Understanding allergies: Types, triggers, and management for better quality of life
Preventive measures such as avoiding an allergenic environment is important for people with allergies. Decorative image by Canva
Taiping Hospital Ear, Nose, Throat (ENT) medical officer Dr Nur Amirah Khairuddin, said that different people have different allergens leading to the reactions shown through non-allergic rhinitis, allergic rhinitis, perennial allergic rhinitis, and seasonal allergic rhinitis, also known as hayfever or rhinosinusitis, a combination of rhinitis and sinusitis.
Rhinitis, as defined by Amirah, is an inflammation of the nose and nasal passages that causes runny nose, stuffiness, sneezing, itchy nose, and red, watery eyes.
With over 20 per cent of people worldwide having allergic rhinitis, as reported last three years, it will cause one's nasal lining to swell once the immune system reacts to allergens, though usually harmless, such as pet hair and pollen.
"Allergic rhinitis can cause swelling in the lining of the nose. If a stuffy nose is not well controlled with medications, we can offer an operation to reduce the size of the inferior turbinate," Amirah said.
Non-allergic rhinitis, on the other hand, is "a reaction not caused by the immune system but can be triggered by chemicals, odours, irritants, and changes in temperature or air pressure," the otolaryngologist said.
In certain conditions, some people may face the overlapping of these two conditions, Amirah said.
According to a health website, seasonal allergic rhinitis often occurs in countries with temperate climates, such as the United Kingdom, the United States, and other Western countries, during spring, exposing allergic people to pollen from trees, flowers, and grasses.
"Seasonal allergic rhinitis is usually caused by pollen from trees, grass and flowers, which is only present in the air at a certain time of the year, commonly referred to as hayfever," Amirah said.
"In Malaysia, we do experience wet and dry seasons only; therefore, the most common allergens are dust mites, animal dander, and food.
"As these allergens are present throughout the year, Malaysians are more likely to have perennial allergic rhinitis than hay fever.
She said that in preventive steps, reducing exposure to pollen or grass could help to reduce nasal symptoms," she added.
Perennial allergic rhinitis occurs with year-round allergies due to allergens in the air people breathe, such as pet dander, dust mites, indoor pollutants, or mould spores that thrive in damp areas, Amirah said.
Additionally, according to research, sinusitis affects over 15 per cent of people globally, with five to 10 per cent suffering chronic (long-standing) conditions and with only two to three per cent of doctors' visits having been received due to the disease, further insinuating low awareness.
Sinusitis is the inflammation of the sinuses, which are hollow organs within the respiratory system to help lighten the head, keep breathed air warm and moist, make the voice sound better and keep airways clear.
"Sinusitis is an inflammation of the sinuses. The sinuses are connected to the nose by narrow tubes. Their function is to warm, moisten, and filter the air we breathe as it travels to the lungs and to aid in forming certain sounds during speech.
"Additionally, the sinuses produce fluid (mucus) that drains out of the narrow passages in the nose, keeping it clean and free of bacteria, allergens, and other germs.
"When the sinus tissue becomes inflamed, the narrow tubes get blocked, preventing mucus from draining out of the nose. This leads to pain and discomfort in the face due to increased pressure inside the sinuses.
"Blocked sinuses can create an environment where bacteria may overgrow, further leading to infection," the otolaryngologist said.
Further addressing the possibility of the co-existence between sinusitis and rhinitis, Amirah referred to a specific condition called rhinosinusitis; this disease affects both the nasal passages and the sinuses.
"Infections, such as colds, are a type of rhinitis that typically do not last long, and sometimes they can also affect sinuses, leading to symptoms of rhinosinusitis," Amirah added.
Addressing whether rhinitis was easily contagious, she said that rhinitis following infections such as the Covid-19 infection would be contagious.
Meanwhile, allergic rhinitis is not a communicable disease since it is a hypersensitivity reaction of the immune system to allergens, she said.
"These conditions may coexist together. Therefore, no comparison can be made regarding which conditions are worse," the ENT doctor said.
Discussing the link between mental health and chronic allergy sufferers, Amirah said that their disease may also affect their mental health in ways that they would develop higher anxiety levels due to being worried about possibly being exposed to allergens, aside from stress hormones influencing the immune system and intensifying reactions that would lead to worsening allergy symptoms.
Amirah addressed common allergens such as dust mites, mould, and dander (tiny skin flakes) from animals.
She shed light on the steps that could be taken to improve nasal symptoms from allergic reactions by avoiding exposure to allergens.
"Reducing exposure to the identified allergen will help to improve the nasal symptoms," she said.
Other specific steps include replacing carpets with sealed floors, washing bedding every two weeks, keeping pets outside if possible, and not allowing pets on beds, sofas, chairs, and cushions, Amirah said.
She added that people are advised to vacuum the floor regularly so as to avoid dust buildup.
According to research, long-term exposure to irritants may develop adult-onset allergies, causing the immune system to suddenly recognise irritants as allergens and worsening symptoms in the future.
Another doctor, Wafa Abdul Muiz Dzihni from the University of Leeds, said that sinusitis could lead to facial pain, nasal obstruction, and thick or purulent nasal discharge when the paranasal sinuses are inflamed, whether due to infections or allergens.
"In the United States, around 20 per cent of the population has allergic rhinitis. In 2021, a study found that more than 81 million people had seasonal allergies," Wafa said.
Wafa also said that insect droppings and saliva, wood, and flour dust are also known allergens.
Wafa addressed triggers differing from one individual to another, making it important to recognise one's own triggers and minimise contact or exposure to avoid the immune system "overreacting" to allergens.
Wafa said that among the medicines used to relieve the severity of the symptoms include antihistamines, decongestant tablets, eye drops, and nasal sprays.
"In uncommonly worse cases, immunotherapy injections may be needed," Wafa said, adding that in certain cases, surgery may be needed for complications from allergic rhinitis, such as the removal of nasal polyps, which are soft growths along the lining of nasal passages or sinuses.
She further said that allergic rhinitis is not contactable and is usually inherited, stressing the role of genetics.
"You're more likely to have AR (allergic rhinitis) if a parent or immediate family member has allergies," she said.
She addressed people with existing conditions such as asthma and eczema to be more susceptible to hayfever, medically termed "the atopic triad", which is the co-existence of AR, asthma, and eczema.
Citing a study stating that more than 81 million people in 2021 had seasonal allergies, she emphasised the importance of managing symptoms by "taking antihistamines preemptively and over-the-counter (OTC) medications" that work best for themselves.
"Hayfever, or AR, is usually simply manageable with OTC medications. Additionally, sinusitis, if caused by bacterial infection in vulnerable groups like old people or people with weak immune systems, might cause severe symptoms and lead to complications — in these cases, antibiotics would be advised," the doctor said.
