Nasal Allergy (Allergic Rhinitis), often called “hay fever,” is a condition in which the lining of the nose overreacts to certain substances in the air. Bouts of sneezing, a watery runny nose, itching and congestion are its most familiar complaints. While it is not a life-threatening illness, it can noticeably affect sleep, performance at work or school and overall quality of life.
What Is Nasal Allergy (Allergic Rhinitis)?
The inside of the nose is covered by a thin, moist lining called the mucosa. It warms and humidifies inhaled air and traps dust and germs. In allergic rhinitis, the immune system treats harmless substances such as pollen, house dust mites or pet dander as dangerous invaders and produces antibodies against them called IgE.
When the person meets the same substance again, mast cells in the nasal lining release histamine and other chemicals. These substances widen blood vessels, make the lining swell, stimulate nerve endings and switch on the mucus glands. As a result, sneezing, a runny nose and itching start within minutes, while congestion tends to take over within hours.
Nasal allergy is one of the most common chronic conditions in the world and can appear at any age. It usually begins in childhood or adolescence, but it is also possible to notice it for the first time in adulthood. People with a family history of allergies, asthma or eczema are more likely to develop it.
Seasonal and Year-Round Allergic Rhinitis
- Seasonal (intermittent) allergic rhinitis: Becomes noticeable in spring and summer, when tree, grass and weed pollen levels in the air are high.
- Year-round (perennial) allergic rhinitis: Linked to house dust mites, mold, cockroaches and pet allergens; it continues throughout the year and may get worse in winter, when people spend more time indoors.
- Occupational allergic rhinitis: Can develop in people who work with flour, wood dust, latex or laboratory animals, due to substances in the workplace.
Causes of Nasal Allergy
Allergic rhinitis develops through a combination of genetic predisposition and environmental factors. Two people in the same home may react differently because each immune system responds in its own way. If one parent has allergies, a child’s risk of developing them rises; if both parents do, the risk is higher still.
The main allergens that trigger nasal allergy include:
- Tree, grass and weed pollen
- House dust mites living in mattresses, pillows, carpets and upholstery
- Fur, skin flakes (dander) and saliva from cats, dogs and other pets
- Mold spores that grow in damp environments
- Cockroach particles
Some factors are not allergens but can still make existing symptoms worse. Cigarette smoke, vehicle exhaust, strong perfumes and detergent smells, sudden temperature changes and air pollution easily irritate a sensitized nasal lining. Avoiding irritants brings relief even when allergens cannot be fully eliminated.
Symptoms of Nasal Allergy
Symptoms range from mild to severe depending on how long a person is exposed to the allergen and how sensitive they are. Some patients are bothered for only a few weeks during pollen season, while others have complaints all year long.
- Repeated bouts of sneezing, especially in the morning
- A clear, watery runny nose
- Itching inside the nose, on the roof of the mouth and in the ears
- Congestion on one or both sides of the nose
- Itchy, watery, red eyes
- Postnasal drip (mucus running down the back of the throat) and a frequent need to clear the throat
- A reduced sense of smell
- Poorer sleep, daytime tiredness and difficulty concentrating
Some typical signs stand out in children. Constantly rubbing an itchy nose upward with the palm is called the “allergic salute,” and over time it can leave a horizontal crease across the bridge of the nose. Dark circles under the eyes, mouth breathing and snoring are also common. Because long-term mouth breathing can affect the development of the teeth and jaw in children, these signs should be taken seriously.
Nasal Allergy or a Common Cold?
A common cold usually clears up within 7–10 days and is often accompanied by a mild fever and body aches; the nasal discharge may thicken over time. In allergic rhinitis there is no fever, the discharge usually stays clear, itching is prominent and the complaints continue for weeks as long as contact with the allergen continues. A “cold” that returns in the same months every year should raise the possibility of an allergy.
How Is Symptom Severity Assessed?
International guidelines classify allergic rhinitis as intermittent or persistent according to how long the symptoms last, and as mild or moderate-to-severe according to their impact. Disturbed sleep, reduced performance at school or work, limitations in sports and social activities, or symptoms the person finds troublesome are enough for the condition to be considered moderate-to-severe. This classification guides the choice and duration of medication.
How Is Nasal Allergy Diagnosed?
Diagnosis is built on a detailed history. The doctor asks in which season the complaints increase, whether they are worse indoors or outdoors, and about contact with pets, occupation and family history of allergy. An ENT (ear, nose and throat) examination of the inside of the nose follows; in allergic rhinitis the lining usually looks pale, bluish-gray and swollen.
When needed, nasal endoscopy, performed with a thin camera, is used to evaluate the back of the nose, the sinus openings and the area behind the nose (the nasopharynx). This examination can reveal problems that may accompany allergy, such as a deviated septum, enlarged turbinates (the ridges of tissue on the side walls of the nose) or polyps.
The following tests are used to identify which substances a person is allergic to:
- Skin prick test: Drops of allergen extracts are placed on the forearm and introduced into the skin with a small lancet; the resulting bumps and redness are assessed after about 15–20 minutes. Antihistamine medications need to be stopped for a certain period before the test.
- Specific IgE blood test: Preferred for people who cannot have skin testing, who have widespread skin disease or who cannot stop their medication.
- Nasal secretion analysis: In some cases, the nasal discharge may be examined for allergy-related cells called eosinophils.
A test result alone is not enough; it must always be interpreted together with the patient’s actual symptoms. Not every allergen that tests positive causes complaints in real life. Patients traveling from abroad are encouraged to bring any previous allergy test results, imaging reports and a list of their current medications to the first visit.
Treatment of Nasal Allergy
Treatment of allergic rhinitis rests on three pillars: avoiding allergens, medication and, in suitable patients, allergy shots. The plan is tailored to the severity and duration of the symptoms and to the person’s lifestyle.
Avoiding Allergens
- Keeping windows closed during pollen season, especially in the morning, and showering and changing clothes after coming indoors
- For dust mite allergy, using mite-proof covers on mattresses and pillows and washing bedding in hot water once a week
- Reducing carpets, heavy curtains and stuffed toys in the bedroom
- Keeping indoor humidity balanced and dealing with dampness and mold
- For pet allergy, at the very least keeping the animal out of the bedroom
Medication
Corticosteroid nasal sprays are among the most effective medications for moderate and severe allergic rhinitis. They reduce the inflammatory reaction in the nasal lining; their effect begins within a few days and builds with regular use. Using the correct technique, aiming toward the outer wall of the nose rather than the central partition, reduces side effects such as nosebleeds.
Newer-generation oral antihistamines relieve sneezing, itching and runny nose and cause less drowsiness than older medications. Antihistamine nasal sprays, leukotriene modifiers and eye drops can also be added for patients who need them. Saline nasal rinsing mechanically clears away allergens and mucus, supporting the effect of the medications.
Over-the-counter decongestant nasal sprays should only be used for a short time. Used for more than a few days, they can cause rebound congestion that keeps getting worse.
The most common problem in treatment is stopping the medication as soon as the symptoms ease. For people with seasonal allergies, starting the spray a few weeks before pollen season begins and continuing it regularly throughout the season generally works better at keeping symptoms from flaring.
Allergy Shots (Immunotherapy)
Allergy immunotherapy is considered for patients with proven sensitivity to specific allergens who do not get enough relief from medication. The allergen is given in increasing doses, either as injections under the skin or as tablets or drops under the tongue, with the aim of helping the immune system get used to the substance. Treatment usually lasts 3–5 years and reduces symptoms and the need for medication in most patients. Immunotherapy is planned in collaboration with an allergy specialist.
When Is Surgery Needed?
Surgery does not cure the allergy itself. However, long-standing allergy can cause the lower turbinates to become permanently enlarged. In patients whose congestion persists despite medication, turbinate reduction, together with septoplasty if a deviated septum is also present, can improve nasal breathing and help medications reach the nose more effectively.
Possible Risks and Important Considerations
Untreated nasal allergy can, over time, set the stage for problems such as sinusitis, fluid buildup in the middle ear, sleep disturbance and snoring. Because allergic rhinitis and asthma frequently occur together, people with nasal symptoms who also have wheezing, shortness of breath or a nighttime cough should have these symptoms evaluated as well.
Using medications without a doctor’s advice can also cause problems. Long-term decongestant use, drowsiness from some antihistamines and medication choice during pregnancy should always be discussed with a physician.
An ENT examination without delay is recommended in the following situations:
- Congestion on one side only that keeps getting worse
- Bloody or foul-smelling nasal discharge
- Complaints accompanied by facial pain, swelling or fever
- Complete loss of the sense of smell
- Symptoms lasting several weeks despite medication
Nasal Allergy: Frequently Asked Questions
Does nasal allergy ever go away completely?
Allergic rhinitis is usually a long-term tendency; however, with the right treatment and preventive measures, symptoms can be brought largely under control. In suitable patients, allergy immunotherapy can keep working for years after the course is finished. In some children, symptoms may ease as they grow older.
Are steroid nasal sprays harmful?
Because nasal sprays deliver the medication directly to the lining of the nose, the amount that reaches the bloodstream is very low. When used at the recommended dose and with the correct technique, they are generally considered safe for long-term treatment. The most common side effects are nasal dryness and minor bleeding.
How is nasal allergy treated during pregnancy?
Hormonal changes during pregnancy can increase nasal congestion. Saline nasal rinsing is the first choice in this period; when medication is needed, products with well-established safety data are chosen together with the patient’s obstetrician.
How do I rinse my nose with salt water?
A ready-made isotonic solution from the pharmacy, or saline prepared with water that has been boiled and cooled, is delivered into one nostril with a special bottle or spray and allowed to flow out of the other nostril or the mouth. The rinse is done while leaning forward. It is important not to use unboiled tap water and to clean the device after each use.
Can nasal allergy cause headaches?
Allergy-related swelling of the nasal lining can narrow the sinus openings and cause a feeling of fullness and pressure in the forehead and around the eyes. Pain that is severe, one-sided or accompanied by fever, however, suggests sinusitis or another cause and requires an examination.
Conclusion
Op. Dr. Tayfun Demirel, ENT specialist, evaluates patients with nasal allergy complaints at the practice in Ataşehir, Istanbul, through a detailed ENT examination and, when necessary, endoscopic assessment. For patients diagnosed with allergic rhinitis, an individualized treatment plan is created that takes into account their triggers, any accompanying nasal problems and their living conditions. Please contact the clinic for examination and appointment information. This article is for informational purposes only; an in-person examination is required for diagnosis and treatment.
