Allergic rhinitis, often called hay fever is very common in the community affecting all ages, meanwhile, the incidence is highest during the teenage years. However, it is frequently underappreciated and underdiagnosed.
Allergic rhinitis is a risk factor for the development of asthma. Moreover, the association of allergic rhinitis and asthma control is clinically relevant as it results in poor asthma control.

Worldwide, allergic rhinitis affects between 10% and 30 % of adults and 40% of children. Worldwide, sensitization (IgE antibodies) to foreign proteins in the environment is present in up to 40% of the population. The prevalence of allergic rhinitis may vary within and among countries. The highest prevalence of severe allergic rhinitis symptoms in children were observed in Africa and Latin America. This may be due to geographic differences in the types and potency of different allergens and the overall aeroallergen burden.

Causes
Allergic rhinitis occurs when the immune system mistakes a normally harmless airborne substance for a threat. The body produces an antibody called immunoglobulin E (IgE) to attack the threat, and it releases the chemical histamine. Histamine causes the symptoms.
Seasonal allergic rhinitis triggers include pollen and spores that only cause symptoms at certain times of the year.
Examples of allergic rhinitis triggers include: tree pollen in the spring, grass pollen in late spring and summer, weed pollen, especially during fall, fungi and mold spores, more common in warm weather.

Formaldehyde

Indoor exposure to formaldehyde is a major health concern, especially for school-age children who spend most of their time indoors, because at room temperature, formaldehyde evaporates from wood-based products, flooring materials, paints, fabrics, cosmetics, cleaning products, and air fresheners.

Formaldehyde irritates the nose, eyes, and throat. These irritations can happen at low levels of formaldehyde, especially in people who are especially sensitive to the odors. Indoor formaldehyde level was associated with rhinitis, severity of rhinitis, hyposmia , nasal obstruction, headache and nausea. Exposure may cause wheezing, asthma attacks and other respiratory symptoms.

Risk Factors
Some factors increase the risk of allergic rhinitis.
Genetic factors: If a close family member has hay fever or another allergy, the risk is higher.
Gender and age: Before adolescence, hay fever is more common among boys, but after adolescence, females are more affected.
Birthdate: People born during the high pollen season have a slightly higher risk of developing allergic rhinitis.
Other allergies or asthma: People with other allergies or asthma are more likely to have allergic rhinitis as well.
Second-hand smoke: Exposure to cigarette smoke during the early years of life increases the risk of allergic rhinitis.
An infant who has had fewer childhood infections may have a higher risk of autoimmune problems later in life.

Symptoms
People with allergic rhinitis generally experience symptoms after breathing in an allergy-causing substance such as pollen or dust. In the spring, the most common triggers are tree and grass pollen. In the fall, a common allergen is a ragweed or other weed pollens or outdoor mold.
When a sensitive person inhales an allergen, the body’s immune system may react with the following symptoms (listed in order of frequency): stuffy nose due to blockage or congestion, runny nose or postnasal drainage, itching, usually in the nose, mouth, eyes, or throat, red and watery eyes, puffy, swollen eyelids, sneezing and cough.
Symptoms also may be triggered by common irritants such as cigarette smoke, strong odors, such as perfume, or hair spray and fumes, cleaning solutions, pool chlorine, car exhaust and other air pollutants (i.e., ozone) and air fresheners.
Allergic rhinitis can be associated with: decreased concentration and focus, limited activities, decreased decision-making capacity, impaired hand-eye coordination, problems remembering things, irritability, sleep disorders, fatigue, missed days of work or school, more motor vehicle accidents and more school or work injuries.
Many parents of children with allergic rhinitis have said that their children are more moody and irritable during allergy season. Since children cannot always express their symptoms verbally, they may express their discomfort by acting up at school and at home. In addition, some children feel that having an allergy is a stigma that separates them from others.
It is important that the irritability or other symptoms caused by allergy symptoms are not mistaken for attention deficit disorder. Symptoms of allergic rhinitis have other causes as well, the most customary being the common cold – an example of infectious rhinitis. Most infections are relatively short-lived, with symptoms improving in three to seven days.

Occupational Rhinitis
If you develop symptoms that resemble those of allergic rhinitis and that appear or become more serious at work, you may be suffering from occupational rhinitis. Occupational rhinitis, or work-related rhinitis, is a condition in which symptoms are triggered or further aggravated by allergens in the workplace. These symptoms can include sneezing, a runny nose and watering eyes. Common triggers include cleaning products, chemical fumes, certain types of dust, and corrosive gases.

Complications of Allergic Rhinitis
If you have allergic rhinitis, there’s a risk you could develop other problems. A blocked or runny nose can cause: difficulty sleeping, drowsiness, irritability and problems concentrating. Allergic rhinitis can also make symptoms of asthma worse. The swelling in the nose can also sometimes cause other conditions. These include nasal polyps, acute or chronic sinusitis, and middle ear infections dental problems (overbite) caused by excessive breathing through the mouth, palatal abnormalities and Eustachian tube dysfunction.

Tips to Minimise Exposure to Allergens
The first approach in managing seasonal or perennial forms of allergic rhinitis should be to avoid the allergens that trigger symptoms, if possible.
Outdoor Exposure
Stay indoors as much as possible when pollen counts are at their peak, usually during the midmorning and early evening (this may vary according to plant pollen), and when wind is blowing pollens around. Avoid using window fans that can draw pollens and molds into the house. Wear a hat to prevent pollen from collecting in the hair and then sprinkling down onto the eyes and face. Wear glasses or sunglasses when outdoors to minimize the amount of pollen getting into your eyes. Don’t hang clothing outdoors to dry; pollen may cling to towels and sheets. Try not to rub your eyes; doing so will irritate them and could make your symptoms worse.
Indoor Exposure
Reduce exposure to dust mites, especially in the bedroom. Wash your bedding frequently, using hot water.
Do not have flowers inside your home. Keep windows closed and use air conditioning in your car and home. Make sure to keep your air conditioning unit clean. Keep all surfaces, floors, and carpets as dust free as possible.
To limit exposure to mold, keep the humidity in your home low (between 30 and 50 percent) and clean your bathrooms, kitchen, and basement regularly. Use a dehumidifier, especially in the basement and in other damp, humid places, and empty and clean it often. If mold is visible, clean it with mild detergent and a 5 percent bleach solution. Clean floors with a damp rag or mop, rather than dry-dusting or sweeping. Keep away from cigarette smoke, and quit, if you are a smoker. Smear vaseline around the inside edges of your nostrils, as it helps stop pollen from getting through.
Exposure to Pets
Wash your hands immediately after petting any animals; wash your clothes after visiting friends with pets. Keep your pet out of your home as much as possible. If the pet must be inside, keep it out of your bedroom so you are not exposed to pet allergens while you sleep. Close the air ducts to your bedroom if you have forced-air or central heating or cooling. Replace carpeting with hardwood, tile, or linoleum, all of which are easier to keep dander-free.

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