Allergic rhinitis is an immunoglobulin E (IgE)-mediated inflammatory nasal condition resulting from allergen introduction in a sensitised individual.
Presumptive diagnosis of allergic rhinitis is usually clinical and is made if someone experiences one or more of rhinorrhoea, sneezing, itching of nose/palate/eyes, or nasal congestion in response to allergen exposure. Cough is also a common symptom.
The diagnosis is confirmed with demonstration of specific IgE reactive to environmental allergens. Food allergy testing is not recommended in the routine evaluation of rhinitis.
Treatment includes allergen avoidance (reducing exposure to relevant allergens such as dander, dust mite, and pollen), pharmacotherapy, and immunotherapy.
Intranasal corticosteroids remain the single most effective class of medications for treating allergic rhinitis.
Immunotherapy is often recommended for patients with persistent symptoms.
Allergic rhinitis (AR) is an immunoglobulin E (IgE)-mediated inflammatory nasal condition resulting from allergen exposure in a sensitised individual. AR is a common inflammatory condition of the upper respiratory tract, characterised by nasal pruritus, sneezing, rhinorrhoea, and nasal congestion. Frequently, there is associated palate, throat, ear, and eye itching as well as eye redness, puffiness, and watery discharge.
AR may sometimes be due to occupational or hobby exposures to proteins that do not commonly provoke IgE-mediated responses. Examples include woodworkers becoming sensitised to wood dusts, or food service workers becoming sensitised to grain dusts.
History and exam
Key diagnostic factors
- presence of risk factors
- nasal pruritus
Other diagnostic factors
- palate, throat, ear, and eye itching
- eye redness, puffiness, and watery discharge
- fatigue and irritability
- nasal congestion
- 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 atopic conditions or family history of atopy
- age <20 years
- exposure to aeroallergens (pollen, moulds, house dust mites, pollution)
- exposure to animal dander
- positive allergen skin-prick tests
1st investigations to order
- therapeutic trial of antihistamine or intranasal corticosteroid
Investigations to consider
- allergen skin-prick testing
- in vitro specific IgE determination
mild or intermittent symptoms
persistent and moderate to severe symptoms
usual therapy ineffective or poorly tolerated
Gary C. Steven, MD, PhD, CPI, FAAAAI, FACAAI, FAPCR
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.
Mark Davis-Lorton, MD
Clinical Immunology Coordinator
Division of Rheumatology, Immunology and Allergy
MDL declares that he has no competing interests.
Glenis Scadding, MD
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.
- Non-allergic rhinitis
- Acute sinusitis
- Chronic sinusitis
- 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
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