Allergic Rhinitis: Beyond “Hay Fever”
Currently it is estimated 20-30% of Australians have allergic rhinitis. When people think of allergies, the term hay fever or pollen allergy often comes to mind. Many imagine springtime sneezing, itchy eyes, and a runny nose triggered by grass, trees or flower. While pollens are indeed a major allergen culprit, they are only part of the story. Allergic rhinitis is more than seasonal exacerbations—it is also a year-round problem driven by dust mite allergy. Understanding the different causes and tailoring treatment accordingly is crucial for lasting relief.
Dust Mites: The Invisible Trigger
Dust mites are microscopic organisms that thrive in household environments, particularly in bedding, upholstered furniture, and carpets. Their waste particles are potent allergens that can trigger nasal congestion, sneezing, postnasal drip, and itchy eyes. Chronic allergies can also cause mouth breathing, snoring, fatigue and loss of concentration.
Unlike pollen, which fluctuates with the seasons, dust mites are present all year round. For many patients, waking up congested or experiencing persistent symptoms at home are strong clues that dust mites are the hidden driver of their allergic rhinitis. At least half of allergic rhinitis patients have both pollen and dust mite allergies.
Dust Mite Minimisation Strategies
Reducing exposure to dust mites can significantly improve symptoms. While it is nearly impossible to eliminate them completely, several evidence-based strategies can help:
- Bedding control: Use dust mite–proof covers for pillows, mattresses, and duvets. Wash sheets and pillowcases weekly in hot water (>60°C).
- Bedroom focus: Because we spend a third of our lives sleeping, the bedroom should be the primary target. Remove unnecessary soft furnishings, stuffed animals, and heavy curtains.
- Vacuuming and cleaning: Regular vacuuming with a HEPA filter vacuum and damp dusting can reduce allergens.
- Humidity control: Dust mites thrive in humid conditions. Aim to keep indoor humidity below 50%.
These measures are particularly important for children and adults with persistent, year-round symptoms.
Initial Treatment: Combination Nasal Sprays
For many patients, pharmacological treatment is the first step to symptom relief. Combination nasal sprays such as Ryaltris or Dymista are now more often recommended as initial therapy. These sprays combine an antihistamine with a corticosteroid, tackling both the immediate allergic reaction and the underlying inflammation. Clinical studies show that these combination sprays work quicker and better than single medication sprays (e.g. Nasonex, Rhinocort, Azep etc), reduce nasal congestion, and are generally well-tolerated when used regularly.
Oral antihistamines and saline rinses can be useful adjuncts, but for moderate to severe symptoms, combination nasal sprays are usually more effective.
Allergen Immunotherapy: Treating the Cause
While medications control symptoms, they do not change the underlying allergy response. Allergen immunotherapy (AIT)—commonly known as “allergy shots” or “allergy drops”—is the only treatment that modifies the disease process itself. By exposing the immune system to gradually increasing doses of the allergen, immunotherapy retrains the body to tolerate it.
What can be treated with AIT?
- Pollens (grass, trees, weeds)
- House dust mite
- Cat allergen
- Dog allergen
Efficacy and Safety
Immunotherapy has been shown in numerous trials to significantly reduce symptoms, improve quality of life, and decrease the need for medications. Benefits often persist for many years after treatment is completed. The therapy has a well-established safety profile when administered under medical supervision. Mild local reactions (such as redness or itching at the injection site) are the most common side effects, while serious reactions are rare in properly managed settings.
For patients with year-round dust mite allergy or severe seasonal pollen symptoms, immunotherapy is a particularly valuable long-term option.
Allergy Testing: Finding the Cause
Accurate diagnosis is key to effective treatment. Two main types of tests are used to identify specific allergens:
- Skin prick testing (SPT): A small amount of allergen extract is placed on the skin (usually the forearm or back) and gently pricked. If the patient is allergic, a small itchy bump (like a mosquito bite) appears within 15–20 minutes. This is quick and provides immediate results. SPT is more accurate than blood tests
- Blood testing: A blood sample is analysed for allergen-specific IgE antibodies. This can be useful if skin testing is not possible
Access to Immunotherapy in Australia
Over the past decade, access to allergen immunotherapy in Australia has improved considerably. Effective aeroallergen immunotherapy products are now easily available, including both subcutaneous (injection) and sublingual (tablet or drop) options. This means that treatment can be tailored to the patient’s needs and lifestyle, with greater convenience and choice making it a realistic option for many Australians with allergic rhinitis, asthma and/or chronic eczema who previously had limited access.
Key Points for Allergies
Allergic rhinitis and also Asthma is not a one-size-fits-all condition. For some, pollen is the major trigger; for others, dust mites or pet allergens are the culprit. A structured approach works best:
- Identify the trigger through history, examination, and allergy testing.
- Minimise exposure, especially in the bedroom for dust mites.
- Start effective symptom control with combination nasal sprays such as Ryaltris or Dymista and/or appropriate Asthma management
- Consider allergen immunotherapy for those with persistent, severe, or year-round hay fever (allergic rhinitis) and/or asthma symptoms, targeting the specific allergen(s) responsible.
In Summary
Allergic rhinitis and Asthma are more than just a seasonal nuisance. By recognising pollen and dust mite allergy as a common cause and offering minimisation strategies and effective root cause and long-term medical therapies, we can help patients achieve not just acute relief but long-term resolution. For those who struggle with daily symptoms or have multiple allergen sensitivities, allergen immunotherapy offers a safe, proven path toward lasting control.
We offer aero allergen skin prick testing and aero allergen immunotherapy management.
If you would like a comprehensive assessment and further information, Schedule an appointment with Dr Michael Shen at Madison Medical Practice Hornsby. Call (02) 9987 2226 or book online through Healthengine.