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Allergic Rhinitis

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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:

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

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