| Allergic rhinitis, also called hay fever, is an inflammation of the mucous membrane lining of the nose (nasal mucosa), triggered by an allergic reaction. Individuals with allergic rhinitis either experience symptoms during certain months and are classified as having "seasonal allergic rhinitis" or experience symptoms throughout the year and are classified as having "perennial allergic rhinitis." Incidence and Prevalence: Allergic rhinitis affects 10% to25% percent of the world population (Wang). In 2011, 16.9 million adults in the US reported that in the past 12 months they had been told by a doctor that they had allergic rhinitis; that represents 7.3% of the US population (Schiller). |
Source: Medical Disability Advisor
| Allergic rhinitis often appears in children, adolescents, and young adults, but may occur in people of all ages. It often runs in families. Seasonal allergic rhinitis is caused by exposure to seasonal allergens like pollen from grass, trees, and weeds. Since grasses, trees, and weeds have well-defined pollinating periods, their pollens are airborne only during certain seasons. Perennial allergic rhinitis is usually caused by one of four common indoor allergens: animal dander, house dust mites, cockroaches, or mold spores, which produce year round exposures. Allergic rhinitis has also been reported due to changes in lifestyle, diet, geography, climate, socioeconomic conditions, family structure or history, infant feeding, excessive allergen exposure especially during early life, and cigarette smoking (Wang). This condition can also be caused by the processed materials or chemicals used in a workplace setting. |
Source: Medical Disability Advisor
History: Individuals may report symptoms that occur at a certain time of day or in a certain season of the year. Individuals may report an exposure to a specific substance such as cat dander, ragweed, or dust, or they may be unaware of what precipitated the episode. Symptoms can include sneezing; itching of the nose, eyes, mouth, throat, or skin; runny nose (rhinorrhea); stuffy nose (nasal congestion); tearing eyes; impaired sense of taste or smell, coughing, and frontal headache (in the presence of sinus obstruction). Physical exam: The exam usually reveals reddened nose, swollen and either pale or red nasal membranes, watery and reddened eyes (occasionally with dark circles [allergic shiners] underneath), and occasionally nasal polyps. Examination of the throat may reveal redness with postnasal drip. The lungs will be clear on examination. Tests: Tests are not required to diagnose allergic rhinitis. Allergy testing is advised if the individual develops rhinitis on a frequent or chronic basis that does not readily respond to treatment. Allergy skin tests help identify the specific allergens responsible so that exposure can be avoided or kept to a minimum. Intradermal, scratch, patch, or other tests may be performed. |
Source: Medical Disability Advisor
The four steps in treating allergic rhinitis are education, allergen avoidance, drug therapy, and allergy shots (specific allergen immunotherapy or desensitization).
Avoidance of the causal allergen(s) is key to successful treatment. All sources of an allergen at home or work should be removed. While avoidance is the best treatment, complete avoidance of a specific allergen may not be possible, in which case exposure should be minimized.
Drug therapy can include antihistamines, decongestants to reduce nasal congestion (these drugs should not be used for more than 3 days in a row), and nasal corticosteroids to reduce the immune response. The older antihistamines have side effects that often include drowsiness; newer antihistamines do not. Nasal steroids are recommended as the first-line treatment for rhinitis. Alternatives include nasal cromolyn sodium (a mast cell stabilizer); montelukast (a drug that blocks the leukotrienes, chemicals produced by the immune system that cause allergy symptoms), or nasal ipratropium.
When individuals fail to respond to front line treatment, further treatment of allergic rhinitis may require the identification of the agent(s) causing the allergic reaction. Allergy shots (immunotherapy or desensitization) are recommended when an allergen cannot be avoided, symptoms are severe or persistent, or medications don't relieve symptoms. Desensitization includes regular injections of the allergen(s) during three to five years, given in increasing doses to desensitize the body to the allergen. Desensitization is only recommended for certain allergens after carefully weighing the risks and benefits (Pipet). |
Source: Medical Disability Advisor
While treatment can effectively reduce most symptoms of allergic rhinitis, treatment only affects the current exposure. Future exposures will cause another allergic reaction. Allergy identification through testing with attempts to avoid allergen exposure can reduce the number of future occurrences.
On occasion, an individual, mainly during childhood, may outgrow an allergy as their immune system becomes less sensitive to the specific allergen(s). However, once a specific allergen has caused a reaction, it will generally continue to do so. |
Source: Medical Disability Advisor
- Chronic rhinitis
- Foreign bodies of the upper airway
- Rhinitis medicamentosa
- Upper respiratory tract infections (URTI)
- Vasomotor rhinitis
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Source: Medical Disability Advisor
- Allergist/Immunologist
- Family Physician
- Internal Medicine Physician
- Otolaryngologist
- Pulmonologist
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Source: Medical Disability Advisor
- Asthma
- Compromised immunity
- Deviated nasal septum
- Nasal polyps
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Source: Medical Disability Advisor
| Complications associated with allergic rhinitis are few and generally minor. Most involve a superimposed viral or bacterial infection in the region of the nose and throat. Prolonged nasal congestion can precede a common cold (nasopharyngitis) or can lead to obstruction of sinus drainage resulting in sinusitis. Nasal polyps are associated with longstanding symptoms. Continuous postnasal drip can cause inflammation of the throat (pharyngitis), tonsils (tonsillitis), or voice box (laryngitis). Although temporary use of a decongestant spray or drops may reduce symptoms, continued use can eventually make them worse. With immunotherapy, there is danger of a life-threatening allergic reaction (anaphylaxis) shortly after an allergy injection is given; however, this is a rare occurrence. |
Source: Medical Disability Advisor
| Length of disability can be influenced by the severity of the individual's symptoms, effectiveness of symptom-relieving medication, ability to avoid the offending allergens, underlying chronic medical conditions involving the immune system or the respiratory tract, and any complication(s). |
Source: Medical Disability Advisor
| Workplace accommodations include the avoidance of inhaled irritants to which the individual is allergic. If complete avoidance is not possible at work, goggles and/or masks may need to be worn. Some over-the-counter and prescription drugs used to treat allergic rhinitis require that the individual avoid driving or operating heavy equipment while taking the medication; however, these medications can be readily replaced by equivalent products free of sedative effects. Risk: In patients who do not respond to front line treatment, and undergo allergy testing, those who are allergic to exposures in the work place may be at increased risk for persistent symptoms.
For more information on risk, refer to "Disease and Injury Causation," pages 552-554. Capacity: There should be no impact on capacity in individuals with allergic rhinitis that is well controlled. Capacity may be reduced if the work environment continues to expose a susceptible individual. Tolerance: Individuals may benefit from variable combinations of nasal antihistamines, decongestants, and corticosteroids to permit greater tolerance in the work environment. |
Source: Medical Disability Advisor
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have seasonal allergies to trees, grasses, and weed pollens?
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Do the symptoms occur at a specific time of the day or year?
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Is individual at home or at work when most symptomatic?
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Is individual allergic to indoor allergens such as animal dander, dust mites, cockroaches, or mold?
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Do symptoms include sneezing, itchy eyes, nose, mouth, throat, or skin? Does individual have a runny or stuffy nose, or a cough or frontal headache?
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On physical exam, were the affected areas reddened and swollen, or pale? Was postnasal drip present? Were the lungs clear?
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Has individual undergone allergy testing? What were the results?
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Have conditions with similar symptoms been ruled out?
Regarding treatment:
- Has the agent(s) causing the allergic reaction been identified? Does individual attempt to avoid the offending agents?
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Has individual responded favorably to drug therapy? If not, have other drugs been tried?
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Has individual undergone specific allergy desensitization?
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Is individual compliant with the treatment regime?
Regarding prognosis:
- Can individual's employer accommodate any necessary restrictions?
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Can individual avoid the allergens or use personal protective equipment such as masks, goggles, or gloves? Does individual follow these restrictions while at home?
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Does individual have any conditions such as asthma or a compromised immune system that may delay recovery?
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Does individual have any complications such as a superimposed viral or bacterial infection in the nose or throat? Does individual have sinusitis?
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Is there irritation from the postnasal drip?
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Have decongestant sprays or drops been used for an extended period?
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Source: Medical Disability Advisor
| CitedMelhorn, J. Mark, and William Ackerman, eds. Disease and Injury Causation, Guides to the Evaluation of. AMA Press, 2008.Pipet, A., et al. "Allergen Specific Immunotherapy in Allergic Rhinitis and Asthma. Mechanisms and Proof of Efficacy." Respiratory Medicine 103 800-812. Schiller, J. S. , J. W. Lucas, and J. A. Peregoy. "Summary Health Statistics for US Adults: National Health Interview Survey, 2011." Vital and Health Statistics 10 (2012): 1-218. Skeikh, Javed. "Allergic Rhinitis." eMedicine. Eds. Michael A. Kaliner, et al. 4 Apr. 2014. Medscape. 6 Apr. 2014 <http://emedicine.medscape.com/article/134825-overview>. Wang, D. Y. "Risk Factors of Allergic Rhinitis: Genetic or Environmental?" Therapeutics and Clinical Risk Management 1 (2005): 115-123. |
Source: Medical Disability Advisor