Led By The Nose

“Although seldom lifethreatening, allergic rhinitis and its symptoms can affect your quality of life and diminish work or academic performance.”

It typically begins with sneezing

Your nose starts to feel blocked, runny or itchy - sometimes, all of the above! You think you have caught a cold so you take an overthe- counter pill and decide to wait for it to (literally) blow over.

After a few days, you are still sneezing and sniffling, but now a cough threatens to develop. Unlike a cold, allergic rhinitis is not caused by a viral infection. Neither does it go away after a few days. As its name implies, it is your body’s reaction to the presence of, or stimulation by, an allergen.

Allergic rhinitis symptoms affect nearly 40% of people here, according to 2014 findings by scientists from the National University of Singapore (NUS) and the Agency for Science, Technology and Research (A*STAR).

Dr Lau Chee Chong, an ENT specialist at the Ear Nose & Throat Centre CC Lau, says that there has been no real increase in the number of people with allergic rhinitis. What has increased, however, is the pick-up rate, since it has become much easier to test for and diagnose the condition. “Some 20 years ago, only a few centres conducted skin-prick allergy tests, which were time-consuming and expensive,” he explains. “Today, tests have become easier and simpler, and are readily available in most hospitals and clinics.”

Why do you have allergic rhinitis?
Allergic rhinitis is brought on by various substances; in particular, pollen. That’s why, in countries with four seasons, the ailment is usually associated with hay fever. It commonly occurs in spring and summer, when a lot of pollen is released into the environment by flowering plants. So avoid these seasons when you are visiting temperate countries or wear a mask if you must be outdoors.

There is no seasonal change in Singapore, so we don’t have a hay fever period. Therein lies the irony. “Our grasses and flowers grow throughout the year, [resulting in] a perennial source of allergens,” says Dr Lau.

Allergic rhinitis in Singapore is largely caused by house dust mites, as revealed in the aforementioned study by NUS and A*STAR, which was published in the science journal Allergy. It is a chemical in the excrement of dust mites that triggers the symptoms.

Dust mites thrive in a warm and humid climate - like that in Singapore. They are also more likely to be found indoors, an environment most of us spend a large part of the day in since we love air-conditioned spaces. Dust mites delight in bedding, furniture, curtains and carpets. To reduce dust mite growth, it is important to ensure that these items are clean. Wash blankets every week in hot (60°C) water, and cover your pillows and mattresses in dustproof cases or sheets.

When vacuuming, wear a mask so you don’t end up inhaling the allergens. Stay away from the vacuumed area for around 20 minutes so that the allergens can settle. Check that your vacuum cleaner has a double-layered microfilter bag or a HEPA filter that traps allergens that pass through its exhaust.

You may also want to invest in a dehumidifier to keep humidity at about 50% or lower to reduce dust mite growth. Just remember to have it cleaned regularly.

Animals, or rather their dead skin cells, urine or saliva, can trigger an attack of allergic rhinitis, too. The culprit can be your beloved pet, be it a dog, cat or rodent.

Another thing: allergy tends to run in the family, so if your parents have allergic rhinitis, you’re more likely to develop it as well.

Do you have allergic rhinitis?
The earliest signs of this condition affect different parts of your body. Most family physicians can help patients manage straightforward allergic rhinitis with medication and advice on avoiding allergens, says Dr Lau.


  • Sinus headache


  • Itchy and teary


  • Feel blocked (due to blockage in the Eustachian tubes)


  • Sneezing, snorting and sniffling
  • Stuffy
  • Feels itchy
  • Watery nasal discharge


  • Chronic cough
  • Post-nasal drip and phlegm

Consult an ENT specialist if symptoms persist despite medication and management. Allergic rhinitis can lead to various other ailments, such as acute or chronic sinusitis, and sleep-disordered breathing conditions, such as snoring and obstructive sleep apnoea. Sometimes, the skin reacts to the allergen by breaking out in hives.

Asthma is also associated with allergic rhinitis, according to Associate Professor Anne Goh, head and senior consultant of Allergy Service, KK Women’s and Children’s Hospital. Those between 4 and 17 years old are especially susceptible to allergic rhinitis. About 40% of children with allergic rhinitis will develop associated asthma, with up to 90% in the converse scenario.

An ENT specialist can investigate symptoms to determine if these are caused by other nasal diseases, adds Dr Lau. Surgery may be recommended to open up the nasal airways to reduce congestion and a runny nose even with exposure to allergens.


You can have non-allergic rhinitis. One out of three people with rhinitis are non-allergic.

Symptoms are similar to allergic rhinitis, including sneezing and congestion, but these are not caused by the presence of an allergen, hence symptoms can come and go throughout the year.

Common causes can range from environmental irritants (such as hair spray) to food (spicy dishes) and medication (aspirin and ibuprofen, among others). Stress - either emotional or physical - may also lead to non-allergic rhinitis.

It affects both children and grown-ups, but is more prevalent among those aged 20 and above. Women are more vulnerable to the condition, as nasal congestion worsens during menstruation and pregnancy, when the bodies are affected by hormonal changes.

Non-allergic rhinitis sounds less serious than allergic rhinitis, but it can disrupt your daily life. Chronic inflammation from the sneezing and dripping can result in nasal polyps on the lining in your nose, and breathing becomes difficult. The constant nasal congestion also increases your likelihood of developing sinusitis and middle ear infection. For some people, the sense of smell is dulled.

Meanwhile, the other cause of rhinitis is the common cold. Known as an infectious rhinitis, it can be due to any of over 200 types of viruses. Fortunately, symptoms are usually short-lived, lasting between three and seven days.