Allergic rhinitis

Last reviewed: 23 Feb 2023
Last updated: 13 Jan 2022



History and exam

Key diagnostic factors

  • presence of risk factors
  • sneezing
  • nasal pruritus
More key diagnostic factors

Other diagnostic factors

  • palate, throat, ear, and eye itching
  • eye redness, puffiness, and watery discharge
  • fatigue and irritability
  • nasal congestion
  • rhinorrhoea
  • allergic shiners
  • conjunctival injection
  • ocular mucoid discharge
  • nasal crease
  • pale nasal mucosa
  • swelling of the nasal mucosa and turbinates
  • abundant clear nasal secretions
  • Dennie-Morgan lines (creases present under the lower eyelids)
Other diagnostic factors

Risk factors

  • other atopic conditions or family history of atopy
  • age <20 years
  • exposure to aeroallergens (pollen, moulds, house dust mites, pollution)
  • exposure to animal dander
  • ethnicity
  • positive allergen skin-prick tests
More risk factors

Diagnostic investigations

1st investigations to order

  • therapeutic trial of antihistamine or intranasal corticosteroid
More 1st investigations to order

Investigations to consider

  • allergen skin-prick testing
  • in vitro specific IgE determination
More investigations to consider

Treatment algorithm


mild or intermittent symptoms

persistent and moderate to severe symptoms


usual therapy ineffective or poorly tolerated




Medical Director

American Academy of Allergy, Asthma & Immunology Registry

Assistant Clinical Professor of Medicine

Medical College of Wisconsin

Adjunct Clinical Instructor

College of Nursing

University of Wisconsin-Milwaukee

Allergy, Asthma & Sinus Center




GCS has taken part in sponsored research for the ALK clinical trial of the house dust mite SLIT tablet for use in paediatric patients. He is a member of the Joint Task Force on Practice Parameters Workgroup on the Allergic Rhinitis Practice Parameter.


Dr Gary C. Steven would like to gratefully acknowledge Dr Alexander Greiner, a previous contributor to this topic.


AG has received grant/research support from: AstraZeneca; Boehringer Ingelheim; Cephalon Circassia Ltd; Clement Clarke Cytos biotechnology; GlaxoSmithKline; Glenmark Specialty, S.A.; Hoffman-LaRoche/Genentech; HRA/Novartis; Janssen Research & Development; Kalypsys , Inc.; Lupin; Merck; Mylan Pharmaceuticals, Inc.; Nestle (Nestec Ltd); Novartis Ono Pharmaceutical Co., Ltd.; Perrigo; Rigel Pharmaceuticals, Inc.; Roxane Laboratories Inc.; Shionogi Inc.; Sunovion TEVA Branded Pharmaceutical Products; UBC (United Biosource Corporation)/Amgen Pharmaceuticals; and sponsorship for pharmaceutical trials from Allergen Research Corporation/Aimmune Therapeutics, Inc. and AstraZeneca.

Peer reviewers

Mark Davis-Lorton, MD

Clinical Immunology Coordinator

Division of Rheumatology, Immunology and Allergy

Winthrop-University Hospital




MDL declares that he has no competing interests.

Glenis Scadding, MD

Consultant Allergist/Rhinologist

Allergy & Rhinology Department

Royal National Throat, Nose and Ear Hospital




GS is a consultant/advisory board member for ALK, Britannia Pharmaceuticals, CMP Therapeutics, Grupo Uriach, GSK, Merck, Sanofi-Aventis, Schering Plough, and UCB. She has received research funds from ALK, GSK, UCB, and Schering Plough. She has given talks for ALK, GSK, Merck, Schering Plough, and UCB and has co-written articles for Schering Plough and GSK.

  • Differentials

    • Non-allergic rhinitis
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    • Chronic sinusitis
    More Differentials
  • Guidelines

    • Japanese guidelines for allergic rhinitis 2020
    • 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
    More Guidelines
  • Patient leaflets

    Hay fever

    Hay fever: avoiding pollen and mould

    More Patient leaflets
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