Allergic rhinitis
Allergic rhinitis is an inflammation of the nasal lining caused by the immune system overreacting to a substance that is otherwise harmless. In everyday speech it is called hay fever, even though hay usually has nothing to do with it.
It shows as sneezing in bursts, a watery runny nose, itching of the nose, eyes, palate or ears, and a blocked nose. The seasonal form comes back every year at the same time, while the year-round form persists throughout the year and often has different triggers.
How to tell it apart from a cold
Itching is the most reliable distinguishing sign. A cold does not usually cause an itchy nose and eyes, but an allergy almost always does.
The course also differs. A cold settles within three to seven days, the discharge becomes thick and yellowish, and a slightly raised temperature is common. Allergic rhinitis lasts weeks or months, the discharge stays watery and clear, and there is no fever.
The third hint is repetition. If the same symptoms appear every year in the same week, when the grass is mown, after visiting a house with a dog, or in the morning after waking in the bedroom, it is an allergy and not a series of colds.
What triggers it
In Slovenia, seasonal symptoms are caused by pollen. In early spring hazel, alder and birch flower, in May and June grasses, and at the end of summer mugwort and ragweed. The time when symptoms appear therefore often tells you by itself which allergen is most likely.
Year-round symptoms are most often caused by house dust mites, moulds, and the dander and saliva of pets. Symptoms typically get worse in the morning after waking, when tidying up and when changing the bedding.
Besides allergens, the nasal lining is irritated by cigarette smoke, exhaust fumes, dry air in heated rooms and strong smells. They do not cause the allergy themselves, but they make it noticeably worse.
When to call 112 and when it is something else
If you have sudden swelling of the lips, tongue or throat, difficulty breathing or swallowing, or hives across the body with dizziness or a feeling that you are about to collapse, call 112 immediately. These are signs of anaphylaxis. If you have been prescribed an adrenaline auto-injector, use it immediately and only then call.
Allergy is not the only cause of a blocked nose. A nose blocked on one side, a blood-streaked discharge from one side, a loss of smell that does not pass after weeks, and facial pain with fever should be examined at the ENT clinic, where it is established whether there is a deviated nasal septum, polyps or sinus inflammation.
When a runny nose is accompanied by a persistent feeling of blocked ears or poorer hearing, an assessment of the middle ear makes sense. In children this shows as louder speech and responding less well when called.
What the assessment involves
The examination at the ENT clinic begins with a conversation about how your symptoms vary over the year, about triggers and about treatment so far. This is followed by an examination of the nasal cavity, throat and ears to assess the state of the lining and rule out other obstacles to breathing through the nose.
Allergy testing and immunotherapy are handled by the pulmonology clinic, which covers allergic conditions at the centre. If testing makes sense, the specialist will direct you there.
A test result is not a diagnosis in itself. It only gains meaning in connection with when your symptoms appear. That is why it is worth noting for a few weeks before the examination when your nose is most blocked and where you are at the time.
What helps
The first measure is to reduce contact with the trigger as far as is practical. When pollen levels are high, it helps to keep windows closed in the middle of the day, shower and change clothes when you get home, and dry laundry indoors. For dust mites, bedding covers, regular washing at a high temperature and fewer textiles in the bedroom make sense.
The basis of treatment for moderate and more severe symptoms is corticosteroid nasal sprays. They act on the inflammation, so the effect is not immediate; the full effect appears after one to two weeks of regular use. Aim the spray towards the outer wall of the nose, not towards the septum.
Antihistamine tablets work well against sneezing, itching and a watery runny nose, but have less effect on a blocked nose. Rinsing the nose with saline solution also helps, as it mechanically removes pollen and mucus.
When medicines and avoidance are not enough, immunotherapy may be considered, that is, gradually getting the immune system used to the allergen. Treatment lasts several years and requires regular monitoring, and the decision about it is made by the doctor after the examination and results.