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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Man to Man Man to Man

Nasal Allergies -- Nothing To Sneeze At

January 24, 2013

By Harvey B. Simon M.D.

Harvard Medical School

It's easy to dismiss hay fever — allergic rhinitis — as a minor nuisance. But it's a legitimate medical problem that is linked to asthma, sinusitis and other more serious problems. Allergic rhinitis is very common — and expensive. It affects about one in five Americans and costs the U.S. economy over $2 billion a year. Fortunately, it's very treatable.

Nosing Around

Your sense of smell comes from your nose. Smell contributes importantly to taste, which is a major player in maintaining good nutrition. Our sense of smell also warns us of dangers ranging from toxic fumes and smoky fires to spoiled food. In addition, the nose:

  • Conditions the air before it reaches the sensitive tissue of your lungs
  • Adds moisture to the air you breathe in by producing large amounts of mucus
  • Warms the air by passing it over a large network of blood vessels
  • Traps small particles, keeping them out of the lungs.


Allergic rhinitis can blunt your sense of smell. It can also interfere with the other important functions of the nose.

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Types of Rhinitis

  1. Allergic rhinitis – This is the most common type. As your nose traps pollen or other particles to which you are sensitive, an inflammatory process starts in your nose. Immune system mast cells in the nasal tissue release chemicals such as histamine and leukotrienes. Blood vessels swell causing nasal congestion, and mucus production soars, which causes a runny nose.


Seasonal allergic rhinitis comes and goes as various plants come into bloom.


Likely allergen


Tree pollen


Grass, weed pollens

Late summer, fall


Year-round (perennial allergic rhinitis)

Dust mites, molds, animal dander

  • Rhinitis due to viruses – The common cold is an example.

  • Drug-induced rhinitis – Many drugs can cause rhinitis, including Viagra (and the other ED pills), the alpha-blockers used to treat benign prostatic hyperplasia, the ACE inhibitors and beta-blockers used for hypertension, and aspirin and non-steroidal anti-inflammatory drugs.

  • Exercise or eating-induced rhinitis – For some people, exercise, eating, or exposure to cold or dry air, air pollutants, or strong smells can trigger rhinitis.

  • Rhinitis medicamentosa – Overuse of the decongestant nose sprays, such as phenylephrine and oxymetazoline, can irritate the nasal membranes. Some people use these sprays for quick relief of allergic rhinitis.

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What Are the Symptoms?

Nearly everyone with allergic rhinitis complains of a stuffy, runny nose. Additional symptoms are:

  • Sneezing
  • Postnasal drip, which can trigger coughing
  • An itchy or sore throat
  • Itchy, burning and watery eyes that may look red due to allergic conjunctivitis


Between 20% and 40% of patients with allergic rhinitis also have asthma. Some patients have nasal polyps, a deviated nasal septum or sinusitis.

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How Is it Diagnosed?

Most people with allergic rhinitis can diagnose the problem themselves simply by recognizing the typical symptoms. In complicated cases, an ENT (ear, nose, and throat) specialist can check for polyps and other nasal abnormalities. If necessary, allergists can perform skin tests to identify specific allergic triggers. A RAST (radioallergosorbent) test using a blood sample can also help pin down the culprits.

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Treating Allergic Rhinitis

There are three strategies for treating allergic rhinitis.

  1. Avoiding your triggersMedication
    • Limit your time outside when pollen counts are high. Ragweed counts usually peak in early midday, grass pollen in late afternoon and early evening. If you have to do yard work during pollen season, wear an N95 mask. Shower, wash your hair, and change your clothes afterwards.
    • Keep your windows and doors closed as much as possible during pollen season.
    • Use air conditioners instead of fans. Drive with your windows and vents closed and your air conditioner on.

    For year-round allergic rhinitis:

    • If you have a dog or cat bathe it weekly. Keep it off furniture and out of the bedroom.
    • Put pillows, box springs and mattresses in sealed plastic covers to keep out dust mites. Wash bedding in hot water (above 120°F) to kill dust mites.
    • Remove carpeting from your bedroom.
    • Use a dehumidifier to keep relative humidity below 45% but above 30% to prevent excessive dryness.
  2. Various over-the-counter and prescription medications can relieve itchy, watery eyes, runny nose and congestion.



    Side effects

    Antihistamine tablets
    Non-sedating loratadine (generic, Claritin, Alavert) fexofenadine (Allegra) and cetirizine (Zyrtec)
    High doses can produce sleepiness and dry mouth; men with BPH (benign prostatic hyperplasia) may have difficulty urinating.
    Nasal steroid sprays (prescription)
    Very effective but usually take several days to kick in; examples are beclomethasone (Beconase AQ), budesonide (Nasacort AQ)
    Nasal irritation and headaches
    Antihistamine nasal sprays
    Azelastine (Astelin) and olopatadine (Patanase)
    Some patients experience drowsiness.
    Leukotriene blockers
    Oral prescription drug montelukast (Singulair)
    Decongestants (Not for primary treatment but can be combined with a first-line drug for temporary use)
    Tablets (pseudoephedrine, phenylephrine); nasal sprays (phenylephrine, oxymetazoline) (Don't use for more than a few days.)
    Nervousness, racing heart, elevated blood pressure, and insomnia. Men with BPH may have difficulty urinating.
    Other (Not for primary treatment but can be combined with a first-line drug for temporary use)
    • Anticholinergic nasal spray (ipratropium)
    • Intranasal mast cell stabilizer (Cromolyn)
    • Anti-allergic eye drops
    • Short course of oral steroids for severe rhinitis
  3. Immunotherapy

    Allergy shots can help control allergic rhinitis over the long-term. Skin testing first identifies the allergens. Patients then get weekly injections of gradually larger doses of the allergen, followed by maintenance injections every two to six weeks for several years. Most doctors reserve immunotherapy for patients who do not respond well to medication.


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Nothing To Sneeze At

For many men, allergic rhinitis is a temporary seasonal woe. For others it's a year-round hassle. There are lots of treatment options, which may seem confusing at first. Experiment to find those that are right for your symptoms. They’ll keep your nose running smoothly — without running!

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Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of the Harvard Men's Health Watch newsletter and author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan, Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.

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