Overview
Allergic rhinitis (AR) is an IgE-mediated inflammatory reaction affecting the nasal mucosa following exposure to allergens in sensitised individuals. It is a common problem that can have a significant impact on one’s quality of life.
Allergic rhinitis can be categorised as follows:
- Seasonal AR (hayfever) – happens at certain times of year e.g. spring
- Perennial rhinitis – persistent and occurs throughout the year
- Occupational rhinitis – symptoms arise following exposure to allergens at work
Epidemiology
- AR is very common and affects over 20% of the UK’s population
- Peak onset is in children and adolescents
Risk Factors
- Personal history of atopy e.g. asthma/eczema/food allergy
- Family history of atopy
- Exposure to allergens
- Exposure to animal fur
Presentation
Patients classically have:
- Sneezing
- Nasal itching
- Rhinorrhoea
- Nasal congestion
- Symptoms are usually bilateral
Other features:
- Associated allergic conjunctivitis, they may have bilateral:
- Eye itching
- Eye redness
- Tearing
- Cough
- Postnasal drip
Differential Diagnoses
Acute sinusitis
- Acute onset (<2 weeks) with associated upper respiratory tract infection features
- Facial pain and nasal discharge are more prominent
- There is no associated conjunctivitis
Chronic sinusitis
- Symptoms usually last >12 weeks
- Facial pain and nasal discharge are more prominent
- There is no associated conjunctivitis
Diagnosis
- Clinical diagnosis – based on the history and examination
Management
All patients
- Mild-moderate symptoms: oral/intranasal antihistamines
- Moderate-severe or above measures fail: intranasal corticosteroids
- If refractory: consider short-term intranasal decongestant (ephedrine/xylometazoline)
- Long-term use can cause rebound nasal congestion upon withdrawal (rhinitis medicamentosa)
Monitoring
- Patients are reviewed after 2-4 weeks if symptoms persist after initial treatment.
Patient Advice
- Patients should consider using nasal irrigation with saline
- For patients with grass pollen allergies:
- Avoid walking in grassy open spaces
- Avoid drying and washing outdoors when the pollen count is high
- Shower/wash hair following pollen-exposure
- For people with house dust mite allergies:
- Wash all bedding at least once a week at high temperature
- Choose wooden/hard floors instead of carpets in the house if possible
- Regularly clean surfaces with a clean, damp cloth
- For people with occupational allergies:
- Wear protective clothing at work
- Ensure there is adequate ventilation
Complications
- Reduced quality of life
- Reduced work/school performance
- Allergic asthma
- Sinusitis and nasal polyps
- Oral allergy syndrome
Prognosis
- Allergic rhinitis usually persists throughout life
- Seasonal allergic rhinitis may spontaneously resolve in up to 20% of patients
