Seasonal rhinitis or more commonly known as hay fever is an example of allergic reaction caused by allergens that are usually available in certain seasons. The main causes of this condition are pollen from trees, grasses and weeds and mold spores and dust mite particles. In some regions it is associated with certain plants that produce pollen at certain times of the year. It refers to an inflammation response of the immune system to these non-threatening substances known as allergens. The immune system is triggered to recognize allergens as an enemy and causes inflammation thus the symptoms. 

• Age: SAR typically begins in childhood or adolescence and may persist into adulthood. Although it is most frequently diagnosed in patients between the ages of late teens to early twenties, the disease may present itself at any age. 
• Gender: Outcomes of relative gender distribution are inconclusive Some studies reveal higher rate in males in childhood, in females in adulthood, and vice versa. 
• Genetics: There is also evidence that there is a genetic component to the risk as people with a family history of allergies and asthma are at a greater risk. 
• Environmental Factors: SAR can be affected by factors such as allergens, pollution and changes in the environment such as climate change among others. Some earlier findings have even associated raised prevalence with urbanization. 

• Allergen Exposure: Sensitisation involves exposure of the immune system to allergens such as pollen. 
• Sensitization: IgE antibodies are generated which are specific to the allergen and attach to mast cells and basophils. 
• Re-exposure: Although allergens are cleared from the body when they are first encountered, they remain permanently attached to the IgE on the mast cells surface, and when they are encountered again they bind to the IgE and cause degranulation. 
• Histamine Release: Histamine and other mediators are released by mast cells thus triggering inflammation. 

• Allergens: The main cause of SAR is pollens, and they include trees, grasses and weeds and change with season and geographical location. In certain circumstances, the mold spores also may be an allergen, particularly during autumn or in regions that have high humidity. 
• Immune System Response: Through sensitization, the immune system forms allergen-specific IgE antibodies, at first stage of exposure to the allergen. 
• Genetic Factors: Genetic reasons as a mode of vulnerability are evidenced by the fact that an individual with a history of allergies or asthma in the family is more likely to develop SAR. 
• Environmental Factors: Seasonal variations, higher concentrations of airborne particulate matter, and population densities in areas subjected to modernization may also alter SAR dispersal rates. 
• Pollution: Pollutants in the air can increase the allergenicity of an area, and increase people’s sensitivity to respiratory problems. 

• Allergen Exposure 
• Immune Response 
• Genetic Predisposition 
• Environmental Factors 
• Comorbid Conditions 

Age Group 

• Children and Adolescents: SAR is frequently developed in childhood or in adolescence. The common signs of allergy are red/watering eyes, sneezing, runny nose and problems with breathing through the nose. It can impact on school performance as well as the day-to-day activities since it is with the child all the time. 
• Adults: Common manifestations are cough or wheezing, difficulty breathing, chest pain, and fever or chills as in children but more epidemiological may be caused by chronic syndromes and possibly fatigue and irritability. SAR is the first type of specific phobia which adults may have in their late teens or twenties and it may worsen as the persons ages. 

On examination, children with SARP present with clear manifestations suggestive of inflammation and irritation of the nasal mucosa. It should appear pale, or at times bluish due to lack of oxygen, especially when the person is on a high altitude, swollen and boggy because of congestion. Patients commonly present with significant rhinorrhea or tearing and fre-. there may also be presence of allergic shiners” which are dark circles under the eyes due to venous stasis. Redness of eyes, stringy watery discharge with conjunctival vasodilation or congestion, lacrimation. 

• Asthma 
• Atopic Dermatitis 
• Sinusitis 
• Sleep disturbances 

• Seasonal Variation: Symptoms usually occur suddenly with the start of certain pollen seasons, for instance, in spring, trees are on season while in summer it is grass and in fall weed pollen are a common feature. 
• Symptom Onset: They may begin as mild during start of the season and get aggravated at the height of the season with the pollens. 
• Chronicity: Patients generally have seasonal symptoms, but it is ever recurring and becoming yearly due to poor management. 

Otolaryngology

• Nasal Irrigation: Irrigation using saline nasal sprays or the use of neti pot to remove the allergens and mucus from the nasal passages should be done. 
• Environmental Controls: Measures that should be taken include the adoption of high efficiency filters in home heating and cooling and the HEPA-filtering room air, vacuuming with HEPA vacuum cleaners, and controlling indoor mold and dust mite. 
• Humidification: Humidity in a home is another factor that should be kept at an optimal level in that it moistens the twigs of the nose and thus minimize their rawness. 
• Lifestyle Modifications: Use of protective outfits including masks every time one is outside the house especially in the pollen season, minimum outdoor activities during the pollen season, and avoiding exposure to cigarette smoking and passive smoking. 

Otolaryngology

• Fluticasone propionate: It is a strong glucocorticoid that prevents inflammation and protects against chemicals that cause inflammation by modifying immunologic activity of the nasal mucosa. It is normally given through inhaler using the nasal route. The dose typically recommended is one to two actuations in each nostril in a twenty-four period. 
• Mometasone furoate: It acts by acting on the levels of corticosteroid receptors which results in decreased inflammation and thereby relief of the symptoms of allergic rhinitis. It is used in its administration as a nasal mist. It is used as one spray in each nostril once or twice a day of the plain nasal spray. 
• Budesonide: The mechanism by which budesonide achieves the therapeutic effect involves suppression of cytokine generation and other inflammatory mediators in the nasal mucosa. Used as a nasal spray usually one to two puffs, through each nostril once or twice a day. 

Otolaryngology

• Pseudoephedrine: This action is achieved through the interaction with alpha adrenergic receptors that cause vasoconstriction of the nasal tissues and a decrease in nasal congestion. May be taken as regular tabs or, more often, as modified-release tabs. Oral administration commonly ranges from 10 to 240 mg/day divided in several doses, it may be used as starting dose of 60 mg every 4 to 6 hours or 120 mg once daily of extended-release preparation. 
• Phenylephrine: A selective alpha-1 adrenergic receptor agonist; produces vasoconstriction and hence relieves nasal congestion. Most commonly, it is supplied in the form of oral tablets or liquid preparations. An average patient will use 10 mg every four hours depending on the severity of the condition. 

Otolaryngology

Diphenhydramine: Inhibition of H1 receptors and the fact that it can pass the blood-brain barrier causing sedative effects. It comes in the form of oral tablets, liquid and chewable. Common administration is 25 to 50 mg every 4 to 6 hours as needed. 

Chlorpheniramine: It inhibits H1 receptors hence decreases the allergic response. This one has lesser sedative property than diphenhydramine, but it also possesses the ability to cause drowsiness. 

Otolaryngology

• Nasal Irrigation: It is a process whereby the nasal passages are washed with a saline solution to help wash out allergens, mucus, and debris.. This may be useful in the alleviation of inflammation and enhancing of the ability to breathe through the nose. This is achieved using a neti pot, squeeze bottle or nasal spray. The saline solution can be bought at the pharmacy or prepared using water and salt, if needed. 
• Allergen Immunotherapy: This is the process by which allergen extracts are slowly introduced into the body in gradually increasing quantities so as to help the patient develop a diminished sensitivity. It is given in form of subcutaneous injections commonly referred to as allergy shots and in the form of sublingual tablets for certain types of allergens. The treatment generally involved the build-up phase that involved gradual increments of the doses and a maintenance phase. 
• Nasal Endoscopy: Flexible endoscopy is a diagnostic procedure that makes it possible to have a clear and direct view of the nasal passages and paranasal sinuses. This will especially come in handy in diagnosing cases where there may be underlying structural problems or cases of chronic illnesses causing the symptoms. It is done in an outpatient manner with the usage of either the flexible or rigid endoscope. Local anesthesia is normally used to reduce pain as much as possible. 
• Radiofrequency Ablation (RFA): This is a surgery that involves a small incision on the septum to shrink and minimize the size of the nasal turbinaries that causes congestion. Performed under local anesthesia. To perform the surgery, a small probe is inserted through the patient’s nasal passage to deliver radiofrequency energy to the turbinate’s. 
• Septoplasty or Turbinate Reduction Surgery: Septorhinoplasty, the surgical repair of a deviated nasal septum, or surgery to reduce the size of enlarged turbinates may be recommended for individuals suffering from structural defects. It is done under general anesthesia and there are some complications that are associated with this procedure. Septorhinoplasty is an operation that focuses on putting the nasal septum in the proper position whereas submucosal turbinate surgery uses different techniques such as surgical or laser to minimize the size of the turbinate. 

Otolaryngology

Seasonal allergic rhinitis care is usually performed in steps to ensure optimal management of the symptoms and increased quality of life. The first is the avoidance where patients are encouraged to avoid contact with the allergens by staying indoors during seasons when the pollens are usually high, using air conditioners and not opening windows. The second phase is the pharmacological phase which is managed using antihistamines for sneezing, itching and runny nose, intranasal steroids for inflammation and congestion, decongestants and leukotriene receptor antagonists. The third phase is immunotherapy, in which allergen specific immunotherapy is administered as an attempt to decrease the immune system’s sensitivity to certain allergens gradually.