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ALLERGIES
TREAT ALLERGIC RHINITIS
Before it makes you feel miserable
By Patricia Gomez Dinger, DO
Allergic rhinitis is a chronic inflammatory condition involving
the nasal airway creating symptoms of sneezing, runny nose, itchy
ears, watery eyes, post nasal drainage, nasal congestion, cough, and
sinus pressure.
It has been said to affect between 10 to 30 percent of adults and
children in the United States. It accounts for at least 2.5 percent of
all clinician visits, 2 million lost school days, 6 million lost work
days, and 28 million restricted work days per year. It can be charac-
terized as seasonal or perennial depending on the type of allergen
to which the patient is sensitized and the duration of
symptoms.
A genetic predisposition and a high enough
exposure to an allergen is generally what will
predict whether a patient has allergies. Pa-
tients with allergic rhinitis will often suf-
fer from allergic conjunctivitis, asthma,
or atopic dermatitis. It is imperative to
identify a patient’s triggers in order to
begin instituting environmental controls
and appropriate treatment.
Patients will often misdiagnose their
symptoms for an infectious illness or a com-
mon cold. Some key differences are that when the
symptoms are due to allergic rhinitis it is usually not
accompanied by a fever, it has a seasonal pattern to the recurrent
symptoms, and it is typically characterized by itching and sneezing.
A very common mistake patients make is to start treating symp-
toms too late after they are already feeling miserable. The best allergy
treatment is to have identified the allergic trigger and begin treat-
ment before the patient’s peak allergy season (if seasonal).
I often explain this to patients as putting on your body armor be-
fore going into battle. If the symptoms are perennial, then using al-
lergy medication year-round may be inevitable. These patients are
also candidates for allergy immunotherapy.
A very frequently asked question is: what are the best allergy med-
16 San Antonio Medicine • March 2017
ications to treat allergic rhinitis? Steroid nasal sprays are first line
in the treatment of the condition. There are several now available
over the counter. When these medications are used properly coupled
with an antihistamine nasal spray it is possible to achieve ninety per-
cent symptom improvement. Sinus rinsing can also be beneficial
particularly when the patient has spent time outdoors during their
peak season.
Lack of treatment can severely impact a patient’s quality of life
and has been associated with sleep disturbances, poor concentration,
absenteeism/presenteeism, and generalized fatigue. It is im-
portant that patients understand that relying on cor-
ticosteroids orally or by injection is not the
preferred treatment for allergies. This should
be used as a last resort when proper allergy
medications have failed.
If allergic rhinitis is left untreated, it
can result in a sinusitis and exacerbate
asthma or cause bronchitis, thus requir-
ing antibiotics. It is important to note
that patients complaining of shortness of
breath, wheezing or chest tightness in asso-
ciation with allergic rhinitis may be experienc-
ing allergic asthma and should undergo
pulmonary function testing. Patients whose nasal and
respiratory symptoms are severe or refractory to therapy should
be referred to an allergy specialist for a more definitive evaluation.
Dr. Patricia Gomez Dinger is a board certified al-
lergist with Advanced Allergy, Asthma and Immunology
Center in San Antonio. She is a member of Texas Allergy,
Asthma & Immunology Society, San Antonio Allergy,
Asthma & Immunology Society, Bexar County Medical Society, Amer-
ican College of Allergy, Asthma, & Immunology, American Academy of
Allergy, Asthma, & Immunology, and the Joint Council of Allergy,
Asthma, & Immunology.