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Aeroallergens, Irritants and Upper Respiratory Conditions
|Allergy, Anaphylaxis & Food Disorders - Aeroallergens and Irritants|
Aeroallergens and Upper respiratory tract conditions - Rhinitis, Conjunctivitis and Sinusitis.
By Dr Sharyn Martin PhD
In the last three articles common sources of airborne allergens and irritants as well as some of the adverse health effects resulting from exposure to these were described. In the next series of articles the health effects will be described in more detail. This article deals with the allergic and non-allergic upper respiratory tract conditions resulting from exposure to airborne allergens/irritants.
The Upper Respiratory Tract – the nose and eyes.
Rhinitis is characterised by one or more of the following symptoms – nasal congestion, runny nose, sneezing and itching.
Conjunctivitis is characterised by one or more of the following symptoms – redness of the eye, tearing, itching and burning of the eye.
Sinusitis is characterised by one or more of the following symptoms – nasal congestion, green or grey nasal discharge, post nasal drip, pressure in the face and headache
Rhinitis/conjunctivitis is common in the population, affecting 20-40% of the western population. It can be the result of allergic reactions or non-allergic irritant mechanisms. Allergic rhinitis tends to occur in patients with a genetic predisposition to developing allergies. Regardless of what the mechanism is the symptoms are very similar (nasal congestion, sneezing, sore, itchy eyes). Allergic and non allergic rhinitis can co-exist resulting in a mixed rhinitis condition and this increases the number of substances that can induce symptoms. Sinusitis can develop in people with chronic allergic or non- allergic rhinitis (rhinosinusitus). The resulting chronic inflammation of the sinus and mucus linings results in bacteria not be cleared from the sinus causing secondary bacterial infections.
Allergic rhinitis and conjunctivitis are common allergic inflammatory diseases caused by hypersensitivity to a range of allergens that cause inflammation of the mucosa of nose (rhinitis) and eyes (conjunctivitis).
The symptoms involve the anterior aspects of the nose and can also affect the eyes, throat, sinuses, ears and include runny nose, watery eyes, itching nose throat or eyes, tearing of eyes, blocked nose, sneezing, itchy skin, headaches, sore throat. Other symptoms may include difficulty to concentrate, listlessness and irritability. Asthma may develop, especially if the individual is particularly sensitive and exposed to high levels of allergen.
Allergic Triggers - Aeroallergens such as the Seasonal allergens e.g. pollen, or Perennial allergens e.g. house dust mites, cockroaches.
The symptoms may occur Seasonally(at particular times of the year), known as Hayfever or Perennially (All year) .
The Table below shows the differences between them.
Perennial allergic rhinitis and conjunctivitis.
Seasonal allergic rhinitis and conjunctivitis (Hayfever)
Where and when Allergens found: mainly Indoor and all year round
Where and when Allergens found:
both Outdoor and Indoor, during Spring and Autumn
House dust mites, cockroaches, animal dander and moulds
Pollen of weeds, trees and grasses, seasonal moulds
Nasal - Nasal blockage more pronounced than in seasonal rhinitis, runny nose, sneezing and itching,
Eyes - Redness, tearing, itching and burning of the eyes
Nasal - Bouts of sneezing, nasal itch,
Eyes - Tearing of eyes, burning, stinging, sensitive to light, redness and watery eyes
Non Allergic Rhinitis
Non allergic rhinitis is also an inflammatory condition involving the nasal mucosa, except that in these cases the inflammation is not a result of an allergic, IgE mediated inflammatory mediator release. The underlying mechanisms leading to various forms of non-allergic rhinitis are variable and less well understood than allergic rhinitis. Non allergic rhinitis is also referred to as idiopathic rhinitis.
Non-allergic rhinitis triggers tend to cause changes to the mucosal membranes that lead to damage of the nasal mucosa or cause inflammation. It can become a chronic condition complicated by allergic rhinitis and there is a potential to the develop chronic sinusitis as a result.
The symptoms of non-allergic rhinitis are nasal congestion and runny nose. Where it differs from allergic rhinitis is that there is rarely significant itching or sneezing, though if the condition is a Mixed allergic and non allergic rhinitis, all symptoms can co exist.
Triggers - Nasal symptoms are triggered by a wide range of non-allergens including environmental irritants such as Car & diesel exhaust, Perfume and fragrance, Volatile Organic Compounds (VOC’s), Cleaning products, Incense, Newsprint, Hairspray, strong smells and irritants, changes in weather and barometric pressure, hormonal fluctuations, and ingestion of alcohol or certain foods.
Comparison of Allergic and Non-Allergic Rhinitis
The information below describes the differences between allergic and non allergic rhinitis.
Onset of condition
Allergic rhinitis usually presents in childhood and there is typically a strong family history of atopic diseases including rhinitis, asthma, and atopic dermatitis.
Non-allergic rhinitis usually presents after the age of 20 (adult-onset nasal symptoms) and often there is no evidence of a familiar pattern. There is a strong female predominance in non-allergic rhinitis not seen in allergic rhinitis.
Allergens/Triggers of allergic and non-allergic rhinitis
Triggers of allergic rhinitis are aeroallergens, most commonly seasonal allergic rhinitis to pollens although perennial allergic rhinitis to allergens such as cat or dust mite does occur. Symptoms are produced following exposure to cats, dogs, feathers, other furred animals and seasonal variations such as pollens.
People with non-allergic rhinitis generally have perennial symptoms. The triggers of Non-allergic rhinitis are broad and includes VOC’s, fragrance, particulate materials, as well as changes in weather and barometric pressure
Differences in symptoms
Allergic rhinitis has very significant sneezing and nasal itch and also has ocular symptoms with tearing and itch.
Non-allergic rhinitis usually involves only the nose, and typically have more nasal congestion and runny nose, and rarely have significant itching or sneezing
In allergic rhinitis laboratory tests include measurement of allergen specific IgE levels and allergen specific skin prick tests. Raised levels of allergen specific IgE or a positive reaction to allergen on skin prick tests confirm a diagnosis of allergic rhinitis
In non allergic rhinitis there are no specific laboratory tests, allergens tests above are usually negative and is usually diagnosed by exclusion
Treatment of allergic rhinitis can involve medications, allergen avoidance and immunotherapy.
Treatment of non-allergic rhinitis is almost solely with medications
Sinusitis – Complication of Chronic Rhinitis (regardless of mechanism)
Poorly controlled rhinitis (either allergic or non allergic) can lead to sinusitis. Sinusitis is an inflammation of the nasal sinuses and tends to cause symptoms involving the sinus cavities in the posterior aspects of the nose. Sinusitis may become a long-term, chronic condition, complicated by allergies or structural problems in the nose. Chronic inflammation of the sinus and mucus linings prevents the usual clearance of bacteria from the sinus cavity, increasing the chances of developing secondary bacterial sinusitis. As the sinus cavities become inflamed, chemical mediators similar to those seen in allergic rhinitis are released leading to rhinitis symptoms.
Sinusitis can occur following an acute inflammation caused by bacterial infection such as the common cold, allergies or increased sensitivity to irritants such as smoke, perfume or VOC’s.
Thick mucus from the nose or down the back of the throat, loss of sense of smell or taste, bad breath / bad taste in the mouth, sore throat, cough, tiredness, temperature or shivers (fever), facial congestion (a feeling of fullness) and pain, headache, toothache, sensation of pressure in the face that is worse with leaning forward.
To summarise the following table compares the symptoms suffered from a cold or flu attack with the different conditions resulting from exposure to allergens or irritants in the indoor and outdoor environment .
Viral Rhinitis (Cold/Flu)
Runny nose with watery to thick yellow nasal discharge
Low grade fever
Weakness and fatigue
Runny nose with thin watery discharge
Itchy nose, throat and eyes
Tearing of eyes
Post nasal drip
Symptoms generally only involve the nose
Green or grey nasal discharge
Post nasal drip
Pressure in the face
Symptoms appear one to three days post exposure to cold virus
Symptoms persist as long as exposed to allergen
Symptoms persist as long as exposed to irritants
Symptoms appear after a cold or triggered by allergies or irritants
In the next article I will explain the condition Vocal Cord Dysfunction, a disorder that affects respiratory function by causing the vocal cords to close on inhalation. The symptoms are similar to asthma and the condition is often confused with asthma, but unlike asthma it is not the lungs but the larynx (Throat) that is affected.
If you suspect you have an allergy, visit your GP or Allergy specialist.
ASEHA leaflets on Indoor and Outdoor Air pollution; Chemical Sensitivity; Pesticides; Skin Allergy
For more information on the allergic diseases and the prevention of allergic reactions to aeroallergens please visit the following sites.
ASCIA website http://www.allergy.org.au/content/category/3/48/241/ Provides information about the Allergenic Pollen plants, and what times of the year the plants usually flower all over Australia.
Asthma Foundation www.asthmaaustralia.org.au
National Institute of Allergy and Infectious diseases http://www.niaid.nih.gov/
World Allergy Association www.worldallergy.org
RPAH allergy clinic www.sswahs.nsw.gov.au/rpa/allergy/
National Asthma Council of Australia http://www.nationalasthma.org.au/content/view/460/632/#ar
Safe Cleaning Tips for Your Home http://www.ewg.org/schoolcleaningsupplies/safecleaningtips
ACAAI: Home is Where the Allergies Are. By Neil Osterweil, Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. November 14, 2006
Asthma A guide for health professionals and Air Pollution Australian Government Department of Health and Ageing 2004 Australian Government Department of Health and Ageing 2004 in collaboration with the Australasian Society of Clinical Immunology and Allergy.
Bousquet J, W.Fokkens, P.Burney, S.R.Durham, C.Bachert, ,C.A.Akdis, G.W.Canonica, S.-E.Dahlen, T.Zuberbier, T.Bieber’ S.Bonini, P.J.Bousquet, J.L.Brozek, L.-O.Cardell, R.Crameri, A.Custovic, P.Demoly, ,R.G.vanWijk, M.Gjomarkaj, C.Holland, P.Howarth, M.Humbert, S.L.Johnston, F.Kauffmann, M.L.Kowalski, B.Lambrecht, S.Lehmann, B.Leynaert, K.Lodrup-Carlsen, J.Mullol, B.Niggemann, E.Nizankowska-Mogilnicka, N.Papadopoulos, G.Passalacqua, H.J.Schnemann, H.-U.Simon, A.Todo-Bom, E.Toskala, R.Valenta, M.Wickman, J.P.Zock 2008. Review article. Important research questions in allergy and related diseases: non allergic rhinitis: a GA2 LEN paper Allergy 2008: 63: 842–853
Brandt D, Bernstein JA 2006. Questionnaire Evaluation and Risk Factor Identification for Nonallergic Vasomotor Rhinitis Ann Allergy Asthma Immunol. 2006;96:526-532
Corsinia E, and Kimberb I. 2007 Letters. Volume 168, Issue 3, Pages 255-259
Elberling J, Linnebergw A, Dirksenz A, Johansen J. D. , Frlund§ L.F., Madsen§, N. H. Nielsenz and H. Mosbech 2005. Mucosal symptoms elicited by fragrance products in a population-based sample in relation to atopy and bronchial hyper-reactivity Clin Exp Allergy 2005; 35:75–81
Environmental Health Perspectives Volume 107, Number 7, July 1999, Focus A Healthy home Environment
Mølgaard E, Thomsen SF, Lund T, Pedersen L, Nolte H, Backer V. 2007. Differences between allergic and nonallergic rhinitis in a large sample of adolescents and adults Allergy: 62: 1033–1037.
Rios and Mullol World Allergy Organization XXI World Allergy Congress (WAC): Abstract 707. Presented December 8, 2009
Rondón C; Canto G; Blanca M 2010. Local Allergic Rhinitis: A New Entity, Characterization and Further Studies, Curr Opin Allergy Clin Immunol. 2010;10(1):1-7
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases NIH Publication No. 03-7045 April 2003 www.niaid.nih.gov
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