Link Between Allergic Rhinitis and Thyroid Disease

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Although it may seem surprising that a condition that causes sneezing and a runny nose could have anything to do with one that wreaks havoc with the thyroid gland, it actually makes sense: Both allergic rhinitis (hay fever) and autoimmune thyroid disease (AITD) result from similar immune system responses. This may be particularly helpful to know if you are unsuccessfully managing hay fever, but have not yet been evaluated for a thyroid condition.

Symptoms

In the case of allergic rhinitis, the immune response is triggered by an external allergen such as pollen, mold, or dust mites. Since most of these allergens are breathed in through the nose or mucous membranes in the eyes, the symptoms of allergic rhinitis—sneezing, runny or stuffy nose, post-nasal drip, coughing, sinus headache, and watery eyes—center on these areas.

(Note that there are two types of allergic rhinitis: seasonal, which flares up at times of the year when allergens are most prevalent, and perennial, which occur year-round.)

Causes

A number of studies in recent years have found connections between allergic rhinitis and autoimmune thyroid disease.

Among them, a 2015 study published in the American Journal of Rhinology and Allergy reported that over 16% of 2,000 people with allergic rhinitis had Hashimoto's thyroiditis, the leading cause of hypothyroidism (low thyroid function). This is significant because the incidence of Hashimoto's thyroiditis in the general population is only around 1.5%.

Research has also found a link between allergic rhinitis and Graves' disease, the leading cause of hyperthyroidism (overactive thyroid). Compared to the general population, people with Graves' disease are 42.9% more likely to have chronic or recurrrent allergic rhinitis.

Associations between autoimmune thyroid disease and other autoimmune diseases that often co-exist with allergic rhinitis (such as eczema and asthma) have also been noted, as have links between AITDs and food allergies.

Diagnosis

It is unclear why people with allergic rhinitis are more susceptible to autoimmune thyroid disease or vice-versa. But it seems reasonable that if you're affected by allergic rhinitis, your doctor may want to test your thyroid levels, especially if you have risk factors for AITDs (including family history or another autoimmune disease such as rheumatoid arthritis or type 1 diabetes).

Treatment

Antihistamines and decongestants, both over-the-counter and prescription strength, are the medications most often used to treat allergic rhinitis. The package inserts of these drugs sometimes state that they shouldn't be taken by people with thyroid disease.

This is because when a person's thyroid hormone levels are high, they may be oversensitive to certain side effects of decongestants, such as tremors or nervousness. Similarly, low thyroid levels can exacerbate the sluggishness and drowsiness that are common side effects of antihistamines.

With that said, neither scenario is likely to play out when hormone levels are well-managed and normalized. And other medications sometimes prescribed for allergic rhinitis—such as cromolyn (a nasal spray) and leukotriene receptor antagonists like Singulair (montelukast)—are not known to be problematic for people with autoimmune thyroid disease.

These drugs aren't known to react with thyroid medications either. However, people who happen to be sensitive to certain ingredients in Synthroid (levothyroxine), a synthetic form of thyroid hormone used to treat Hashimoto's disease and hypothyroidism, may respond to the drug with symptoms that are similar to allergic rhinitis.

The antithyroid medications used to treat Graves' disease aren't known to interact with allergy drugs. Even so, it is important to tell your doctor about any and all drugs you take, including OTC products and supplements.

If you're under the care of an endocrinologist as well as an allergist or ENT (ear, nose, and throat specialist), make sure that all of the doctors are aware of the treatments you are undergoing.

Coping

Research shows that allergies sometimes can aggravate an AITD (or even induce one). As such, effectively managing both conditions will help you feel your best. One important aspect of managing both allergic rhinitis and autoimmune thyroid disease is doing all you can to avoid whatever triggers you're allergic to.

The American College of Allergy, Asthma, and Immunology (ACAAI) recommends taking the following measures to steer clear of substances that cause allergic reactions:

  • If you're sensitive to pollen, keep the windows of your car and your home closed when pollen levels are heavy; use air conditioning if it's hot out.
  • Wear glasses or sunglasses to keep pollen out of your eyes.
  • Use bedding that's labeled "mite-proof" to limit exposure to dust mites.
  • Prevent mold in your home by using a dehumidifier in mold-prone areas.
  • After petting an animal, wash your hands before touching your face.
  • Do all you can to stay away from any other allergens you're aware of such as cigarette smoke, cleaning solutions, or car exhaust fumes.
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