Some patients have sneezing and a running nose almost all the year round.
A majority of them complain of a blocked or stuffy nose and of post-nasal discharge as well. Many of them snore at night because of this condition, and develop the habit of breathing through the mouth. They experience discomfort in the ears as well due to a blocking of the ear tubes that open in the throat called eustachian tubes.
SYMPTOMS
Children develop a peculiar mannerism of wiping their nose. They elevate the tip of the nose with the palm of the hand and wriggle the nose and mouth from side to side; this gives them a temporary relief from the symptoms. Constant rubbing of the nose sometimes leads to the development of a crease across the nose, called the ‘allergic crease’.
The mucous membrane of the paranasal sinuses may also be involved in the allergic process and infections, causing blockage of the opening of the sinuses and accumulation of the secretions; there may be associated fever. The middle ear may get infected repeatedly, causing flow of pus from the ears. Some of the patients develop cough and wheezing as well.
Exposure to cold wind, sunlight, dusts and fumes etc. precipitate the onset of symptoms or aggravate them. These symptoms occur more often in the ealry morning, but may last throughout the day and even the night.
EXAMINATION OF THE NOSE
In the acute stage, examination of the nose reveals a swollen, grayish-pale mucous membrane which is covered over with mucous secretion, the swollen mucous membrane may even be obstructing the nasal passages.
In the chronic stage of the disease, the nasal membrane may be swollen, baggy and pearl grey, with mucous and pus or even frank pus, if there is a superimposed infection. Nasal polyps in the form of bunch of grapes hanging from the mucous membrane may also be seen blocking nose.
DIAGNOSIS
Diagnosis of the condition is helped by the history of the disease, a family history of allergy, and examination of the nose. Much more important, is the laboratory examination of the nasal secretion which shows a large number of eosinophil cell—a type of white blood cells which on staining take red colour, indicative of allergy.
But all this gives no indication of the agents to which the patient is allergic; this needs skin testing with the different allergens such as pollens and dust etc.
TREATMENT
Exposure to some allergens, pollutants and irritants can be reduced. These include house dust, outside dust and dust that arises in different occupations. Strong fumes whether from the kitchen or the laboratory or storng perfumes should be avoided.
After the causative allergens have been found, hyposensitization is the best method of treatment. The result, however, are not as good as in seasonal sneezing or hay fever.
In the circumstances where arrangements for hyposensitization are not available or till such time as the effect of hyposensitization does not appear, drug treatment has to be given to provide relief from symtoms. Antihistamines help, but not as much as in seasonal cases. Nose drops containing ephedrine and antihistamines also give temporary relief.
Care must, however, be taken to limit their use to the minimum. Nasal drops containing corticosteroids havenot proved very helpful. Cauterisation—burning the muscous membrane so as to make it insensitive and such like measures which destroy viable (live) tissue do more harm than good. Nasal surgery is rarely, if ever, indicated.
Adequate improvement obtained after hyposensitization and drug treatment leads very often to disappearance of the nasal polyps as well; they need no surgical excision, unless they are obstructing the nose to the extent that respiration becomes difficult.
DIFFERENTIATION FROM COMMON COLD
Frequent occurences of the common cold, a virus infection, with super-added—bacterial infection, sometimes makes it difficult to differentiate between it and the perennial allergic rhinitis. Common cold usually begins with malaise, aches, and pains, diminished appetite and a slight rise of temperature. Running nose and sneezing occur either simultaneously or soon after. The nasal discharge is at first watery, but later it becomes thick. With the nasal obstruction, there may be headache, loss of sense of taste accompanied by mouth-breathing. The symptoms may persist for some days or even weeks.
History of the disease, family history, examination of the nose and nasal smear help to differentiate between perennial allergic rhinitis and common cold. A nasal smear does not show eosinophils in a viral infection, while it does so in a case of perennial allergic rhinitis. Presence of positive or negative skin tests against various allergens also help in differentiating the conditions.