Allergic Rhinitis

1> Comprehensive history is essential

Always obtain detailed information on environmental exposures, dietary factors, and family history of atopic diseases (e.g., eczema, asthma, allergic rhinitis).

2> Typical AR symptoms include

Sneezing, rhinorrhea, nasal itching, and congestion. These are usually bilateral and persistent with exposure to known allergens.

3> Confirmatory lab findings

Elevated total IgE, positive specific IgE (sIgE), and skin prick test positivity support the diagnosis of IgE-mediated AR.

4> Distinguishing AR subtypes

Intermittent vs. persistent AR can be differentiated based on symptom duration and exposure patterns.

5> Rule out nonallergic rhinitis

Symptoms may resemble AR but lack IgE elevation or allergen-specific sensitization. Triggers are often nonspecific or unknown.

6> NARES

Nonallergic rhinitis with eosinophilia mimics AR clinically and responds to similar treatments, but occurs without IgE sensitization.

7> Recognize vasomotor rhinitis

Characterized by nasal hyperreactivity to physical stimuli (e.g., temperature changes, strong odors, humidity), not allergens.

8> Structural or iatrogenic causes

Evaluate for nasal polyps, septal deviation, or rhinitis medicamentosa due to overuse of topical decongestants.

9>Include hormonal and systemic conditions 

Hormonal rhinitis (pregnancy, hypothyroidism), neoplasms, vasculitides, and granulomatous diseases may present with rhinitis-like symptoms.

10> Assess occupational exposures

Common irritants and allergens in the workplace include grain dust, latex, enzymes, wood dust, solvents, and cold air.

Management of allergic rhinitis involves allergen avoidance, pharmacotherapy, and immunotherapy, with treatment tailored to the patient’s age, symptom severity, and individual needs.

1> Allergen Avoidance and Environmental Control

• The primary principle of treatment is to avoid or minimize exposure to causative allergens. Strategies include:
• Reducing exposure to indoor allergens, such as house dust mites, pet dander, and mold.
• Limiting contact with outdoor allergens, such as pollen, by monitoring pollen counts and using protective measures.
• Improving air quality by reducing exposure to tobacco smoke, air pollution, and other irritants.

2> Pharmacological Therapy

Medication selection depends on the type and severity of symptoms. Commonly used medications include:

• Antihistamines
• Intranasal and oral corticosteroids
• Leukotriene receptor antagonists
• Decongestants
• Cromolyn sodium
• Anticholinergic agents

For seasonal allergic rhinitis, pre-seasonal prophylactic therapy may help reduce symptom onset. Persistent symptoms often require long-term maintenance therapy.

3> Administration:

Medications may be administered intranasally or orally. Intranasal administration delivers the drug directly to the nasal mucosa, providing rapid relief with fewer systemic side effects.

4> Allergen Immunotherapy

Allergen immunotherapy offers long-term benefits, often persisting after discontinuation. It can also reduce the risk of new sensitizations and may prevent the progression to asthma in some patients.