Rhinitis, including hay fever, is the most common of all the allergic diseases. The typical symptoms such as blocked nose, watery eyes, & running nose may persist all year round (perennial rhinitis) or may be seasonal. Even though it’s often undiagnosed and its symptoms often thought of as harmless, the impact perennial rhinitis can have on a person’s overall quality of life can be significant.
What is rhinitis?
Rhinitis is inflammation of the nose. It may, or may not, be caused by an allergy.
Another symptom of perennial allergic rhinitis is post-nasal drip, where mucous runs down the back of the nose and then into the throat and the airways, producing a persistent phlegm cough.
Causes of allergic rhinitis
Allergic rhinitis is caused by exposure to an airborne allergen. Common allergens include:
What happens when the allergen is breathed in
In allergic rhinitis, blood flow is increased, the mucous membranes swell and there is increased mucous production, all occurring in response to histamine production on exposure to the allergen. The result is nasal congestion, nasal blockage, and/or a runny nose.
Allergic rhinitis diagnosis
A simple description of your symptoms and their seasonality may be all that is required to diagnose rhinitis.
If confirmation and/or identification of an allergic cause is needed, then a skin prick test can be used. A tiny drop of allergen extract is placed on the skin at either the arm or the back. If you are allergic to the substance, a small red weal will appear within a short period.
Allergic rhinitis can be reduced by avoiding exposure to allergic triggers, for example:
House dust mite
Medical treatments for allergic rhinitis
If your symptoms are mild, you can use a long-acting non-sedating antihistamine such as Claritin (loratadine), NeoClaritin (desloratadine), Zyrtec (cetirizine), Xyzal (levocetirizine) or Allegra (fexofenadine). These are available without a prescription, but you should always consult your pharmacist before use.
The older antihistamines like chlorpheniramine (Piriton) and hydroxyzine (Atarax) have a significant sedating effect and should not be used if you are driving, operating machinery, or studying. These older drugs also interact with alcohol so having even a small amount to drink may significantly affect performance.
If rhinitis mainly affects your eyes, antihistamine eye drops, such as Otrivine (antazoline) may help.
In addition to an antihistamine, a nasal decongestant (drops or a spray) may also be helpful in clearing a blocked nose. Some of these decongestants are corticosteroids, which act by reducing inflammation including Beconase (beclomethasone) and Flixonase (fluticasone). Non-corticosteroid nasal decongestants include Otrivine/Sudafed (xylometazoline). All of these can be bought without a prescription. However, only use a decongestant for as short a time as possible, as the nose tends to stop responding to these medications over time.
In general, antihistamines and topical nasal steroids are most effective against seasonal allergic rhinitis/hay fever but may still help with perennial allergic rhinitis.
Can an air cleaner help?
While numerous manufacturers of ‘air cleaners’ / ‘air filters’ claim to be able to clear those allergens leading to rhinitis from the air, they can only reduce, not eliminate, the problem, because:
However, evidence has been increasing for some time that all of these products contain industrial chemicals which can, among other things, damage lungs, aggravate asthma and cause tumours.
Sprays, plug-ins and gels
Chemical sprays, plug-ins and gels for home perfuming are hugely popular but they can include an array of hazardous substances which may cause lung damage and tumours, interfere with our hormones and aggravate conditions such as asthma.
Many air fresheners employ carcinogens, volatile organic compounds (which are characterised by their low boiling point which mean they form a gas at room temperature) which are known to increase the risk of asthma in children and known toxins such as phthalate esters in their formulas.
The evidence of harm is mounting:
But manufacturers refute such concerns
Manufacturers of air fresheners, however, maintain that their products are safe. In June 2015, SC Johnson, which makes Glade air fresheners, published specific information on most of the ingredients in its products for the first time.
Company chairman Fisk Johnson says: 'We take great care in making ingredient choices to offer products that are both safe and effective.'
However, not all of the ingredients used in the actual perfumes are fully listed and could well be made up of many different chemicals.
However, SC Johnson maintains that all its fragrance ingredients, even those not listed, are safe: 'While they are not disclosed, the remaining ingredients also must meet our strict standards.'
Incense are no better
Millions of us burn them every day to send spiritually inspiring wafts of spiciness around our homes. Research shows that ingredients such as frankincense can cause chemical changes in our brains, lifting our moods.
However, incense's mystic allure has been clouded by new findings warning that its fumes may be more dangerous than cigarette smoke, causing cancerous mutations in our DNA.
Burning incense releases tiny chemical particles which can become trapped in our lungs, causing potentially dangerous inflammatory reactions.
The research also found that incense particles from commonly used ingredients agarwood and sandalwood are more toxic to our cells' DNA than tobacco smoke.
Nor are scented candles
Scented candles bring another dimension, adding that subtle hint of aromatic bliss. Scientists remain unmoved however, voicing extreme concerns about the pollution that they are bringing to our lives.
In March 2015, a team of experts tested six scented candles, with such aromas as clean cotton, strawberry and kiwi fruit.
Behind their labels, however, lay a host of potentially dangerous industrial chemicals, including formaldehyde at levels which, with long-term exposure, are known to raise the risk of respiratory problems and cancer.
The candles also gave off significant levels of VOCs. Furthermore, the study warned that you don't even need to light such candles because simple evaporation will enable them to pollute your home.
Most scented candles are made with paraffin, which brings other problems. The oil by-product gives off ultra-fine soot particles containing acetone, benzene and toluene, usually seen in diesel emissions, and known carcinogens.
Then along came Airora 4-in-1 ...
Why try to 'cover up' smells such as wet dog, cigarette smoke, damp, toilets and cooking? Airora 4-in-1 simply removes such smells and creates a wonderfully fresh, clear and clean atmosphere. Don't just take our word for it, our independent test panel says Airora makes them feel:
Noise pollution adversely affects the lives of millions of people. Multiple studies have shown the direct links between noise and health.
According to one study, around 50,000 people in just the European Union die prematurely each year from heart attacks caused by traffic noise. Another study showed that people living in streets with average noise levels above 65-70dB, the average risk of heart disease is 20% higher than for people living in quieter streets.
Other problems that have been proven to be related to noise include stress related illnesses, high blood pressure, speech interference, hearing loss, sleep disruption, and lost productivity.
Traditional filter-based air purifiers
Most air purifiers on the market use HEPA or Electrostatic filters, and these air purifiers typically create a noise of over 70dB at their most effective (highest) fan speed. Indeed, manufacturers tacitly recognise that this noise level is unbearably high in the home, so most have a ‘sleep’ / ‘quiet’ mode which makes them a little quieter but effectively cripples their effectiveness!
In other words, to use a traditional air purifier at its most effective fan speed, exposes people to a noise level similar to street traffic inside their home.
In fact, according to the World Health Organisation’s Night Noise Guidelines, above 40db (rainfall, a refrigerator or an air conditioner at 100 feet, a quiet suburb) of noise can have adverse health effects and noise at this level may well affect most people’s sleep.
So-called ‘silent’ air purifiers
You may have come across ‘silent’ air purifiers, these are air purifiers without a fan.
There are basically two types of ‘silent’ air purifier:
And then there is Airora …
This means that hydroxyls can reach every nook and cranny of a room within seconds, acting on all of the air and all exposed surfaces.
Mould spores are a potent allergen that can trigger severe asthma and rhinitis symptoms and cause a broad range of respiratory conditions. It occurs both indoors and outdoors and the density of mould spores is normally much higher than that of Pollen.
Mould spores, sometimes also called fungal spores, are light and are therefore readily carried through the air of your home or office. This is because their diameter is between one and 100 microns, depending on species, with most being between 2 and 10 microns. Moulds come in a variety of colours: white, grey, orange, green, pink and black.
Your first step in keeping the mould count under control is to ensure that you tackle any damp areas. Another important step is to neutralise mould spores in the air and on surfaces, to prevent the mould from spreading.
Types of mould
When inhaled, tiny fungal spores, or sometimes pieces of fungi, may cause allergic rhinitis or trigger an asthma attack. Because they are so small, mould spores also can reach the lungs.
In a small number of people, symptoms of mould allergy may be brought on or worsened by eating certain foods such as cheeses processed with fungi. Occasionally, mushrooms, dried fruits, and foods containing yeast, soy sauce, or vinegar will produce allergy symptoms.
Mould spores can also cause Allergic Bronchopulmonary Aspergillosis (ABPA) which is an allergy to the spores of Aspergillus fumigatus. Around 5% of adults with asthma develop ABPA at some time during their lives.
Where do moulds grow?
Mould loves damp conditions, so you will tend to find it in places such as:
What is the best way of preventing indoor mould?
Keep your home or office well-ventilated and dry, and discourage the dispersal of mould spores:
A mixture of bleach and water, a mixture of white spirit and surgical spirit, or a specialised anti-fungal spray can be used to get rid of mould patches. Mould tends to reoccur, so you may well have to repeat your cleaning operations.
Can an air purifier help?
While numerous manufacturers of ‘air cleaners’ / ‘air filters’ claim to be able to clear mould spores from the air, they can only reduce, not eliminate, the problem, because:
A study on Household Cleaning Sprays and Asthma by Professor Zock of the Municipal Institute of Medical Research in Spain, was published in the American Journal of Respiratory and Critical Care Medicine in 2007.
Professor Zock undertook the research as ‘Cleaning work and professional use of certain cleaning products have been associated with asthma, but respiratory effects of nonprofessional home cleaning have rarely been studied’.
According to the study, the exposure to certain cleaning products during professional cleaning work has been associated with MCS and other asthma symptoms for some time. This study, however, focused on the respiratory effects of non-professional home cleaning.
The study identified 3,503 persons, in 10 countries, doing the cleaning in their homes and who were free of asthma at baseline. Frequency of use of 15 types of cleaning products was obtained in a face-to-face interview. The researchers studied the incidence of asthma defined as physician diagnosis and as symptoms or medication usage at follow-up. Associations between asthma and the use of cleaning products were statistically analysed.
Participants were assessed for asthma, wheeze, physician diagnosed asthma and allergies during follow-up. They were also asked to report the number of times per week they used cleaning products.
Two thirds of the study population who reported doing most of the cleaning were women. 6% of them had asthma at the time of follow-up. Fewer than 10% of them were full-time homemakers.
Risks were predominantly found for the commonly used glass-cleaning, furniture, and air-refreshing sprays. Cleaning products not applied in spray form were not associated with asthma.
The report's conclusions
American Journal of Respiratory and Critical Care Medicine Vol. 176. pp. 735-741, (2007); The Use of Household Cleaning Sprays and Adult Asthma, An International Longitudinal Study.
Asthma has become one of the most common chronic disorders in the developed world. Asthma is difficult to describe, but the International Consensus Report on the Diagnosis and Management of Asthma defines it the following way: “Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role".
Throughout the developed world, typically 5% of adults and 10% of children have clinically significant asthma. Its prevalence has increased significantly over the last 25 years and is now thought to affect around 300 million people worldwide.
Asthma can be a serious condition, which occasionally proves fatal, accounting for 1,131 deaths in the UK in 2009. However, most deaths and hospital admissions for asthma are preventable. Asthma is a condition that can be managed successfully and part of that management should include a strategy for allergen avoidance.
For example, in the UK, around 5.4 million people suffer from asthma, which includes 1.1 million children. The condition costs health services around £1 billion a year and accounts for an annual 1.1 million lost working days and around 80,000 hospital admissions.
Asthma comes in several forms
There are two primary types of asthma – childhood onset and adult onset. Most asthma does begin in childhood and is often associated with other related conditions like eczema and rhinitis.
Childhood onset asthma often has clearly identifiable triggers which will bring on an attack.
Adult onset asthma may be a continuation of childhood onset asthma, or it may be a new onset of the condition. Asthma can occur at any age, and should be considered in anyone who has a chronic cough. In adult onset asthma, there is often no obvious trigger, except for a chest infection.
There are also several sub-categories of asthma, including:
It can run in families
Asthma tends to run in families. However, asthma is not a single-gene disorder, with a clear line of inheritance. There are several ‘susceptibility’ genes involved in asthma, each contributing to the risk of developing the disease.
Diagnosis depends upon the doctor taking a careful medical history from the patient and noting whether the hallmark symptoms of wheeze, chest tightness, breathlessness, and cough are present. There are no laboratory or other tests which can definitely diagnose asthma and distinguish it from other lung conditions. However, if your doctor suspects asthma you may be subject to breathing tests to help confirm the diagnosis. Such tests include:
Spirometry: Spirometry is breathing into a machine which measures how much air you can exhale, which shows whether the airways are obstructed or not.
Peak expiratory flow rate test: A small hand-held device, called a peak flow meter, is used to measure how fast you can blow air out of your lungs in one breath. The peak flow meter can be a useful tool to use yourself at home to monitor your asthma.
Skin prick, or blood tests, are often carried out to find out which allergens might be triggering your asthma.
Thorough diagnosis by a doctor is a must, as asthma can easily be mistaken for other conditions, including:
Asthma tends to be a chronic disease (that is once you have asthma it will remain with you for the rest of your life). However, around a half of children do ‘grow out of’ asthma by the time they become teenagers, sometimes to re-emerge in adulthood. Like other chronic diseases, such as diabetes, asthma is not curable in the same way that, say, an infection can be cured. However, asthma can be controlled successfully so you can still live a full life.
Why all the focus on air filter efficiency?
Designers of traditional air purifiers have a tough job. There are lots of different air purifiers, so how to stand out from the crowd? Well, a little like high end music systems, ‘measures of performance’ are created which appear important to potential buyers but which are pretty meaningless in practice, and then competing products can be compared, and superiority claimed, based on that same measure.
One such misleading measure is ‘filter efficiency’ where you often see a focus on the percentage of particulates (pollens, mould spores, pet dander and house dust mite excretions) captured by the filter in the air purifier. For example “my filter captures 99.7% of all particles and yours only captures 99.2%”, or “my filter captures smaller particles than yours does” and so on.
And it isn't just the %, some manufacturers stoop to terms such as 'True HEPA' to muddy the waters, when in fact there is no such thing, a filter either meets the standard for HEPA filters or it doesn't!
Sadly, the fact is that such measures are pretty much meaningless in the real world. But, you say, surely it matters how much of the particulates in the air, which may well be allergens, irritants and other pollution, the device filters out?
My reply is that there are at least two major problems with using this measure of air purifier effectiveness, both of which make the number, be it 90%, 95% or 99.97% ( or even in fact 100%! ), pretty much meaningless!
The filter % measures the wrong thing
Measuring the percentage of particulates that are captured from the air passing through the filter measures only that, the percentage of particulates captured from the air passing through the filter. It doesn’t measure the percentage reduction of particulates in the air in the room, and the relationship between the two is tenuous at best!
The unfortunate truth is that the air in the room is constantly changing (typically it is replaced hourly with contaminated air from outside and elsewhere in the home), the air passing through the device is immediately remixed with unclean air in the room and some of the air in the room never goes through the device at all. Some air never goes through the device because of insufficient air flow, temperature stratification and the formation of eddies (where the air in parts of the room rotates in a circular motion without ever moving through the air purifier).
Furthermore, as pointed out by the US Environmental Protection Agency;
"for typical room sizes, most portable air cleaners currently on the market do not have high enough air flows to effectively remove large particles such as pollen, dust mite and cockroach allergens"
The reason being that the larger (and heavier) particles, such as pollen, simply sink to the floor or onto other surfaces, ready to be re-distributed into the air when they are next disturbed!
If you model how air cleaners work and include the constant infiltration of polluted air from elsewhere, they can take hours to reach a stable minimum of pollution and that minimum is related to many factors, but only marginally to the efficiency of the filter itself.
Think of it this way, imagine that an air filter, which captures 99.7% of particulates, effectively reduces the amount of particulates in the air of a room, after several hours, by say 50%. Changing the filter to one which captures only 90% will only have a marginal effect, perhaps limiting the reduction to, say, only 46%.
Be it either 50% or 46%, it doesn’t matter – neither are nearly enough!
What about gasses?
Well, a HEPA filter only ‘traps’ particles down to a particular size, below that size they are not captured at all. And all of the basic technologies, HEPA, electrostatic and ionic completely fail to capture or neutralise polluting gasses which can themselves be breathing irritants and cause asthma attacks.
Then along came Airora ...
The problems outlined above have earned traditional air purifiers a poor reputation, to the point where physicians will generally only say “well try one, it might help”.
Plants produce tiny—too tiny to see with the naked eye—round or oval pollen grains to reproduce. In some species, the plant uses the pollen from its own flowers to fertilise itself. Other types must be cross-pollinated. Cross-pollination means that for fertilisation to take place and seeds to form, pollen must be transferred from the flower of one plant to that of another of the same species. Insects do this job for certain flowering plants, while other plants rely on wind for transport.
Pollen grains contain potent allergens which can cause hay fever, asthma attacks and conjunctivitis. Clearly, as pollen comes from trees, grass and weeds, most exposure occurs outdoors. However, pollen will inevitably also find its way indoors, so those allergic to pollen also find themselves reacting to pollen indoors.
Pollen grains include proteins that cause the immune system in an allergic person to over-react (it is these proteins that an Airora hydroxyl cascade neutralises). Exposure to the allergen proteins triggers a release of histamine from mast cells, that in turn leads to symptoms of allergy like redness, sneezing, swelling and runny nose.
A skin prick test, where you are exposed to various pollen allergens, can be used to confirm whether you have a pollen related allergy. Pollen grains that cause allergies are typically between 10 and 40 microns (a micron is 1/1000 of a millimetre) in size but can also fragment into smaller particles of around one micron in size. Airborne pollen can travel a surprising distance, for example into the centre of cities, but in a still internal environment it can quite quickly fall onto a surface, only to re-enter the atmosphere when it is disturbed.
Pollen allergies and your health
Pollen can cause various allergic reactions, individuals may suffer from one or more of these.
Conjunctivitis is inflammation of the membranes lining the inside of the eyelids.
Tips for reducing exposure to pollens outdoors
Tips for reducing exposure to pollens outdoors
Season and time of day matters
One of the most obvious features of pollen allergy is its seasonal nature.
People have symptoms only when the pollen grains to which they are allergic are in the air. Each plant has a pollinating period that is more or less the same from year to year. Exactly when a plant starts to pollinate seems to depend on the relative length of night and day—and therefore on geographical location—rather than on the weather. On the other hand, weather conditions during pollination can affect the amount of pollen produced and distributed in a specific year. Thus, in the Northern Hemisphere, the farther north you go, the later the start of the pollinating period and the later the start of the allergy season.
For example, in the UK:
A pollen count, familiar to many people from local weather reports, is a measure of how much pollen is in the air. This count represents the concentration of all the pollen (or of one particular type) in the air in a certain area at a specific time. It is shown in grains of pollen per square meter of air collected over 24 hours.
Pollen counts tend to be the highest early in the morning on warm, dry, breezy days and lowest during chilly, wet periods. Although the pollen count is an approximate measure that changes, it is useful as a general guide for when it may be wise to stay indoors and avoid contact with the pollen.
Night-time ‘pollen showers’
On a warm day, when there is naturally a lot more pollen around, warm air rises up from ground level, taking pollen up with it. When the air cools, after dusk, the pollen that has risen during the day drifts back towards the ground. This effect creates what is sometimes termed a 'pollen shower' and explains why, in the middle of a hot night, you may get an allergic attack when you are in bed, particularly if you have the bedroom windows open.
Types of pollen
It is common to hear people say they are allergic to colorful or scented flowers like roses. In fact, only florists, gardeners, and others who have prolonged, close contact with flowers are likely to be sensitive to pollen from these plants. Most people have little contact with the large, heavy, waxy pollen grains of such flowering plants because this type of pollen is not carried by wind but by insects such as butterflies and bees.
Generally, it is tree, grass and weed pollens that cause the more common allergic reactions.
The tiny grains of pollen readily become airborne and are capable of travelling significant distances away from their source.
Although there are more than 1,000 species of grass, only a few produce highly allergenic pollen.
Pollens which you may be allergic to:
Besides self-help and allergen avoidance, it's important to get your hay fever medication right. What you use needs to be safe and effective.
If you are still using sedating anti-histamines, think about the impact the side effects may have on work or school performance and on activities like driving or operating machinery. There are non-sedating alternatives available. It may also be that your medication is not effective for the level of your hay fever symptoms. Again, there are many other options.
Most hay fever medications are available over-the-counter but if your usual tablet or spray is not controlling your symptoms, or if you are experiencing side effects, it's worth asking your pharmacist for advice.