People with allergic rhinitis frequently describe themselves as catching colds constantly. Colds do not occur every fortnight for years, and the absence of fever is the giveaway.
Allergic rhinitis is extremely common in urban Chennai, is often untreated, and affects sleep, concentration and quality of life more than most people realise.
Recognising It
Several features distinguish allergy from infection.
- Clear watery discharge rather than thick coloured mucus
- Sneezing in bouts of several in a row
- Itching of the nose, eyes, palate or ears, which infection does not cause
- No fever
- Symptoms lasting weeks or recurring in a pattern
- Symptoms triggered by specific exposures: dust, cleaning, a particular room, early morning
- Dark circles under the eyes
- A horizontal crease across the nose from repeated upward rubbing
Itching is the most useful discriminator. A cold does not itch.
The Common Triggers Here
Chennai's climate and urban environment produce a specific pattern.
- House dust mites: the dominant allergen, thriving in warm humid conditions. Present year round, which is why symptoms are perennial rather than seasonal
- Mould spores, particularly after the monsoon and in damp bathrooms
- Cockroach allergen, a significant and under recognised trigger in urban homes
- Pet dander
- Pollen, less dominant than in temperate countries
- Air pollution and traffic exhaust, which worsen symptoms even where not truly allergic
Because dust mites are present all year, Indian allergic rhinitis is usually perennial. Patients expecting a seasonal pattern often do not connect their year round symptoms to allergy.
Why It Matters Beyond the Nose
Allergic rhinitis is frequently dismissed as trivial. Its effects are broader than the symptoms suggest.
- Disturbed sleep from nasal blockage, causing daytime fatigue
- Reduced concentration and school or work performance
- Mouth breathing, which in children can affect facial and dental development
- Contributing to chronic sinusitis
- Recurrent middle ear fluid in children
- Worsening asthma, since the upper and lower airways are linked
- Reduced sense of smell
The asthma link is important. Treating allergic rhinitis improves asthma control, and a person with both should have both addressed rather than one.
Reducing Exposure at Home
Environmental measures work when done thoroughly. Half measures achieve little.
- Encase mattresses and pillows in allergen proof covers, which is the single most effective step
- Wash bedding weekly in hot water above sixty degrees
- Remove carpets and heavy curtains from the bedroom
- Reduce soft toys, or freeze them periodically to kill mites
- Damp dust rather than dry sweeping, which disperses allergen into the air
- Use a vacuum with a HEPA filter
- Keep humidity down where possible, and fix damp and mould
- Control cockroaches, keeping food sealed and surfaces clean
- Keep pets out of the bedroom
The bedroom is the priority, since that is where continuous exposure over eight hours occurs.
Medications and Getting the Technique Right
Treatment is effective, and most failures come from wrong drug choice or wrong technique.
- Intranasal steroid spray: the most effective treatment for persistent symptoms. Must be used daily for two to four weeks before judging effect
- Non sedating antihistamines: good for sneezing and itching, less effective for blockage
- Antihistamine nasal sprays: faster acting, useful alongside steroid
- Saline irrigation: cheap, safe and genuinely useful, particularly after outdoor exposure
- Leukotriene antagonists where asthma coexists
- Avoid decongestant sprays beyond a few days, because of rebound congestion
Spray technique is critical. Use the right hand for the left nostril and vice versa, aiming outward toward the ear on that side rather than at the septum. Do not sniff hard. Poor technique makes an effective drug appear useless, and it also causes nosebleeds from spraying at the septum.
Allergy Testing: When It Helps
Testing is not needed for everyone. It is useful when symptoms are severe, when the trigger is unclear, when avoidance measures need targeting, or when immunotherapy is being considered.
Skin prick testing gives results within twenty minutes and is the usual first choice. Blood specific IgE testing is used where skin testing is not possible, such as with extensive eczema or where antihistamines cannot be stopped.
Note that a positive test indicates sensitisation, not necessarily clinical allergy. Results must be interpreted alongside your actual symptom pattern, which is why testing without a proper history produces confusion rather than clarity.
Immunotherapy
For patients with significant symptoms not controlled by avoidance and medication, immunotherapy can modify the underlying allergy rather than just suppressing symptoms.
It involves gradually increasing exposure to the identified allergen, either by injection or by sublingual tablets or drops, over a course of three to five years.
It is the only treatment that alters the natural course of allergic disease, with benefit persisting after completion. It also reduces the likelihood of developing asthma in children with allergic rhinitis.
The commitment is substantial and it requires accurate identification of the relevant allergen. Our ENT department assesses suitability.
When Symptoms Are Not Allergy
Several conditions produce similar symptoms and are treated differently.
- Non allergic rhinitis: triggered by temperature change, strong smells or spicy food, with negative allergy testing
- Rhinitis medicamentosa: from overuse of decongestant sprays
- Deviated septum: causing persistent one sided blockage
- Nasal polyps: causing blockage and loss of smell
- Pregnancy rhinitis, which resolves after delivery
Persistent blockage on one side only, bleeding, or a one sided discharge should always be examined rather than treated as allergy, since these suggest a structural cause.
Constant sneezing and a blocked nose without fever for weeks is allergy rather than repeated colds. Encase the mattress, treat the bedroom seriously, and use a steroid spray daily with correct technique for at least a month before judging whether it works.
Our ENT department at T. Nagar provides allergy assessment and treatment.
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