Allergic Rhinitis

Allergic rhinitis is a common chronic respiratory disorder in both adults and children, characterized by an allergic inflammatory response of the nasal mucosa. It typically presents with symptoms such as rhinorrhea, nasal congestion, sneezing, and nasal pruritus.

Traditional terms such as seasonal and perennial allergic rhinitis are being replaced by the designations intermittent and persistent, which better reflect symptom patterns.

AR can also be further classified by severity and frequency:

• Mild-intermittent
• Moderate-to-severe intermittent
• Mild-persistent
• Moderate-to-severe persistent

1. Combination of Nasal Symptoms

• Sneezing
• Nasal itching
• Clear rhinorrhea (runny nose)
• Nasal congestion, which may involve one or both nostrils and can alternate sides.

Symptoms often worsen at night.

2. Impact of Nasal Obstruction

Persistent nasal congestion can lead to mouth breathing, which may cause snoring and disrupted sleep. In chronic cases, particularly during early childhood, prolonged nasal obstruction may affect normal facial growth, potentially resulting in malocclusion and the characteristic “adenoidal faces,” defined by an open-mouth posture and a dull facial expression.

3. Nasal Itching and Associated Signs

Nasal itching often leads to frequent rubbing or wrinkling of the nose, sometimes causing nosebleeds. In children, a characteristic sign is the “allergic salute”—using the palm to push the tip of the nose upward. Repeated rubbing in this way may result in a transverse nasal crease across the lower nasal bridge.

Allergic rhinitis develops through a complex interaction of genetic, environmental, and socioeconomic factors.

1. Genetic Factors

• Genetic predisposition is a major contributor. Individuals with a family history of allergic diseases—such as allergic rhinitis, asthma, or atopic dermatitis—are at increased risk.
• Sex differences: Prevalence is higher in males during childhood but becomes more common in females in adulthood.
• Research on the specific genes involved remains limited.

2. Environmental and Socioeconomic Factors

• Living conditions: Urban residence and lower household income are associated with increased risk.
• Allergen exposure: Indoor and outdoor allergens, including house dust mites, pet dander, pollen, mold, and cockroaches.
• Air pollution: Fine particulate matter (PM), indoor pollutants, and secondhand smoke contribute significantly.
• Ventilation: Poor airflow in homes increases exposure to airborne irritants.

3. Climate Change

Rising temperatures and carbon dioxide levels increase pollen production, enhance its allergenicity, and extend pollen seasons, contributing to the global rise in allergic rhinitis.