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Learn about Allergic Rhinitis. This video describes the known pathophysiology, clinical signs and symptoms, and possible treatments for Allergic Rhinitis.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Allergic Rhino-sinusitis
  • Atopic Rhinitis
  • Nasal Allergies

What is Allergic Rhinitis? (Definition/Background Information)

  • Allergic Rhinitis (AR) is an extremely common condition that occurs when the nasal airways and underlying nasal membranes become inflamed due to the introduction of an external allergen, such as pollen, dust, animal dander (hair, skin particles), house dust mites, or chemical particulates
  • Allergic Rhinitis causes nasal congestion, itching, sneezing, and runny nose, leading to discomfort and affecting the normal quality of life. The individual is usually allergic to the external trigger or allergen, but there may also be some individuals with non-Allergic Rhinitis
  • Allergic Rhinitis may be seasonal, such as due to pollen; or perennial (occurring round the year) due to work-related exposure to dander or other pollutants. Factors such as local trees and vegetation, geographical location, smoke related to forest fires, cold, dry air are also important

Who gets Allergic Rhinitis? (Age and Sex Distribution)

  • Allergic Rhinitis may infect any individual. However, most cases occur in children, teenagers, and young adults (age less than 20 years). It is uncommon among the elderly. The incidence of AR decreases with age
  • Among children, boys are slightly more affected than girls
  • Different geographical regions have differing allergens (in terms of type, quality, and potency); hence, prevalence of the condition varies around the world and also within a country

What are the Risk Factors for Allergic Rhinitis? (Predisposing Factors)

The potential risk factors for Allergic Rhinitis are:

  • Environmental or occupational exposure to substances such as pollen (from plants, trees, grasses, weeds), pets (dogs, cats, etc.), dander (animal hair, skin particulates, dust mites), cockroaches, fungal molds, chemical pollutants, detergents, smoke, fumes, and strong scents
  • Other factors include: Early antibiotics usage, born during pollen season, maternal smoking in the early years of the child, male child
  • Consuming certain drugs or foods may cause an allergic response
  • An individual with a family history of allergies (parents are allergic to such allergens), is more prone to the condition
  • Sometimes, the presence of other diseases or disorders (like asthma, eczema) may be associated with Allergic Rhinitis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Allergic Rhinitis? (Etiology)

  • Allergic Rhinitis is caused by exposure to external agents or particles that cause an allergic nasal inflammatory response. An individual is usually allergic to that substance (either single or multiple allergens)
  • When the allergen comes into contact with the nasal airways and mucus membranes lining the nose, the body releases histamine (an organic chemical) triggering the allergy symptoms. This is caused due to a sensitive body immune system

What are the Signs and Symptoms of Allergic Rhinitis?

Signs and symptoms of Allergic Rhinitis often develop immediately in response to the allergy triggering substance, and some develop slowly after a while. These include:

  • Immediate response: Sneezing, watery eyes and runny nose, itchy sensation occurring at the nose, throat, eyes, mouth. There could be an associated mild loss of smell
  • Later development: Nasal congestion, headache, sore throat and cough, complete loss of smell, puffy eyes with dark circles  (called allergic shiners), nasal crease caused by repeated rubbing of the nose with hand (allergic salute), blockage of ears, tiredness, irritability, sleep-disturbed breathing due to nasal blockage, poor concentration at school, and depression

How is Allergic Rhinitis Diagnosed?

Diagnostic tests for Allergic Rhinitis include:

  • Physical exam with medical history, including detailed family, environmental, and occupation history
  • Allergy skin test or serum immunoassays for allergen-specific IgE ; in order to determine the specific allergy causing substance
  • Nasal smear test for eosinophils
  • Endoscopic exam of the airways; especially if other disorders are present
  • Blood analysis; to measure serum IgE level, eosinophil count
  • CT scan, x-rays ; to determine if other complications or physical abnormalities are present, such as sinus problems
  • Referral to other specialists, such as Allergy, Ear Nose Throat , Pulmonology when needed

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Allergic Rhinitis?

Complications due to Allergic Rhinitis include:

  • Sinusitis; acute or chronic
  • Ear infection and permanent damage to the ears
  • Sleep-disturbed breathing, poor concentration at school and work, depression, tiredness, and impaired sexual function
  • Association with asthma, eczema, ear infections, allergic conjunctivitis (red itchy eyes)

How is Allergic Rhinitis Treated?

Allergic Rhinitis is managed by avoidance of the allergic trigger, treatment of the symptoms, and modifying the body immune response system. The methods include:

  • Avoidance of outdoor allergens and control of indoor allergy-inducing irritants. It is important that the specific allergen(s) be identified
  • Medications such as nasal steroids, decongestants, oral antihistamines may be used depending on the type of symptoms and their occurrence rate (seasonal or regular). Other drugs to provide relief from symptoms are oral corticosteroids, eye-drops, nasal drops and sprays
  • Immunotherapy (allergy shots), to desensitize the body and prevent it from overreacting to such external triggers. This method is usually considered, in case of severe or persistent allergic symptoms that does not respond well to treatment, or when other medical disorders, such as a poorly-controlled asthma are also present
  • Surgical intervention may be necessary, if other conditions and complications, lead to severe nasal obstruction

How can Allergic Rhinitis be Prevented?

  • Allergic Rhinitis is a spontaneous ‘overwhelming’ allergic body response to the presence of an allergen. It can be prevented by avoiding exposure to the identified allergens
  • Be aware of the allergy trigger factors and avoid such locations or situations with allergic substances/triggers, such as pollen season, cool, dry air, smoking exposure, mold exposure, perfumes, etc.

What is the Prognosis of Allergic Rhinitis? (Outcomes/Resolutions)

  • Allergic Rhinitis, mild or severe, can be treated; but, it will recur if the person comes into contact again with the particular irritant
  • Over time, a few individuals (usually children) outgrow the condition; since the body gets used to the substance. However, in many, it generally affects them over their entire lifetime but may reduce in severity.  For some patients this gets worse with repeated exposures to the allergen, necessitating allergy shots (immunotherapy)

Additional and Relevant Useful Information for Allergic Rhinitis:

  • Allergic Rhinitis caused by pollen in the atmosphere, is also known as, Hay Fever
  • There are many conditions that can cause signs and symptoms as that of Allergic Rhinitis. These conditions should be ruled out. Some of conditions included in differential diagnosis are:

In Children: Foreign body, nasal polyps (growths), acute viral and bacterial infection causing rhinitis and sinusitis

In Adults: Non-allergic rhinitis, Rhinitis medicamentosa (chronic nasal inflammation and atrophy) from vasoconstrictor nasal sprays, snorting cocaine, oral inhalation of steroid inhalers, systemic disorders such as Wegener's granulomatosis and relapsing polychondritis

What are some Useful Resources for Additional Information?

American Academy of Allergy, Asthma, and Immunology (AAAAI)
611 East Wells St. Milwaukee, WI 53202
Phone: (414) 272-6071
Toll-Free: (800) 822-2762
Website: http://www.aaaai.org

References and Information Sources used for the Article:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001816/ (accessed on 3/11/13)

Uptodate: Allergic rhinitis: Clinical manifestations, epidemiology, and diagnosis (accessed on 3/11/13)

Murray and Nadel's Textbook of Respiratory Medicine: 4th edition; Disorders of the upper airways; 1279-1282

Helpful Peer-Reviewed Medical Articles:

Calamelli, E., Ricci, G., & Pession, A. (2012). Recent advances in diagnosis and therapy of allergic rhinitis and asthma in childhood. Eur Ann Allergy Clin Immunol, 44(6), 215-224.

Izquierdo-Dominguez, A., Valero, A. L., & Mullol, J. (2013). Comparative analysis of allergic rhinitis in children and adults. Curr Allergy Asthma Rep, 13(2), 142-151. doi: 10.1007/s11882-012-0331-y

Kariyawasam, H. H., & Rotiroti, G. (2013). Allergic rhinitis, chronic rhinosinusitis and asthma: unravelling a complex relationship. Curr Opin Otolaryngol Head Neck Surg, 21(1), 79-86. doi: 10.1097/MOO.0b013e32835ac640

Kariyawasam, H. K., Rotiroti, G., & Robinson, D. S. (2013). Sublingual immunotherapy in allergic rhinitis: indications, efficacy and safety. Rhinology, 51(1), 9-17. doi: 10.4193/Rhino11.268

Ramakrishnan, J. B., Kingdom, T. T., & Ramakrishnan, V. R. (2013). Allergic rhinitis and chronic rhinosinusitis: their impact on lower airways. Immunol Allergy Clin North Am, 33(1), 45-60. doi: 10.1016/j.iac.2012.10.009

Brożek, J. L., Bousquet, J., Baena-Cagnani, C. E., Bonini, S., Canonica, G. W., Casale, T. B., ... & Schünemann, H. J. (2010). Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. Journal of Allergy and Clinical Immunology, 126(3), 466-476.

Skoner, D. P. (2001). Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. Journal of allergy and clinical immunology, 108(1), S2-S8.

Nathan, R. A. (2007, January). The burden of allergic rhinitis. In Allergy and Asthma Proceedings (Vol. 28, No. 1, pp. 3-9). OceanSide Publications, Inc.