Rhinitis - Allergic Disease Summary

Overview

Allergic rhinitis is also called hay fever or allergic rhinosinusitis and is defined in the Introduction section.

Allergic rhinitis affects approximately 5-10% of the worldwide population. The Epidemiology section gives a detailed discussion on the cases affected by allergic rhinitis worldwide.

There may be various diatheses for allergic rhinitis sensitization, but the most important mechanisms are genetic factors and the production of IgE antibody. These mechanisms are discussed in the Pathophysiology section.

Allergic rhinitis has different types and is classified according to severity and frequency of symptoms and based on patterns of exposure to allergens. The Classification section described each one of these types. 

History and Physical Examination

Patients with allergic rhinitis typically presents with nasal itching, watery rhinorrhea, nasal obstruction or congestion, sneezing, and postnasal drainage. Other symptoms are further discussed in the Clinical Presentation section.

The Physical Examination sections enumerate these signs and symptoms. In the History section, the essential information that needs to be elicited from the patient to come up with the proper diagnosis and management are mentioned.

Diagnosis

The Laboratory Tests and Ancillaries section discusses allergy testing that can help in the management of the disease and the identification of allergens to facilitate avoidance.

Other diseases that have similar symptoms should be ruled out are listed in the Differential Diagnosis section. This section also has information about allergic asthma.

Management

The assessment of the patient’s allergic rhinitis will be based on the patient’s symptomatology, the patient’s exposure to allergens, and the visual analog scales (VAS). Discussion of these parameters for assessing is in the Evaluation section. Visual analog scales (VAS), evaluation of disease control and the MACVIA-ARIA Sentinel NetworK for Allergic Rhinitis (MASK-Rhinitis) approach are elaborated in this section as well.

Treatment is based on the duration and severity of symptoms. A stepwise approach to treatment is recommended for adolescents and adults. Step down therapy as the patient’s symptoms improve and step up when the symptoms worsen. Detailed information regarding these 2 approaches is in the Principles of Therapy section.

Drugs that can be considered in the management of allergic rhinitis such as anticholinergics, corticosteroids, immunotherapy, etc are enumerated and discussed in the Pharmacological Therapy section.

Allergen avoidance strategies and patient education are essential parts of the management of patients with allergic rhinitis and are elaborated in the Nonpharmacological section.  

Inferior turbinate reduction is a surgical procedure that can be performed for patients with persistent allergic rhinitis and is discussed in the Surgery section.

Referral to an immunology or allergy specialist is recommended if warranted. Indications for referral of patients with allergic rhinitis are in the Monitoring section.