Allergic rhinitis, commonly called hay fever, is a relative newcomer to the allergy stage. While the ancient Greeks described asthma and food allergy, there is no reference to hay fever until the tenth century, when Persian scholar Rhazes described the causes of the coryza that took place in the spring when roses were in bloom. In the early twentieth century, hay fever was considered to be a rare illness of the upper class. The Scottish doctor and golfer John Morrison Smith described his own hay fever while still in medical school:
“I gradually recognized that it was not an ordinary cold and that the symptoms were much worse on the golf course or even during a nice day rowing on Loch Lomond. At first I did not know what I had, and neither did any other doctor I encountered in the next two or three years…”
Just 100 years later, millions of people now have hay fever or allergic rhinitis. The hygiene hypothesis is one possible reason for this meteoric rise in the prevalence of allergic rhinitis. While nearly 18 million Americans have asthma, more than twice as many—approximately 40 million people—suffer from allergic rhinitis. The prevalence of allergic rhinitis has followed the rise in asthma cases; like asthma the incidence of allergic rhinitis has tripled over the past twenty years in most developed countries.
There are two forms of allergic rhinitis—seasonal and perennial. Seasonal hay fever is caused by exposure to tree, grass, or weed pollens. Perennial, or year-round allergic rhinitis, is triggered by exposure to dust mites, molds, and animal parts. Some authorities believe that untreated allergic rhinitis leads to asthma. This concept has been difficult to prove, as there are few well-researched population studies that have followed individuals with allergic rhinitis for several years. Two decades ago, Dr. Guy Settipane identified a group of freshman students at Brown University in Providence, Rhode Island, who had allergic rhinitis and positive allergy skin tests. Dr. Guy Settipane tracked these Ivy League students for twenty years after their graduation. Twenty years after graduation, 10 percent of the students with allergic rhinitis had developed asthma.
In a similar study in Italy, 40 percent of more than five hundred I indents with allergic rhinitis developed asthma within eight years of follow-up. I used to believe that allergic rhinitis, even if untreated, did not cause asthma but simply preceded it. Now I am not so sure. This concept raises an interesting question. Would aggressive treatment of allergic rhinitis, including administering immunotherapy or allergy injections, especially to young children, prevent the development of asthma? Several worldwide studies now underway should ultimately answer this very important question.
The major symptoms of allergic rhinitis are sneezing, itchy nose and eyes, and clear, watery discharge. People with seasonal hay fever report symptoms during specific pollen seasons, while those with year-round or perennial allergic rhinitis complain when house dust mites, molds, and household pets precipitate or aggravate their symptoms.
People who suffer from long-standing allergic rhinitis, especially children, can often be diagnosed just by looking at their facial characteristics and mannerisms. There is often a discoloration and swelling under the eyes called “allergic shiners.” When nasal obstruction persists, the typical open-mouth or adenoidal face is apparent. Frequent rubbing of an itchy nose results in the allergic salute, which produces a transverse “allergic crease” across the lower third of the nose. In allergic rhinitis, the mucus membranes inside the nose are often pale-bluish in color, as opposed to the typical red color seen in non-allergic rhinitis or the common cold. The treatment of allergic rhinitis includes antihistamines, decongestants, and anti-inflammatory nasal sprays similar to those used in asthma, combined with proper environmental controls. In more persistent cases, allergy injections or immunotherapy may be indicated.