a person feel better. • Emotional or physical stress Common allergic and nonallergic symptoms • Hormonal changes, especially in women Symptoms that are common in people who have allergies and in those who • Hot or spicy foods, alcoholic drinks don’t include: • Medicines such as aspirin, ibuprofen, • Chronic sneezing ACE inhibitors, beta-blockers, sedatives, • Runny nose antidepressants, birth control pills, and erectile dysfunction • Stuffy nose • Overuse of decongestant nasal sprays • Postnasal drip • Viral infection People with these symptoms have either or nonallergic rhinitis. Allergic rhinitis occurs when the immune system reacts to a foreign protein Allergic rhinitis triggers such as pollen or dust mite droppings. People with allergic rhinitis are said • Animal dander to have allergies. Nonallergic rhinitis does not involve the immune system. • Chemicals in shampoos, detergents, Finding out if it’s allergic or nonallergic cosmetics rhinitis • Cockroach droppings There are 2 types of diagnostic tests that can help. One is a skin test. The • Dust mite droppings other is a blood test. If either test is negative, the person might have nonallergic • Foods rhinitis. • Insect stings (eg, bees, wasps, fire ants) A skin test requires a separate puncture for each allergen that might be causing the symptoms. With the blood test, there is only one skin puncture. • Medications such as penicillin Doctors can choose which allergens to include in the blood test, thus tailoring • Molds the test for each person. Blood testing is especially useful when the person1: • Nickel • Poisonous plants (eg, poison ivy, oak, or sumac) • Pollen

1 Rhinitis

FACTS

Rhinitis facts • Has a widespread skin disease • Allergic rhinitis is more common (about • Has a high risk of anaphylaxis (a severe, systemic reaction to the 3 times) than nonallergic rhinitis.2,3 allergen challenge) from skin testing • 10% to 30% of the world’s population • Is receiving medications (eg, beta-blockers, angiotensin-converting have allergic rhinitis.4 enzyme inhibitors, and some and tricyclic antidepressants) • In 2007, there were 13.4 million visits that interfere with skin testing to a doctor, hospital, or emergency room • Is uncooperative due to a mental or physical impairment for allergic rhinitis problems.5 The blood test can be used for patients 3 months of age and older, regardless • $11.2 billion were spent on allergic of skin condition. There is no need to stop current medications before drawing rhinitis treatment in 2005.6 a blood sample. • 4 million workdays are lost each year Additionally, nasal endoscopy or a computerized tomography (CT) scan because of hay fever.7 can be used to look for a structural abnormality that might be causing • People with allergic rhinitis have 3 nonallergic rhinitis. additional doctor office visits, 9 more Treatment—avoiding the triggers prescriptions filled, and $1500 more in healthcare costs in 1 year than people The most important thing is to avoid the trigger(s). This is true for both allergic without it. and nonallergic rhinitis. So, narrowing down the possibilities using a medical history and diagnostic testing is crucial. When total avoidance isn’t possible, References other things can be used to help the patient feel better. 1. Bernstein IL, Li JT, Bernstein DI, et al. Allergy diagnostic testing: an updated practice parameter. Ann Some tips for avoiding allergens Allergy Immunol. 2008;100(Suppl 3):S1-S148. Once the allergic and nonallergic triggers are identified, the affected person can 2. Bachert C, van Cauwenberge P, Olbrecht J, et al. Prevalence, classification and perception of allergic and try to avoid them. Avoiding them should help him/her feel better. Here are just nonallergic rhinitis in Belgium. Allergy. 2006;61:693-698. a few ways to avoid the triggers: 3. Mølgaard E, Thomsen SF, Lund T, et al. Differences • Use an air conditioner and have someone change the filters regularly; between allergic and nonallergic rhinitis in a large sample of adolescents and adults. Allergy. 2007; this helps decrease pollen, molds, and house dust mites. 62:1033-1077. • Consider using a dehumidifier to help prevent mold and keep humidity 4. Allergy statistics. American Academy of Allergy, constant. Asthma, and Immunology website. www.aaaai.org/ about-the-aaaai/newsroom/allergy-statistics.aspx. • When landscaping, choose nonflowering plants that require little water; Accessed February 28, 2013. this helps decrease pollen and molds. 5. Schappert SM, Rechtsteiner EA. Ambulatory medical • Vacuum or dust each week; this helps decrease pet dander, dust mites, care utilization estimates for 2007. National Center for Health Statistics. Vital Health Stat 13(169). 2011. and cockroach droppings. www.cdc.gov/nchs/data/series/sr_13/sr13_169.pdf. • Use allergen-proof covers for mattresses and pillows; this helps decrease Accessed February 28, 2013. pet dander and house dust mites. 6. Soni A. Allergic rhinitis: trends in use and expenditures, 2000 and 2005. AHRQ Statistical Brief #204. http://meps. • Stay away or wear a mask when grass is being cut or a room is being ahrq.gov/data_files/publications/st204/stat204.pdf. cleaned; this helps decrease contact with pollens, molds, pet dander, Accessed February 28, 2013. and house dust mites. 7. Allergy statistics and facts. WebMD website. http://www.webmd.com/allergies/allergy-statistics. • Don’t overuse decongestant nasal sprays; overuse can trigger the very Accessed February 28, 2013. symptoms the person is trying to prevent. 8. Bhattacharyya N. Incremental healthcare utilization • Get plenty of sleep, exercise, and eat a healthy diet; this helps avoid and expenditures for allergic rhinitis in the United States. viral infections. Laryngoscope. 2011;121:1830-1833.

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