Allergic Rhinitis

Allergic rhinitis, also known as hay fever, is a common allergic condition that affects the nasal passages. It occurs when the body’s immune system overreacts to allergens in the environment, such as pollen, dust, or animal dander, causing inflammation of the nasal passages.

Case:
Mrs. A, a 35-year-old female, presents to the clinic complaining of sneezing, runny nose, and itchy eyes for the past 2 weeks. She reports that these symptoms occur every year during springtime and that they are affecting her daily activities.

Pathophysiology

Allergic rhinitis is caused by an IgE-mediated hypersensitivity reaction. When an allergen enters the body, it triggers the production of IgE antibodies, which bind to mast cells in the nasal passages. When the allergen re-enters the body, it binds to the IgE on the mast cells, causing the release of histamine and other inflammatory mediators, which leads to nasal congestion, sneezing, itching, and other symptoms.

Signs and Symptoms:

The signs and symptoms of allergic rhinitis can vary in severity and include:

  • Sneezing
  • Runny nose
  • Itchy nose, eyes, and throat
  • Nasal congestion
  • Postnasal drip
  • Watery eyes
  • Fatigue
  • Headache
  • Decreased sense of smell and taste

Investigations

The diagnosis of allergic rhinitis is based on the patient’s clinical history and physical examination. However, if the diagnosis is unclear or if the patient has severe symptoms, the following tests may be ordered:

  • Skin prick test: This test involves placing a small amount of allergen on the skin and pricking the skin to see if a reaction occurs.
  • Blood test: A blood test can measure the levels of IgE antibodies in the blood, which can indicate the presence of an allergy.
  • Nasal endoscopy: This test involves inserting a small camera into the nose to examine the nasal passages.

Treatment

The treatment of allergic rhinitis aims to reduce the severity of symptoms and improve the patient’s quality of life. The following treatments may be recommended:

  • Avoidance of allergens: The most effective way to treat allergic rhinitis is to avoid exposure to allergens that trigger the symptoms.
  • Medications: Antihistamines, decongestants, nasal corticosteroids, and leukotriene receptor antagonists are medications that can help reduce the symptoms of allergic rhinitis.
  • Immunotherapy: Immunotherapy, also known as allergy shots, can help desensitize the patient to allergens over time, reducing the severity of symptoms.

Dos and Don’ts

The following dos and don’ts can help manage allergic rhinitis:

Dos:

  • Identify and avoid allergens that trigger symptoms.
  • Use air filters and purifiers to reduce indoor allergens.
  • Keep windows and doors closed during peak pollen seasons.
  • Wash bedding and clothes frequently to remove allergens.
  • Use saline nasal sprays to help reduce nasal congestion.

Don’ts:

  • Don’t smoke or allow others to smoke around you.
  • Don’t rely on over-the-counter medications without consulting a healthcare provider.
  • Don’t ignore symptoms and delay treatment.
  • Don’t expose yourself to allergens knowingly.

Reference:

  • Wallace DV, Dykewicz MS, Bernstein DI, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122(2 Suppl):S1-S84.
  • Brozek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466-476.
  • Pawankar R, Canonica GW, Holgate ST, Lockey RF, Blaiss MS. WAO White Book on Allergy 2013 Update. World Allergy Organization. https://www.worldallergy.org/UserFiles/file/WhiteBook2-2013-v8.pdf. Accessed March 25, 2023.
  • Fokkens WJ, Lund VJ, Mullol J, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464.
  • Bousquet J, Schünemann HJ, Togias A, et al. Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol. 2021;147(2):429-453.
  • Canonica GW, Bousquet J, Schünemann HJ, et al. ARIA update: I–Systematic review of complementary and alternative medicine for rhinitis and asthma. J Allergy Clin Immunol. 2006;117(5):1054-1062.

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