🤧 Men's Health

Allergic Rhinitis (Hay Fever) — Nigeria Guide

Persistent sneezing, runny nose, and itchy eyes — diagnosis and treatment in Nigeria

Allergic rhinitis (hay fever) is one of the most common chronic conditions in Nigeria, affecting up to 20% of the population. It is caused by an allergic immune response to airborne allergens — in Nigeria, house dust mites, cockroach allergens, mould spores, and plant pollen are the dominant triggers. Unlike in Europe where pollen season is well-defined, Nigerian allergic rhinitis is often perennial (year-round). It significantly impairs sleep, school performance, and work productivity, and untreated, it worsens asthma.

Signs and Symptoms

✓ Sneezing — often in rapid succession, particularly in the morning

✓ Nasal congestion — blocked, stuffy nose

✓ Runny nose — clear, watery discharge

✓ Itchy nose, eyes, throat, and roof of the mouth

✓ Watery, red eyes (allergic conjunctivitis)

✓ Post-nasal drip — mucus draining into the throat causing cough

✓ Reduced sense of smell (anosmia) in severe cases

✓ Fatigue, impaired concentration — 'allergic brain'

Risk Factors

Family history of allergy (atopy) — atopic triad: rhinitis, asthma, eczema
Personal history of eczema or asthma
Living in dusty environments — harmattan season in Northern Nigeria, dusty roads
Cockroach allergen exposure — very high in urban Nigerian housing
House dust mite exposure — warm, humid Nigerian climate promotes mite proliferation
Mould exposure — water-damaged housing, poor ventilation
Occupational exposures — flour dust (bakers), animal dander, latex
Early childhood antibiotic exposure — reduces microbial diversity, increases allergy risk

When to Seek Help

SoonNasal symptoms that have not responded to antihistamines after 2–4 weeks — topical nasal steroids needed

RoutineAllergic rhinitis causing significant sleep disturbance or affecting work/school performance

Refer to specialistSuspected occupational allergy, or rhinitis not responding to standard treatment — allergy testing and immunotherapy

UrgentAcute severe nasal swelling with difficulty breathing — possible angioedema, needs emergency assessment

Book appointmentRhinitis with recurrent sinusitis, ear problems, or nasal polyps — ENT assessment

Tests & Diagnosis

🧪 Clinical diagnosis

Typical symptoms + positive family history + improvement with antihistamines confirms allergic rhinitis in most cases — no tests required for initial treatment

🧪 Skin prick testing

Gold standard for identifying specific allergens. Small amounts of allergen extracts applied to the skin with a lancet. A wheal (bump) develops if allergic. Available at allergy clinics at LUTH and select private centres

🧪 Serum specific IgE (RAST/ImmunoCAP)

Blood test measuring IgE antibodies to specific allergens. Useful when skin prick testing is impractical or contraindicated. Available at major Nigerian reference labs

🧪 Nasal smear (cytology)

Eosinophils in nasal secretions support allergic diagnosis — simple, inexpensive test

🧪 Spirometry

If asthma coexists — 40% of allergic rhinitis patients have asthma. Rhinitis and asthma share the same airway inflammation and should be managed together

Treatment Options

Allergen avoidance

House dust mites: wash bedding in hot water (60°C+) weekly, use dust-mite-proof mattress covers, vacuum regularly, reduce carpets. Cockroach: seal cracks, remove food waste promptly, professional pest control. Mould: fix water leaks, improve ventilation, dehumidify

Intranasal corticosteroids — first-line treatment

Mometasone, fluticasone, or beclomethasone nasal sprays — the most effective treatment for allergic rhinitis. Use daily (even on asymptomatic days). Take 1–2 weeks for full effect. Minimal systemic absorption — safe long-term. Available at Nigerian pharmacies

Antihistamines — for sneezing, itch, and watery eyes

Non-sedating: cetirizine 10 mg daily or loratadine 10 mg daily (both available OTC in Nigeria). Fexofenadine 120 mg daily — least sedating. Older sedating antihistamines (chlorphenamine, promethazine) — effective but impair driving and concentration. Use non-sedating during the day

Combination: intranasal steroid + antihistamine

For moderate-severe symptoms not controlled by either alone. Azelastine+fluticasone combination nasal spray (Dymista) — highly effective but expensive and limited availability

Saline nasal irrigation

Nasal saline rinse (neti pot or nasal spray) twice daily — clears allergens and mucus, reduces symptoms. Very safe, inexpensive, and effective adjunct

Sodium cromoglicate (cromolyn) nasal spray

Preventive — must be used before allergen exposure. Less effective than nasal steroids but very safe. Useful for seasonal use before harmattan

Allergen immunotherapy (AIT)

The only disease-modifying treatment — gradually desensitises the immune system. Subcutaneous (injections) or sublingual (drops/tablets). 3-year course. Highly effective, reduces medication need. Limited availability in Nigeria — available at allergy specialist centres

Treat asthma concurrently

If rhinitis and asthma coexist, treat both — inhaled corticosteroids for asthma, intranasal steroids for rhinitis. Montelukast (a leukotriene receptor antagonist) has modest benefit for both

Frequently Asked Questions

Is hay fever the same as a cold?

They can look similar (runny nose, sneezing), but the key differences are: hay fever has itchy eyes, nose, and throat (colds do not); hay fever has no fever; hay fever symptoms occur consistently in the same situations (dusty rooms, outdoors); colds typically resolve in 7–10 days whereas allergic rhinitis persists. Antihistamines help hay fever but not colds.

Can I use nasal sprays every day?

Steroid nasal sprays (mometasone, fluticasone) are designed for daily use and are safe long-term. They work best with daily use — using them only when symptomatic is less effective. Decongestant nasal sprays (oxymetazoline/Otrivin) should NOT be used for more than 3–5 days — they cause rebound congestion.

Can allergic rhinitis be cured?

Standard medications control symptoms but do not cure allergic rhinitis. Allergen immunotherapy (allergy shots or drops) is the only treatment that modifies the underlying immune response and can lead to lasting remission. It requires 3 years of treatment and is not widely available in Nigeria yet.

Does wearing a face mask help with allergies?

Yes — a properly fitted mask (N95 or even surgical mask) filters pollen and dust particles and significantly reduces allergen inhalation. Many allergic rhinitis patients reported improvement during the COVID-19 mask-wearing period. Wearing a mask during harmattan, dusty commutes, or outdoor work is a simple, free intervention.