Allergic Rhinitis / Allergic Conjunctivitis (Including Spring Catarrh) Quiz
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Cough worsens in a specific place at work or home
Speaking with their nose
Eye irritation
Have a runny nose
Nose symptoms are the worst symptom that I have trouble with
Cough
Sneezing
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What is Allergic Rhinitis / Allergic Conjunctivitis (Including Spring Catarrh)?
A condition caused by allergens like pollen and dust mites, resulting in a runny nose, stuffy nose, sneezing, and itchy eyes.
Typical Symptoms of Allergic Rhinitis / Allergic Conjunctivitis (Including Spring Catarrh)
- Allergies other than to food, metal or drugs
- Family history of Asthma, Eczema, Allergic rhinitis or Allergic conjunctivitis
- White area of the eyeball is puffy or swollen
- Presence of clear, colorless nasal discharge
- Nasal voice
- Runny nose
- Known food allergy
- Stuffy nose
Diagnostic Questions for Allergic Rhinitis / Allergic Conjunctivitis (Including Spring Catarrh)
Your doctor may ask these questions to check for this disease:
- Have you had any allergies besides food, drugs, or metal?
- Does anyone in your family have a history of asthma, allergies, or hay fever?
- Is the white part of your eye puffy or swollen?
- Do you have clear, colorless nasal discharge?
- Does your voice sound nasal?
Treatment of Allergic Rhinitis / Allergic Conjunctivitis (Including Spring Catarrh)
The condition typically improves when the trigger, such as pollen, is removed. A doctor may prescribe oral medications, eye drops, or nose sprays to alleviate symptoms.
Reviewed By:
Eric A. Gantwerker, MD, MMSC (Otolaryngology (ENT))
Pediatric Otolaryngologist at Northwell Health and Associate Professor of Otolaryngology at Zucker School of Medicine at Hofstra/Northwell. He holds a Master of Medical Science (MMSc) in Medical Education with a special focus on educational technology, educational research, and game-based learning from Harvard Medical School and a Master of Science in Physiology and Biophysics from Georgetown University. He has a special interest in faculty development and has been a speaker or faculty at hundreds of local, national, and international courses and conferences. He is also an active blogger and podcaster for several organizations, including the Harvard Macy Institute (HMI), Harvard Medical School CME Online, and BackTable Innovations. He has been featured in the news and print for media outlets such as USA Today, Businesswire, The Washington Post, Nature Medicine, Fox News, and KevinMD. He was also the Vice President, Medical Director of a medical video game company, Level Ex from 2018 to 2023 that utilized game technology and psychology to create interactive experiences for healthcare professionals. | He is recognized as an expert on the implementation of educational technologies and gaming with a foundation in educational theory for health professions education. He was honored to be inducted as an Associate Member of the American College of Surgeons (ACS) Academy of Master Surgeon Educators and as an Associate Fellow of the Association for Medical Education in Europe (AMEE).
Rohini R, MD (Otolaryngology (ENT))
Dr. Rohini R is an ENT, Head and Neck Surgeon, with a Fellowship in Advanced Endoscopic Sinus and Skull Base Surgery and a Fellowship in Aesthetic Medicine and Lasers. Besides clinical practice and working with Ubie, she is actively training and mentoring medical students and residents. She has functioned in various work settings - teaching hospitals, private and free health centers, and worked with patients from all socioeconomic backgrounds due to her experience in free hospitals and volunteering in India and Singapore.
Content updated on Apr 4, 2024
Following the Medical Content Editorial Policy
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FAQs
Q.
Still Congested? Why Fluticasone Fails & Your Medically Approved Next Steps
A.
Persistent congestion on fluticasone usually means something needs adjusting, not that treatment failed, with common reasons including not using it long enough or correctly, an inadequate dose, heavy allergen exposure, or a different cause like a cold, chronic sinusitis, non-allergic rhinitis, or nasal polyps that may need combination therapy. Medically approved next steps are to use it daily for 2 to 3 weeks with proper technique, add saline irrigation, consider add-ons like oral or nasal antihistamines while reducing triggers, and seek medical review if symptoms persist or you develop fever, severe facial pain, eye swelling, or vision changes. There are several factors to consider, and the complete guidance with specifics on dosing, technique, exposure control, and when to see a doctor is outlined below.
References:
* Wang H, Cao Z, Wang X, et al. Mechanisms of Corticosteroid Resistance in Chronic Rhinosinusitis With Nasal Polyps. Front Immunol. 2021 Dec 22;12:800160. doi: 10.3389/fimmu.2021.800160. PMID: 35002951; PMCID: PMC8730999.
* Wang Y, Li Z, Huang H, et al. Treatment of Chronic Rhinosinusitis: A Review of the Current Guidelines. J Clin Med. 2022 May 25;11(11):2984. doi: 10.3390/jcm11112984. PMID: 35683416; PMCID: PMC9180749.
* Chiu AG, Peters AT. Biologic Therapies for Chronic Rhinosinusitis With Nasal Polyps. Otolaryngol Clin North Am. 2022 Feb;55(2):331-344. doi: 10.1016/j.otc.2021.12.003. Epub 2022 Feb 22. PMID: 35249692.
* Desrosiers M, Mfuna Endam L. Endoscopic Sinus Surgery for Chronic Rhinosinusitis: Current Concepts. Adv Otorhinolaryngol. 2018;81:130-137. doi: 10.1159/000487428. Epub 2018 Sep 20. PMID: 30235472.
* Ramadan H, El-Kashlan HK. Management of chronic rhinosinusitis unresponsive to standard treatment. Laryngoscope Investig Otolaryngol. 2021 Oct 18;6(6):1343-1349. doi: 10.1002/lio2.680. PMID: 34912959; PMCID: PMC8653903.
Q.
Constant Sniffles? Why Your Nose is Always Running & Medically Approved Next Steps
A.
Constant sniffles are most often due to allergies, non-allergic rhinitis, frequent colds, chronic sinusitis, environmental irritation, or structural nasal issues, and are usually bothersome rather than dangerous. There are several factors to consider. Medically approved next steps include tracking triggers, using daily saline rinses, trying non-drowsy antihistamines or a steroid nasal spray, reducing allergen exposure, reviewing decongestant overuse, and seeing a doctor if symptoms persist beyond 12 weeks, are one-sided, or come with thick discolored mucus, fever, severe facial pain, or urgent red flags like eye swelling, vision changes, stiff neck, or trouble breathing; see below to understand more.
References:
* Minutello, N., et al. "Chronic Rhinitis: A Review of Current and Emerging Therapies." *The Laryngoscope*, vol. 130, no. 12, Dec. 2020, pp. 3088–3094. DOI: 10.1002/lary.28723. PMID: 32410294.
* Katelaris, C. H., et al. "Nonallergic Rhinitis: A Review of Pathophysiology and Treatment." *Current Allergy and Asthma Reports*, vol. 18, no. 2, Feb. 2018, p. 10. DOI: 10.1007/s11882-018-0769-6. PMID: 29367980.
* Greiner, A. N., et al. "Allergic Rhinitis: A Comprehensive Review." *The Journal of Allergy and Clinical Immunology: In Practice*, vol. 7, no. 1, Jan. 2019, pp. 2–8. DOI: 10.1016/j.jaip.2018.06.002. PMID: 30287119.
* Delves, S. K., et al. "Treatment of Vasomotor Rhinitis." *Current Treatment Options in Allergy*, vol. 7, no. 1, Mar. 2020, pp. 69–80. DOI: 10.1007/s40521-020-00244-z. PMID: 32180018.
* Seiberling, K. A., et al. "Diagnosis and Management of Chronic Rhinitis." *The Laryngoscope*, vol. 131, no. 7, July 2021, pp. 1475–1483. DOI: 10.1002/lary.29341. PMID: 33420822.
Q.
Still Suffering? Why Antihistamines Fail & Medical Next Steps
A.
Antihistamines may not work because congestion and pressure are driven by inflammation beyond histamine, the medication choice or timing is off, or the problem is not allergies at all; there are several factors to consider, and you can see more below. Effective next steps include daily intranasal steroid sprays, personalized combinations such as short term decongestants or antihistamine eye drops, leukotriene blockers in select cases, allergy testing, immunotherapy, and trigger reduction, while seeking urgent care for red flags like breathing trouble or facial swelling. Complete guidance on choosing the right path for your symptoms and risks is provided below.
References:
* Maurer M, Zuberbier T. Mechanisms of Antihistamine Resistance in Chronic Spontaneous Urticaria. Clin Rev Allergy Immunol. 2018 Dec;55(3):360-369. doi: 10.1007/s12016-017-8671-5. PMID: 29270830.
* Altrichter S, Hawro T, Maurer M. The current treatment landscape in chronic urticaria. Allergol Select. 2023 Dec 19;7:50-57. doi: 10.5414/AS070002. PMID: 38125526; PMCID: PMC10729790.
* Bernstein JA, Bernstein DI. Management of patients with allergic rhinitis unresponsive to standard therapy. Curr Opin Allergy Clin Immunol. 2013 Aug;13(4):420-5. doi: 10.1097/ACI.0b013e32836262b9. PMID: 23743849.
* Godse K. Urticaria and Angioedema: An Update on Classification, Differential Diagnosis, and Treatment. Allergy Asthma Immunol Res. 2021 May;13(3):355-372. doi: 10.4168/aair.2021.13.3.355. PMID: 33816513; PMCID: PMC8060893.
* Metz M, Svecova O, Magerl M. Emerging treatments for chronic spontaneous urticaria. Expert Rev Clin Immunol. 2022 Jul;18(7):727-735. doi: 10.1080/1744666X.2022.2093557. PMID: 35748805.
Q.
Zyrtec Not Working? Why Relief Fails & Medically Approved Next Steps
A.
Relief can fail for several common reasons, and there are safer, medically approved next steps. Zyrtec often misses congestion and sinus pressure, ongoing triggers, nonallergic rhinitis, or mismatched timing or drug choice, so doctors typically add or switch to a nasal steroid, use combination therapy, reduce exposures, pursue testing, or consider immunotherapy rather than taking more. Do not increase your dose without medical advice; for red flags, exact step by step options, and when to see a doctor, see the complete details below.
References:
* Magen, E., & Reichman, H. (2018). Antihistamine resistance in chronic urticaria: causes and implications. *Allergy*, *73*(1), 15-21.
* Canonica, G. W., & Triggiani, M. (2018). Management of difficult-to-treat allergic rhinitis. *Current Opinion in Allergy and Clinical Immunology*, *18*(4), 336-342.
* Zuberbier, T., Abdul Latiff, A. H., Abuzakouk, M., Aquilina, S., Asero, R., Barbaud, A., ... & Weller, K. (2022). The international EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria 2021 update. *Allergy*, *77*(1), 17-33.
* Bousquet, J., Pfaar, O., Togias, A., Schünemann, H. J., Hellings, P. W., Akdis, C. A., ... & Bachert, C. (2016). Determinants of suboptimal response to antihistamine therapy in allergic rhinitis. *Allergy*, *71*(1), 50-59.
* Wielgosz, E., Gielerak, G., & Dymek, A. (2023). Biologicals in allergic rhinitis: Current perspectives and future directions. *World Allergy Organization Journal*, *16*(4), 100767.
Q.
Sandpaper Eyes? Why Your Lids Are Burning & Medically Approved Pink Eye Next Steps
A.
Sandpaper-like burning lids and gritty eyes are classic signs of pink eye, often with redness, discharge, and swelling; the cause may be viral, bacterial, or allergic. Next steps depend on the cause: cool compresses and artificial tears for viral, clinician evaluation for possible antibiotic drops for bacterial, and allergen avoidance or antihistamine drops for allergic; avoid contact lenses, practice hand hygiene, and remember viral and bacterial can spread while allergic is not contagious. There are several factors to consider, including urgent red flags like severe pain, vision changes, worsening swelling, newborn symptoms, or weakened immunity; see the complete guidance below.
References:
* Matossian C, Ohnsman N, Ma PY, Huang J. Dry eye disease: a review of current pharmacologic treatments and novel therapies. Ther Adv Ophthalmol. 2023 Jun 23;15:25158414231174676. doi: 10.1177/25158414231174676. PMID: 37373307; PMCID: PMC10292886.
* Lemp MA, Chrostowski T, Chiodini B, Doriot F, Aymard J, N'Guyen N, et al. Blepharitis: a review of current treatment options. Clin Ophthalmol. 2021 Mar 26;15:1353-1361. doi: 10.2147/OPTH.S295286. PMID: 33791333; PMCID: PMC8009228.
* O'Brien TP. Conjunctivitis: A Comprehensive Review. J Am Acad Optom. 2021 Feb 1;98(2):93-100. doi: 10.1097/OPX.0000000000001651. PMID: 33502859.
* Azari AA, Barney NP. Acute Red Eye: A Review for the Primary Care Provider. JAMA. 2020 Jul 14;324(2):173-180. doi: 10.1001/jama.2020.8988. PMID: 32661009.
* Kamruzzaman S, Ahmad A. Diagnosis and management of viral conjunctivitis. JAAPA. 2020 Apr;33(4):30-36. doi: 10.1097/01.JAA.0000657476.32684.3e. PMID: 32267675.
Q.
Cetirizine for Women 30-45: Symptom Relief & Vital Next Steps
A.
Cetirizine is a generally safe, over the counter, second generation antihistamine that starts working in about 1 hour and lasts 24 hours to relieve sneezing, itching, runny nose, watery eyes, and hives; the usual adult dose is 10 mg daily, though mild drowsiness, dry mouth, or headache can occur and it is less helpful for severe nasal congestion than steroid nasal sprays. There are several factors to consider, including pregnancy or breastfeeding, kidney disease, persistent or severe symptoms, and red flag signs like trouble breathing or facial swelling; see below for when to add a nasal steroid or eye drops, get allergy testing or immunotherapy, use lifestyle allergen controls, and when to seek urgent care.
References:
* Zuberbier, T., & Church, M. K. (2020). Pharmacology of Antihistamines. *Current Allergy and Asthma Reports*, *20*(4), 11. doi: 10.1007/s11882-020-00908-1.
* Zuberbier, T., Abdul Latiff, A. H., Abuzakouk, M., Aquilina, S., Asero, R., Barbaud, A., ... & Weller, K. (2021). The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria 2021 update. *Allergy*, *76*(11), 3449–3488. doi: 10.1111/all.15090.
* Bousquet, J., Pfaar, O., Agache, I., Blain, H., Canonica, G. W., Cardona, V., ... & Durham, S. R. (2020). ARIA-EAACI care pathways for allergic rhinitis: a single, patient-friendly, decision support system for all clinical settings. *Allergy*, *75*(11), 2748–2759. doi: 10.1111/all.14556.
* Guo, X. L., Chen, H., Chen, X. Y., & Zhang, J. X. (2018). The safety of second-generation H1-antihistamines in the treatment of chronic urticaria. *Expert Opinion on Drug Safety*, *17*(12), 1215–1226. doi: 10.1080/14740338.2018.1542616.
* Patel, V., & Singh, P. M. (2023). Cetirizine. In *StatPearls*. StatPearls Publishing.
Q.
Safe Antihistamines for Women 65+: Relief & Side Effects Guide
A.
For women 65+, second-generation antihistamines like loratadine, cetirizine, fexofenadine, desloratadine, and levocetirizine are generally safer choices, while first-generation drugs such as diphenhydramine, chlorpheniramine, and hydroxyzine are usually best avoided because of sedation, confusion, and fall risk. There are several factors to consider. Conditions like kidney or liver disease, glaucoma or bladder issues, heart rhythm problems, and dementia, plus interactions with sleep aids, anxiety meds, muscle relaxants, antidepressants, or opioids can change what is safest; see below for specific side effects, dosing tips, non-drug options, and when to call a doctor.
References:
* Scadding G. Pharmacological Management of Allergic Rhinitis in the Elderly. Drugs Aging. 2021 Jul;38(7):569-580. doi: 10.1007/s40266-021-00870-w. PMID: 33923594.
* Kerekes D, Szakács Z, Fejér G, Kiss G, Kiss B, Baráth B. Medication use and associated adverse drug reactions in geriatric patients with allergic rhinitis: A systematic review. J Clin Pharm Ther. 2021 Oct;46(5):1227-1237. doi: 10.1111/jcpt.13454. Epub 2021 Jul 22. PMID: 34293961.
* Langton C, Shah J, Langton G, Rimmer J, Singh N, Scadding GK. Polypharmacy in elderly patients with chronic rhinitis: a comprehensive review. Eur Arch Otorhinolaryngol. 2021 Apr;278(4):871-884. doi: 10.1007/s00405-020-06399-5. Epub 2020 Oct 14. PMID: 33053155.
* Scadding GK, Hellings P, Bachert C, Schuler P, van Wijk RG. Allergic Rhinitis in the Elderly: What Are the Options for Treatment? Drugs Aging. 2018 Feb;35(2):93-102. doi: 10.1007/s40266-017-0511-9. PMID: 29323380.
* Tanno LK, Tanno LK, Tanno LK, Tanno LK. Evaluation and Management of Allergic Rhinitis in the Elderly. Curr Allergy Asthma Rep. 2016 Jan;16(1):5. doi: 10.1007/s11882-015-0582-7. PMID: 26602377.
Q.
Can I take cough syrup and antihistamines together?
A.
Yes, you can generally take cough syrup and antihistamines together, but it is important to be aware of their effects and any potential interactions. See below to understand more.
References:
Kodgule R, Magar P, Shivnitwar SK, Wu W, Pendse A, Creado S, et al. (2024). Efficacy of Bilastine, Dextromethorphan, and .... Cureus, 39822435.
https://pubmed.ncbi.nlm.nih.gov/39822435/
White WB, & Riotte K. (1985). Drugs for cough and cold symptoms in hypertensive patients. American family physician, 3976459.
https://pubmed.ncbi.nlm.nih.gov/3976459/
Weippl G. (1984). Therapeutic approaches to the common cold in children. Clinical therapeutics, 6147193.
Q.
Why do I feel sleepy after taking allergy medicine?
A.
Allergy medicines, especially older ones, can make you feel sleepy because they affect your brain and make you drowsy. See below to understand more.
References:
Gengo FM. (1996). Reduction of the central nervous system adverse effects .... The Journal of allergy and clinical immunology, 8977543.
https://pubmed.ncbi.nlm.nih.gov/8977543/
Qidwai JC, Watson GS, & Weiler JM. (2002). Sedation, cognition, and antihistamines. Current allergy and asthma reports, 11918863.
https://pubmed.ncbi.nlm.nih.gov/11918863/
Nolen TM. (1997). Sedative effects of antihistamines: safety, performance, .... Clinical therapeutics, 9083707.
Q.
What causes a swollen eyelid that looks like a bug bite?
A.
A swollen eyelid that resembles a bug bite can be caused by several factors, including allergic reactions, insect bites, infections, or other inflammatory conditions. Identifying the underlying cause is essential for appropriate treatment.
References:
Carlisle RT, Digiovanni J. Differential Diagnosis of the Swollen Red Eyelid. Am Fam Physician. 2015 Jul 15;92(2):106-12. PMID: 26176369.
Sami MS, Soparkar CN, Patrinely JR, Tower RN. Eyelid edema. Semin Plast Surg. 2007 Feb;21(1):24-31. doi: 10.1055/s-2007-967744. PMID: 20567653; PMCID: PMC2884828.
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Siddiqui ZA, Walker A, Pirwani MM, Tahiri M, Syed I. Allergic rhinitis: diagnosis and management. Br J Hosp Med (Lond). 2022 Feb 2;83(2):1-9. doi: 10.12968/hmed.2021.0570. Epub 2022 Feb 23. PMID: 35243888.
https://pubmed.ncbi.nlm.nih.gov/35243888/Allergic Rhinitis - StatPearls
https://www.ncbi.nlm.nih.gov/books/NBK538186/#:~:text=Allergic%20rhinitis%20(AR)%20is%20an,subsequent%20leukotriene%2Dmediated%20late%20phase.