This article is on Allergic Rhinitis, a condition commonly experienced by patients and seen by General Practitioners/Otolaryngologists.. It is intended to help inform patients, relatives of patients and health professionals. The information in the grey boxes is more technical and intended more for Health professionals that are reading this article.

 

What is Allergic Rhinitis?

Allergic rhinitis (AR), commonly referred to as hay fever, involves irritation of the nose owing to an allergic reaction to particles in the air. It is not a dangerous condition but can cause irritating symptoms, mainly affecting the nose but also in some cases the eyes. An allergy occurs when the body’s immune system, which should fight infection only, is misguided and generates inflammation in response to things that it doesn’t need to. In the case of allergic rhinitis the most common trigger is grass pollens, causing hay fever symptoms in spring time, although if the trigger is something that is present at other times of the year, such as dust, then symptoms can occur at different times.

 

Who gets AR?

AR is very common and affects around 1 in 5 people. AR can affect almost any age group, typically first becoming a problem in children. Although it is not dangerous, AR can have a significant impact on quality of life.

 

What are the causes?

Causes vary for each individual depending on exactly what they are allergic to. The most common particles to cause AR are dust mites, mould, animal fur and pollens.

There is an overlap between AR and asthma. Patients who have AR are at increased risk of asthma and vice versa.

 

What are the symptoms?

The symptoms of AR include a blocked nose, runny nose, itchy nose and sneezing. It is also common to have watery or itchy eyes. Because of these, AR can also cause poor performance at work or school, poor sleep and irritability.

The severity of symptoms can differ depending on how sensitive a person is to the particles that they are allergic to.

 

How is it diagnosed?

The diagnosis is usually made based on the symptoms and the appearance of the eyes and nose.

Allergy testing may be useful to identify triggers, in particular for patients not responding to treatment. Testing to try to identify what particles you are allergic to can be done either using “skin prick testing” or blood tests although there are advantages and disadvantages to both of these.

 

Diagnostic Criteria:
– 2 or more of nasal congestion, rhinorrhea, itchy nose and sneezing AND
– Symptoms persist >1hr per day

 

What are the potential complications?

Although AR is generally not a risky condition, persisting symptoms can impact on your life including problems with sleep, concentration and mood.

 

What are the treatment options?

There is no cure for AR and current treatments are mainly focused on treating symptoms.

Most symptoms can be managed through allergen avoidance, salt water rinses, antihistamine tablets and steroid nasal sprays.

There is some role for surgery in selected cases of AR. The inferior turbinates tend to swell in AR (see Nose and Sinus Anatomy) and reducing the size of these with an operation (see Inferior turbinoplasty) can help to unblock the nose, helping the breathing but also helping sprays to get into the nose better.

Immunotherapy which aims to increase your tolerance towards certain allergens can be considered in some cases. It is a long term treatment which requires regular clinic visits, commonly over several years.

 

Can you prevent AR?

While there is no treatment for AR, the exacerbation of symptoms can often be prevented by recognising and actively avoiding the cause or allergen.

 

What is the prognosis?

Most cases of AR can be controlled through a combination of avoiding allergens and medical treatment. The condition will be present life long and ideally patients adapt and adjust their lifestyle to co-exist with AR.

 

Further reading:

1. Allergy New Zealand – www.allergy.org.nz
2. Mayo Clinic – Hay fever – www.mayoclinic.org

 

References:
1. Kakli H, Riley T. Allergic Rhinitis. 2016. Prim Care. 43(3):465-75.
2. Mims J. Epidemiology of allergic rhinitis. 2014. Int Forum Allergy Rhinol. 4:S18-20.

 

Author + Affiliation:
Dr Johnny Wu, Department of Otolaryngology, Waikato Hospital.
Reviewed by Dr, Otolaryngologist, Waikato Hospital

 

Date of Publication +/- Review:
Date of Publication:
Date of Review: 14.04.2021

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Allergic Rhinitis

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