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Environmental Allergy

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Background

Allergic rhinitis, commonly called 'hayfever', is the most common allergic disorder in New Zealand and affects up to 40% of children. It can have a significant impact on sleep, concentration, learning and daily function, and affect childhood behaviour and development.

Common aeroallergen triggers of allergic rhinitis are:

 An approach to environmental allergens and allergic rhinitis

Environmental Allergy

  1. Allergy focussed history
    Timing* 
    Environmental allergen exposure may be:
    • year-round (e.g. house dust mite)
    • intermittent (e.g. cat and dog) or 
    • clearly seasonal (e.g. grass pollen).
    *The relationship between triggers and symptoms may give a clear indication of likely causes. 

    Signs and symptoms: 
    Common allergic rhinoconjunctivits symptoms include nasal symptoms - obstruction, itching, sneezing, coryza - and ocular symptoms - itching, tearing, rubbing, angioedema.
  2. Allergen avoidance
    There is limited data that specific allergen avoidance measures are very effective. However, for families who want to try allergen minimisation as a non-medication based option, a patient handout is available on www.allergy.org.au
  3. Specific allergen immunotherapy (SIT)
    Decisions about initiation of SIT will generally be made by a specialist in the area. Families need to be aware that SIT can be done by subcutaneous (SCIT) and sublingual (SLIT) routes. Currently no SCIT or SLIT products are funded in New Zealand. An evidence based review of both SCIT and SLIT is available https://effectivehealthcare.ahrq.gov/topics/asthma-immunotherapy-2010/research/. A patient handout explaining immunotherapy is available on www.allergy.org.au, with e-learning about immunotherapy also available on that site.
  4. Test interpretation
    Allergy skin test results need to be considered alongside the clinical history. For example, if there are year-round symptoms but only grass tests positive, with no history of seasonal symptoms, then the patient may be sensitised but not clinically allergic. Likewise if cat is positive but there are no symptoms with cat the patient may be sensitised but clinically tolerant.

Additional resources

http://www.eaaci.org/resources/guidelines/ait-guidelines-part-1.html

Document last reviewed: March 2018

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