Allergic Rhinitis (1) - Definition, Causes & Symptoms

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- Allergic Rhinitis definition, causes & symptoms

Allergic Rhinitis : Definition

Western Medicine

Allergic rhinitis is a condition that presents frequent attacks of sneezing, nasal discharge or blockage of the nasal passages. It may be seasonal (a limited period of the year) or perennial (throughout the whole year).

Seasonal rhinitis is often called "hay fever" and is the most common of all allergic diseases, about 2 to 20 per cent of the population worldwide are thought to be affected. Teenagers experience the highest prevalence, with up to 30% of young people showing symptoms during the summer months.

Chinese Medicine

Traditional Chinese Medicine (TCM) has a long history of managing hay fever, with symptoms documented as early as 2000 years ago. The Yellow Emperor’s Classic of Internal Medicine provides detailed descriptions of symptoms like nasal congestion, nasal itchiness, sneezing, and clear nasal discharges, which align closely with modern understandings of hay fever. 

The nose is responsible for breathing, smelling, and aiding pronunciation. From a TCM perspective, nasal functioning closely relies on the support and regulation of internal organs and meridians. TCM regards the nose as an orifice of the lungs on the body surface, the external portal for gas exchange. When lung qi is abundant, the nasal passages remain clear, with a keen sense of smell and smooth breathing. Conversely, lung disharmony can lead to nasal congestion, a runny nose, or a decreased sense of smell. Therefore, TCM treatments often aim to regulate and strengthen lung functioning to improve nasal health.

The spleen is responsible for nutrient essence production, and the kidneys are responsible for essence storage of the body; both organs are critical for proper nasal functioning too.

Beside the Lung meridian, the Governor Vessel meridian runs across the midline of the front head, passing through the nose vertically. The acupoint, ying xiang (LI 20, located at the outer edge of the nostril) is the starting point of the Large Intestine meridian and the endpoint of the Stomach meridian. These meridians are closely associated with acupuncture therapy for nose problems. 

Allergic Rhinitis : Causes

Western Medicine

Allergic rhinitis, also known as hay fever, involves inflammation of the nose, sinuses, and eyes. The allergic reaction occurs when the body’s immune system overreacts to allergens such as pollen, dust mites, mold, or pet dander, that are usually harmless. The immune system mistakenly identifies the harmful antigens, and the response leads to the release of histamines and other chemicals, causing inflammation and allergic symptoms. Doctors usually divide the disorder into two categories: 

• Seasonal allergic rhinitis

The antigens which cause the seasonal form of allergic rhinitis are pollen from grasses, flowers, wild plants or trees. Grass pollen is the most common of these seasonal allergens and gives rise to the term hay fever.

• Perennial allergic rhinitis

In perennial allergic rhinitis, the reaction may be caused by specific antigens derived from house dust, fungal spores or animal dander (scurf). However, physical or chemical irritants, such as pungent odors or fumes, including strong perfumes, cold air and dry atmospheres can cause similar symptoms.

 

 

 

Chinese Medicine

TCM claims that the development of allergic rhinitis has internal and external aspects. 

(I) Internal deficiency 

A deficiency inherited at birth, chronic illness, over-exertion, improper diet, or emotional distress can all damage internal organs. Under-functioning of organs and depletion of blood and qi (vital energy) make the body susceptible to illness. For allergic rhinitis, organs like the lungs, spleen, and kidney are mainly associated with the internal deficiency of the rhinitis.

• Lung deficiency: The nose is considered as the external opening of the lungs, usually known as nasal orifices; a lung deficiency leads to weakened nasal functioning. Lung deficiency also leads to weak protective qi, making the exogenous evils invade the nose orifice more easily. The result will be recurring episodes of nasal problems, such as congestion, watery discharges and sneezing.

• Weak stomach and spleen: The spleen and stomach are responsible for transformation and transportation of nutrient essence for the body. When the functions become weak, there will be a decline in qi and blood internally, and the nose will lose its supply of nutrient. This reflects a disorder in the nasal linings (mucous membranes), leading to nasal obstruction, watery discharge, and sneezing. The sense of smell is also affected too.
• Kidney deficiency: Normally, the kidney assists the lungs in ruling qi movements and body fluid distribution inside the body. Kidney deficiency can distribute qi activities and fluid distribution, and also affect the essence supply to the nose, leading to nose problems such as pale and swollen nasal linings, frequent episodes of nasal itching, sneezing, and watery discharges from nose.

(II) Invasion of exogenous evils (external aspect)

The nose is located at the center of the face, representing the most yang part of the body, and the region receives abundant blood flow. Wind evil is the leading cause of many illnesses, often bringing other exogenous pathogens along and likely attacking the nose. Therefore, nasal symptoms are very common in exogenous diseases.

From a TCM perspective, hay fever is usually resulted from a combination of external pathogens and body weakness. When the body is weak and the protective qi is not strong, exogenous pathogens take advantage of the chance and attack the body. Additionally, the extent of influence from internal and external factors determines the development of hay fever. Their roles vary in each case and even during specific episodes. Generally, new cases or acute attacks are primarily influenced by external factors, while chronic or recurring episodes are mainly influenced by internal factors.

 

Allergic Rhinitis : Symptoms

Western Medicine

Individuals with this disorder typically experience cold-like symptoms, such as sneezing, watery eyes, nasal congestion, itchy and runny noses, and sometimes headaches or fatigue. Early morning and late evening are the most usual periods to have symptoms. The episodes are characterized by recurring with acute onset, and each time the symptoms can rapidly subside, leaving individuals healthy between episodes.

Seasonal allergic rhinitis has the following features: 

• Frequent sudden attacks of sneezing, with profuse watery nasal discharge and nasal obstruction.
• Each time, the attack only lasts for a few hours, and is often accompanied by sharp pain, watery and pink eyes (conjunctivitis). 
• Some individuals may have conjunctivitis without nasal symptoms.
• The condition does not cause fever.
• Swelling of the nasal linings may lead to headaches, due to a build-up of pressure in the nasal passages and sinuses.

Since seasonal rhinitis is mild, individuals often don’t seek medical care. However, the disorder can be extremely exhausting for some, with symptoms like persistent sneezing, a constant runny nose, and relentless itching.

Perennial allergic rhinitis

Symptoms are similar but tend to be more continuous and generally less severe. It's not surprising that individuals with multiple clinical sensitivities often experience perennial rhinitis along with one or more predictable seasonal flare-ups, and so vary in severity. 

Individuals usually don't cause dramatic symptoms. However, a persistently blocked nose can lead to complications like mouth breathing, snoring, and a dry throat. Dark circles and puffiness can develop under the eyes. Swollen mucous membranes can easily get infected and further cause recurrent or chronic sinusitis. Drainage from nasal infections can lead to a sore throat and bronchitis. In children, when the eustachian tubes are blocked by swollen mucous membranes, enlarged adenoids, or excess discharges, there can be ear problems like temporary deafness and recurrent middle ear infections.

While individuals with allergic rhinitis tend to develop bronchial asthma more frequently than the general population, the exact increase in risk is not well-defined. Generally, the risk of developing asthma increases with the severity of rhinitis, especially if chronic sinusitis and bronchial infections are present, or if the individual has had asthma attacks in the past.